Form Dpa 435 - County Allegation Of Intentional Program Violation/statement Of Position (Request For An Administrative Disqualification Hearing)

Download a blank fillable Form Dpa 435 - County Allegation Of Intentional Program Violation/statement Of Position (Request For An Administrative Disqualification Hearing) 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 Dpa 435 - County Allegation Of Intentional Program Violation/statement Of Position (Request For An Administrative Disqualification Hearing) 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

State of California – Health and Human Services Agency
California Department of Social Services
COUNTY ALLEGATION OF INTENTIONAL PROGRAM
VIOLATION /STATEMENT OF POSITION
(Request for an Administrative Disqualification Hearing)
County: ________________________________
PROPOSED PENALTY PERIOD
CalWORKs
CalFresh
6 Months
12 Months
Two Years
12 Months
24 Months
Four Years
Permanent
Ten Years
Permanent
Active
Closed
Active
Closed
Person
Street Address
Case No.
City State Zip Code
SSN
Phone
Language
JURISDICTION:
A. Status of Prosecution
•
The case will not be referred to the DA for prosecution because of an agreement with the
prosecutor such as monetary limit thresholds for resulting overpayments of overissuances;
•
The case was referred to the DA but was rejected for prosecution;
• The case was referred to the DA or the court but the factual issues in that case are different in
this case; or
•
The case has not yet been referred to the DA for prosecution.
B. Address Determination
The county at the hearing will affirm that the address used by the State at the time the State sent
notice of this hearing was appropriate (e.g., as reflected in current county records, last known
address with no reports of changed addresses, etc.)
DPA 435 (1/18)
Page 1 of 6

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Hhs 730 - Withdrawal Of Request For An Administrative Law Judge (alj) Hearing Form Hhs 730 - Withdrawal Of Request For An Administrative Law Judge (alj) Hearing Legal
Request For An Administrative Review Of The Support Order Request For An Administrative Review Of The Support Order Legal
Form A-1 - County Board Of Taxation Instructions For Filing Petition Of Appeal Form A-1 - County Board Of Taxation Instructions For Filing Petition Of Appeal Financial
Montana Form Pt-stm - Second-tier Pass-through Entity Owner Statement And Waiver Request (for Tax Years 2011 And Earlier) Montana Form Pt-stm - Second-tier Pass-through Entity Owner Statement And Waiver Request (for Tax Years 2011 And Earlier) Financial
Form Dpa 479 - Administrative Disqualification Hearing Waiver - Calworks/calfresh Form Dpa 479 - Administrative Disqualification Hearing Waiver - Calworks/calfresh Legal
Form 377.7g Food Stamp Repayment Agreementfor An Intentional Program Violation (ipv) Only Form 377.7g Food Stamp Repayment Agreementfor An Intentional Program Violation (ipv) Only Legal
Request For Exemption From Disqualification On Eligibility For Historical Property Contract - County Of Los Angeles, California Request For Exemption From Disqualification On Eligibility For Historical Property Contract - County Of Los Angeles, California Legal
Form Gr-68765 (2-12) - Request For An Appeal Of An Aetna Medicare Advantage Plan Denial Form Gr-68765 (2-12) - Request For An Appeal Of An Aetna Medicare Advantage Plan Denial Business
Form 993-a - Application For An Extension Of Time To File Form 945 Inter-county Return Of Taxable Business Property - 2000 Form 993-a - Application For An Extension Of Time To File Form 945 Inter-county Return Of Taxable Business Property - 2000 Financial
Form 993-a - Application For An Extension Of Time To File Form 945 - Inter-county Return Of Taxable Business Property - 2001 Form 993-a - Application For An Extension Of Time To File Form 945 - Inter-county Return Of Taxable Business Property - 2001 Financial

Related Categories

Parent category: Legal
Download
Go
Page of 6