Form Na 960y Qr - Notice Of Action - Stop Aid - Report Incomplete
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1
2STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
NOTICE OF ACTION
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Notice Date :
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone :
24 Hour
Information :
Address :
(ADDRESSEE)
Questions? Ask your Worker or call the number above.
STATE HEARING: If you think this
action is wrong, you can ask for a
hearing. The back of this page tells
you how. Your benefits may not be
changed if you ask for a hearing
before this action takes place.
As of ________________________, the County is stopping your:
If you need help completing your QR 7, the County will help you.
■ ■
Please contact the County and ask for help.
Cash Aid
Toll free ___________________.
■ ■
CalFresh
Here’s why:
The quarterly report (QR 7) that we got from you this quarter is
not complete.
To continue to get cash aid and/or CalFresh benefits, you must
return a complete QR 7.
A QR 7 is complete when you have answered all of the questions
and have attached required proof.
The County must get your complete report no later than the
first working day of next month. You must send or bring in the
following information:
■ ■
Complete the circled items on the enclosed report.
■ ■
Complete the following questions on the enclosed report.
■ ■
Send or bring the following proof:
The information you give us may change or stop your cash aid
and/or your CalFresh benefits.
If you turn in a complete QR 7 anytime next month that
shows you are eligible for cash aid and/or CalFresh benefits,
your benefits will start from the day you turn in the form.
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
Benefits. If there is a change in your Medi-Cal benefits, you will
get another notice. Keep using your plastic Benefits
Identification Card(s).
You and your family may still continue to get Medi-Cal if your cash
aid stops and:
you have earnings from a job, a business you started or you
●
got a pay raise.
you have star ted to receive or had an increase in
●
child/spousal support payments.
Rules: These rules apply. You may review them at your welfare
office - Cash Aid: MPP 40-105.1, 40-181.22, 40-181.24.
CalFresh: 63-103.(n), 63-508.6. TCVAP, RCA and ECA:
70-105.1, 69-206 and 69-301.
NA 960Y QR (7/12) STOP AID; REPORT INCOMPLETE
Page 1 of ______
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