Form Na 1208 - Basic Approval

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STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
BASIC APPROVAL
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 you how.
Your benefits may not be changed if you ask for a
hearing before this action takes place.
INSTRUCTIONS:
Use to approve Kin-GAP and
Medi-Cal.
The County has approved your Kin-GAP cash aid and
Medi-Cal for __________________. The Kin-GAP
cash aid payment for your first month of aid is $
____________.
Your first day of Kin-GAP cash aid is _____________.
Your first day of Medi-Cal is the first day of the month
you applied for aid or met all eligibility requirements.
The Kin-GAP cash aid payment for your first month
of aid is only for a part of a month. It is for the time
from your first day of Kin-GAP cash aid, shown
above, through the end of the month. If nothing
changes, next month’s Kin-GAP cash aid will be for
a full month.
Your ongoing Kin-GAP amount is figured in the next
column.
Medi-Cal Cards: Soon you will get a plastic Benefits
Identification Card in the mail for each eligible person.
Take the card(s) to your medical provider when needing
care. DO NOT THROW AWAY YOUR CARDS. They
will be good as long as you get Medi-Cal.
NA 1208 (2/00)
Page ____ of ____

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