Form Temp Na 1225 - Notice Of Action
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1
2NOTICE OF ACTION
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Notice Date :
Case
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.
As of ______________________ , the county has approved your back
cash aid of $ _________________________.
HERE’S WHY:
You were pregnant and / or parenting when you turned 18 years old
and your cash aid was stopped. You should have continued to get
cash aid in your own case.
Your back cash aid is figured on the next page.
A check will be sent soon.
A check is enclosed.
You may get another notice about Cal-Learn Supportive Services
or Bonus.
If you get Food Stamps we will count your back cash aid as a resource.
You may get another notice from Food Stamps.
Medi-Cal: This notice does NOT change or stop Medi-Cal benefits. If
there is a change in your Medi-Cal benefits, you will receive another
notice. Keep your plastic Benefits Identification Card(s).
Rules: These rules apply: you may review them at your welfare
office: MPP sections 40-171.11, 42-101, 42-762.21, 82-820.
Page 1 of ____
TEMP NA 1225 (9/01) UNDERPAYMENT COMPUTATION
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