Form Na 996 - Food Stamp Notice Of Discontinuance - Failure To Meet Non-Assistance Cfap Work Rule (Violation After Receipt Of Three Consecutive Month Grace Period)
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1
2STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
FOOD STAMP NOTICE OF
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
DISCONTINUANCE
NOTICE DATE :
________________________________________________________________________
CASE
Failure To Meet Non-Assistance CFAP Work Rule
NAME
:
________________________________________________________________________
(violation after receipt of three consecutive
NUMBER
:
________________________________________________________________________
WORKER
month grace period)
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_____________________________, food stamps received under the California Food Assistance Program (CFAP) will be discontinued
for___________________. The County is taking this action because __________________ has not followed the Non-Assistance CFAP work
rule for:
_________________ month/year.
_________________________ has not provided proof that the rule has been met for_____________________ month/year.
A person who fails to meet the Non-Assistance CFAP work rule more than once during a 36-month period can sometimes get food stamps for
three months in a row without meeting the work rule. When the three months end, a person can only get food stamps if they become excused
or meet the Non-Assistance work rule. This three month period can only be used once and it is not longer available for___________________.
The Non-Assistance CFAP work rule says that each month a person must work an average of 20 hours of more per week, participate in a
workfare assignment, or participate in a work assignment for 20 or more hours per week.
To get food stamps again, ___________________ must:
•
Be excused from the Non-Assistance work rule;
•
Show proof that they either followed the Non-Assistance work rule or were excused for the month shown above; or
•
Work an average of 20 hours per week, participate in a workfare assignment, or participate in a work assignment an average of 20 hours
per week.
Even if you do not become excused or follow the Non-Assistance work rule, you may become eligible for food stamps again when the 36-month
period ends in ___________________. You may reapply at that time.
If your household had other changes you will get another notice.
If the failure to meet the Non-Assistance CFAP work rule also causes a food stamp penalty, that person may not be able to get food
stamps for at least 1, 3 or 6 months. That person will get another notice telling them how long their food stamps will be stopped.
COMMENTS
RULES: These rules apply. You may review them at your welfare office.
MPP
63-407
63-410
W&IC 18930.5
All County Letter 99-78
Other________________________________
NA 996 (11/00)
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