Form Cf 37 - Recertification For Calfresh Benefits Page 5
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11STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
(ii) This information may be disclosed to other Federal and State agencies for official examination,
and to law enforcement officials for the purpose of apprehending persons fleeing to avoid the law.
(iii) If a CalFresh claim arises against your household, the information on this application, including all
SSNs, may be referred to Federal and State agencies, as well as private claims collection agencies,
for claims collection action.
(iv) Providing the requested information including the SSN of each household member, is voluntary.
However, failure to provide an SSN will result in the denial of CalFresh benefits to each individual
failing to provide an SSN. Any SSNs provided will be used and disclosed in the same manner as
SSNs of eligible household members.
The County may verify immigration status of household members applying for benefits by contacting
the USCIS. Information the County gets from these agencies may affect your eligibility and level of
benefits.
The County will check your answers using information in state and federal electronic databases from
the Internal Revenue Service (IRS), Social Security Administration, the Department of Homeland
Security, and/or a consumer reporting agency. If the information does not match, the County may ask
you to send proof.
Use of Social Security Numbers (SSN):
Everyone applying for CalFresh benefits needs to
provide a SSN, if you have one, or proof that you have applied for a SSN
(such as a letter from the
Social Security Office). The County may deny CalFresh benefits for you or any member of your
household who does not give us a SSN.
Some people do not have to give SSN’s to get help such
as, victims of domestic abuse, crime prosecution witnesses, and trafficking victims.
Overissuance: This means you got more CalFresh benefits than you should have gotten. You will
have to pay it back even if the County made an error or if it was not on purpose. Your benefits may be
lowered or stopped. Your SSN may be used to collect the amount of benefits owed, through the courts,
other collection agencies, or federal government collection action.
Reporting: Your household must continue to report the changes the County told you to report. If you
do not report, your benefits may be lowered or stopped. You can also report if things happen that
may increase your benefits, such as receiving less income.
State Hearing: You have the right to a state hearing if you do not agree with any action taken
regarding your recertification for ongoing benefits. You can request a state hearing within 90 days of
the County’s action and you must tell why you want a hearing. The approval or denial notice you
receive from the County will have information on how to request a state hearing.
Nondiscrimination Statement: In accordance with Federal civil rights law and U.S. Department of
Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices and employees,
and institutions participating in or administering USDA programs are prohibited from discriminating
based on race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or
retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
CalFresh Program Rules Page 5 – Please take and keep for your records.
CF 37 (11/16) REQUIRED FORM - NO SUBSTITUTES PERMITTED
PROGRAM RULES PAGE 5 OF 7
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