Form Na 825 - Notice Of Action - Payment Adjust Transportation
Download a blank fillable Form Na 825 - Notice Of Action - Payment Adjust Transportation 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 825 - Notice Of Action - Payment Adjust Transportation 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 how.
TRANSPORTATION:
Your
payment
for
Welfare
to
Work
Cal-Lear n
public transportation
transportation for _________________ is $__________________.
This amount is less than what you asked for.
_____
rate
Here’s why:
X
_____
per ________________
= $ _____
You did not attend your
approved Welfare to Work
activity
job on all of the
days
hours you asked
your car’s mileage
for Welfare to Work payments.
You did not attend your approved Cal-Learn assignment on all
_____
rate
the
days
hours you asked for Cal-Learn payments.
X
_____
per ________________
X
_____
miles
You asked for _____________ miles, but we can only pay for
= $ _____
__________ miles because: __________________________
_________________________________________________.
parking
Other:
Your transportation payment is figured on this notice:
$ _____
month
school term
other
Mileage can be paid only if there is no public transportation
available, or it costs the same or less than public transportation.
other: _________________________
Public transportation is available when it takes two hours or less
round trip to get you from your home to your activity on time. You
____________ rate
cannot count time to go to and from your child’s school or child
care. If you drive your car even though public transportation is
x __________ per ____________
available, you will be paid at the public transportation rate or the
=$ _________
mileage rate, whichever is lower.
You can call your Welfare to Work/Cal-Learn worker if you think
this notice is wrong.
Rules: These rules apply. You may review them at your welfare
office: CalWORKs Implementation Guidelines Section VII & XII,
Welf. & Inst. Code 11323.2, 11323.4 11322.9
Page 1 of ____
NA 825 (8/00) REQUIRED – SUBSTITUTE PERMITTED
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal