Form Temp 2207 - Notice Of Action
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2STATE OF CALIFORNIA
COUNTY OF
NOTICE OF ACTION
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.
You asked that the county review your CalWORKs welfare-to-work
We have removed the sanction based on the problems you
activity assignment for the following reason(s):
listed in your review form. We have sent a separate notice
about the aid we owe you.
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Based on our review of your CalWORKs Welfare-To-Work Activities
Review Request Form and the information that you provided, the
county has approved the following action(s) to fix problems
with your welfare-work assignment:
You will receive an additional _______ months/weeks (circle
one) of training time which will be added to your 18- or 24
month time limit.
We
will
correct
your
welfare-to-work
plan
to
include____________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
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 42-710, 42-711, & 42-716.
TEMP 2207 (5/02) CALWORKs WELFARE-TO-WORK ACTIVITIES REVIEW REQUEST APPROVAL FORM -REQUIRED – NO SUBSTITUTE PERMITTED
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