Form Na 1212 - Notice Of Action - Discontinue Property

Download a blank fillable Form Na 1212 - Notice Of Action - Discontinue Property in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Na 1212 - Notice Of Action - Discontinue Property with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF ACTION -
Notice Date :
Case
DISCONTINUE PROPERTY
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 you how.
Your benefits may not be changed if you ask for a
hearing before this action takes place.
INSTRUCTIONS:
Use to discontinue Kin-GAP cash
aid when the real property is now accessible to the
recipient and must be counted in the property limits.
As of ____________, the County is stopping your
Kin-GAP aid for___________________________.
Here’s why:
The child owns property that is worth more than the
$ ________ limit. We must use the value of all the
countable real property the child owns. The value of
this property now counts against the child.
The child’s countable property is figured on this page.
The child may still continue to get Medi-Cal if the child’s
Kin-GAP cash aid stops. Please complete and send in
the enclosed Transitional Medi-Cal (TMC) form.
NA 1212 (2/00)
Page ____ of ____

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2