Form Na 960x Sar - Notice Of Action - Stop Aid - Report Not Received
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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:
If you need help completing the SAR 7, contact the County and
ask for help.
■ ■
Toll Free _______________________.
Cash Aid
■ ■
CalFresh
Here’s why:
As of the 11th of this month, the County has not received your
semi-annual report (SAR 7) due this month.
To continue to get cash aid and/or CalFresh benefits you must
return a complete SAR 7.
A SAR 7 is complete when you have answered all of the
questions and have attached required proof.
The County must get your complete report no later than the
first working day of next month.
If your benefits are discontinued because you fail to turn in a
complete SAR 7, you will not receive Transitional CalFresh
benefits. If you have any questions about Transitional
CalFresh, please contact your county office.
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.
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
Benefits. If there is a change in your Medi-Cal benefits, you will
get another notice.
Keep using your plastic Benefits Identification Card(s).
You and your family may still continue to get Medi-Cal if your cash
Rules: These rules apply. You may review them at your welfare
aid stops and:
office - Cash Aid: MPP Sections 40-105.1, 40-181.22; CalFresh:
You have earnings from a job, a business you started or if
●
MPP Sections 63-103n(1), 63-508.6. TCVAP, RCA and ECA:
you received a pay raise.
MPP Sections 70-105.1, 69-206 and 69-301.
You have star ted to receive or had an increase in
●
child/spousal support payments.
NA 960X SAR (9/13) STOP AID; REPORT NOT RECEIVED
Page 1 of ______
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