Form Cf 24 - Calfresh Program Request For Policy/regulation Interpretation
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1
2STATE OF CALIFORNIA — HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
PI#
CALFRESH REQUEST FOR POLICY INTERPRETATION
INSTRUCTIONS: Complete items 1 - 10 on the form. Use a separate form for each policy interpretation request. If additional space is
needed, please use the second page. Retain a copy for your records and submit via email to CalFresh-PI@dss.ca.gov.
Please note: the policy interpretation provided is based on the unique set of facts presented and should not be assumed to apply in all
scenarios.
1.
RESPONSE NEEDED DUE TO:
5.
DATE OF REQUEST:
NEED RESPONSE BY:
Policy/Regulation Interpretation
6.
COUNTY/ORGANIZATION:
QC
Other:
7.
SUBJECT:
8.
REFERENCES: (Include ACL/ACIN, court cases, etc. in references)
2.
REQUESTOR NAME:
NOTE: All requests must have a regulation cite(s) and/or a reference(s).
3.
PHONE NO.:
EMAIL:
4.
REGULATION CITE(S):
9.
QUESTION: (INCLUDE SCENARIO IF NEEDED FOR CLARITY):
10.
REQUESTOR’S PROPOSED ANSWER:
11.
STATE POLICY RESPONSE (CFPB USE ONLY):
FOR CDSS USE
DATE RECEIVED:
DATE RESPONDED TO COUNTY/ALJ:
PAGE 1
CF 24 (6/17)
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