Form Aap 3l - Reassessment Information - Adoption Assistance Program Page 2
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5STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Check ( ) one of the following:
We are legally responsible for the support of the child, and we are supporting the child.
I
I
The above-named child has attained the age of 18 or 21.
We are no longer legally responsible for the support of the above-named child.
I
I
We are no longer supporting the above-named child.
Check ( ) one of the following:
1. I/We no longer wish to receive an AAP benefit and/or Medi-Cal coverage for the
I
above-named child. If the child’s need change, I/we may contact the agency at that
time.
2. I/We continue to need an AAP benefit and/or Medi-Cal coverage for the above
I
named child. The needs of the child have not changed to warrant a reduced level of
payment. I/We request that the AAP benefit continue at the current level.
3. I/We continue to need an AAP benefit and/or Medi-Cal coverage for the above
I
named child. I am/We are requesting an increase in the AAP benefit because the
needs of the child have changed. I am/We are providing the agency the following
information to assist the agency in determining whether or not increased assistance
will be granted, and if so, in what amount. (Please complete Section I.)
I
4. I/We continue to need an AAP benefit and/or Medi-Cal coverage for the above
named child. I/We request that the AAP benefit for the above named child be
decreased to $____________ because the needs of the child have changed. I/We
understand if at anytime the child’s needs change we may contact the agency to
renegotiate the AAP benefit.
PAGE 2 OF 5
AAP 3L (12/16)
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