Form Temp 2208 - Notice Of Action
Download a blank fillable Form Temp 2208 - Notice Of Action 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 Temp 2208 - Notice Of Action 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
1
2NOTICE OF ACTION
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
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 you how.
Your benefits may not be changed if you ask for a
hearing before this action takes place.
The county incorrectly applied CalWORKs welfare-to-work
program activity rules. To correct the problem we have removed
your sanction for the period of ___________________________
through ______________________________.
You do not want to get back cash aid payments for these
months. For that reason, the months will not count against
your 60-month time limit.
You want to receive back cash aid payments for the months
you were sanctioned. Because you want this back aid, these
months will count against your 60-month time limit.
Your back cash aid is figured on the next page.
We will send a check soon.
Your check is enclosed.
$ ___________ of your back cash aid will be used to pay
your existing overpayment balance. By law, we must use
back aid to pay back overpayments.
If you get Food Stamps, we will count your back cash aid as a
resource but not as income. It will not count as income or as a
resource in the month received.
You may get another notice from Food Stamps.
Medi-Cal: This Notice of Action does NOT change or stop
Medi-Cal benefits. Keep your plastic Benefits Identification
Card(s).
Rules: These rules apply. You may review them at your welfare
office: MPP 42-700.
TEMP 2208 (4/02) CalWORKs WELFARE-TO-WORK ACTIVITIES REVIEW REQUEST CASH AID APPROVAL FORM -REQUIRED – NO SUBSTITUTE PERMITTED
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal