Form Na 218 - Notice Of Action - Sponsored Non-Citizens (Deemed Property)

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NOTICE OF ACTION
COUNTY OF
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
(Continued)
Notice Date
__________________________________________________________________________
Case
Name
__________________________________________________________________________
Number
__________________________________________________________________________
SPONSORED NON-CITIZENS
(DEEMED PROPERTY)
A.
Items:
VALUE
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
_______________________________________________________________
_________
B.
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
_________
1500
C. Less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
–
_________
D.
Subtotal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
=
_________
E.
Number of Sponsored Non-Citizens on CalWORKs . . . . . . . . . . . . . . . . . . . . . . .
÷
_________
F.
Divide D by E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
=
_________
The amount in F is to be included in the sponsored non-citizen’s property limits for CalWORKs.
Rules:
These rules apply; you may review them at your welfare
office. MPP 42-205.5
State Hearing:
If you think this action is wrong, you can ask for
a hearing. The back of page 1 tells how.
NA 218 (1/00) SPONSORED NON-CITIZENS (DEEMED PROPERTY)
Page _________ of ________

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