Form Na 992 - Notice Of Action - Refugee Cash Assistance (Rca) Application Approval

Download a blank fillable Form Na 992 - Notice Of Action - Refugee Cash Assistance (Rca) Application Approval 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 992 - Notice Of Action - Refugee Cash Assistance (Rca) Application Approval 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
HEALTH AND HUMAN SERVICES AGENCY
NOTICE OF ACTION
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Notice Date
:
Case
Refugee Cash Assistance (RCA)
Name
:
Application Approval
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 cash aid.
Here’s why:
You (and your family) will get cash aid under the Refugee Cash
Assistance Program (RCA).
Your first day of cash aid is __________________________ .
Your first month’s cash aid amount is $ _____________________ .
This amount is based on your full monthly cash aid amount figured
on this notice.
If there are no changes involving your household income or family
composition, your last month to receive RCA cash aid will be
_________________________ .
You can get cash aid from this program for no more than 8 months.
The month you entered the United States or the month you were
granted asylum, is counted as the first month.
This program will help you find a job.
State welfare regulations are available for review at the local office
of the County Welfare Department.
NA 992 (5/03) RCA APPLICATION APPROVAL
Page 1 of ____

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2