Form Na 1268 - Calfresh Informing - Notice Of Sending Intercounty Transfer
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1
2CALFRESH INFORMING
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF SENDING
Notice Date :
Case
INTERCOUNTY TRANSFER
Name
:
Number
:
Worker
Name
:
Number
:
Telephone :
Address :
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing: If you think this action
is wrong, you can ask for a hearing.
The back of this page tells how. Your
benefits may not be changed if you
ask for a hearing before this action
takes place.
You told us you were moving to _____________________ County.
Your CalFresh case will be transferred to ________________________
County.
You do not have to fill out a new application and your CalFresh benefits
will not stop during your transfer to your new county of residence. If you
have any questions regarding your CalFresh benefits during the transfer
to the new county or your decide not to move, please call the worker at
the telephone number listed in this notice.
You will get another notice from the new county telling you about your
new case number and telephone number.
You must continue to report changes that could affect your eligibility on
your periodic report and to the worker listed in this notice until you get
your notice from the new county.
Rules: These rules apply: All County Letter 11-22 and Welfare &
Institutions Code § 11053.2. You may review them at your welfare
office.
Page 1 of ____
NA 1268 (4/13)
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