Form Na 960y Sar - Notice Of Action - Stop Aid - Report Incomplete
Download a blank fillable Form Na 960y Sar - Notice Of Action - Stop Aid - Report Incomplete 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 960y Sar - Notice Of Action - Stop Aid - Report Incomplete 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
2STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
NOTICE OF ACTION
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Notice Date:
Case Name:
Case Number:
Worker Name:
Number/ID:
Telephone:
24 Hour Information:
Address:
(ADDRESSEE)
Questions? Ask your Worker or call the number above.
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.
As of _______________________, the County is stopping your:
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
Benefits. If there is a change in your Medi-Cal benefits, you will
I
get another notice.
Cash Aid
Keep using your plastic Benefits Identification Card(s).
I
CalFresh
Here’s why:
You and your family may still continue to get Medi-Cal if your cash
aid stops and:
The semi-annual report (SAR 7) that we got from you this
You have earnings from a job, a business you started or if you
reporting period is not complete.
received a pay raise.
To continue to get cash aid and/or CalFresh benefits you must
You have star ted to receive or had an increase in
return a complete SAR 7.
child/spousal support payments.
A SAR 7 is complete when you have answered all of the
If you need help completing the SAR 7, contact the County and
questions and have attached required proof. If you are having
ask for help.
problems getting the proof, call the County and we can help you
Toll Free _____________________.
try to get it.
The County must get your complete report no later than the
first working day of next month.
You must send or bring in the following information:
I
Complete the circled questions on the enclosed report.
I
Complete the following questions on the enclosed report:
I
Send or bring in the following proof:
The information you give us may change or stop your cash aid
and/or CalFresh benefits.
If you turn in a complete SAR 7 anytime next month that
shows you are eligible for cash aid and/or CalFresh, your
benefits will start from the date you turn in the form.
If your benefits are discontinued because you fail to turn in a
complete SAR 7, you will not receive Transitional CalFresh
benefits.
Rules: These rules apply. You may review them at your welfare
If you have any questions about Transitional CalFresh,
office - Cash Aid: MPP Sections 40-105.1, 40-181.22; CalFresh:
please contact your county office.
MPP Sections 63-103n(2), 63-508.6. TCVAP, RCA and ECA:
MPP Sections 70-105.1, 69-206 and 69-301.
NA 960Y SAR (10/14) STOP AID; REPORT INCOMPLETE
Page 1 of ______
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal