Form Na 530 - Notice Of Action - 48-Month Time Limit
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1
2NOTICE OF ACTION
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
48-MONTH TIME LIMIT
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. Your
benefits may not be changed if you ask for a hearing
before this action takes place.
CONTACT YOUR WORKER RIGHT AWAY IF YOU DISAGREE
WITH THE INFORMATION ON THIS NOTICE.
If you and the county worker cannot reach an agreement, you
●
must ask for a hearing within 90 days from the date of this
notice.
If you do not request a hearing, you may never get another
●
chance to change the number of months shown on this notice
for your 48-month time limit on aid.
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
Benefits. Keep using your plastic Benefits Identification
Card(s). You will get another notice telling you about any
changes to your health benefits.
CalFresh: This notice DOES NOT stop or change your CalFresh
benefits. You will get a separate notice telling you about any
changes to your CalFresh benefits.
Receiving Medi-Cal and/or CalFresh only DOES NOT count
against your cash aid time limits.
Rules: These rules apply; you may review them at your welfare
office: Senate Bill 72 (Chapter 8, Statutes of 2011).
Page 1 of ____
NA 530 (4/11) 48-MONTH TIME LIMIT - REQUIRED FORM - NO SUBSTITUTE PERMITTED
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