Form Na 1210 - Notice Of Action - Discontinue
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1
2STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF ACTION -
Notice Date :
Case
DISCONTINUE
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.
As of ____________, the County is stopping your
Kin-GAP cash aid for___________________________.
Here’s why:
He/she no longer lives with you.
He/she no longer meets the age rules.
The child has too much income.
The child has too much property. See attached
page.
If the County figured that the child’s car or other
vehicle was worth more than you think it’s
worth, you can give the County proof that it is
worth less. Ask the County how. If you can
prove it is wor th less the child may get
Kin-GAP cash aid.
The legal guardianship was terminated.
You moved out of the State of California.
You did not return your completed redetermination
paperwork.
Other.
Rules: These rules apply. You may review them at
your county welfare office: MPP Sections 90-105.11,
90-105.131, 90-110.1(a), (b), (c), (d), (g).
NA 1210 (4/02) DISCONTINUE KIN-GAP - NO ELIGIBLE CHILD IN THE HOME
Page ____ of ____
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