Form Fsp 3 - Family Stabilization Program Notice Of Change In Program Status

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Family Stabilization Program Notice
Notice Date
:
Case Name
:
of Change in Program Status
Case Number
:
Case Worker
:
Worker Number:
Telephone
:
Address
:
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing: If you think this action is wrong, you
can ask for a hearing. Your benefits may not be
changed if you ask for a hearing before this action
takes place. If you and the county disagree or if you
have not heard back from your worker, do not wait
to ask for a hearing. You must ask for the hearing
before a certain number of days. See the back of
this notice for more information and to find out how
to ask for a hearing.
HOW TO GET YOURSELF BACK IN FAMILY
, as of
,
STABILIZATION
we are taking you out of Family Stabilization and returning
You are being removed from Family Stabilization because
you to the Welfare-to-Work Program.
you did not do or were not able to do what we asked you to
do and you are being moved into the Welfare-to-Work
We will not change your cash aid grant amount.
Program. If you believe you are able to follow your Family
Stabilization Plan, you can contact the county and tell them
We are taking you out of Family Stabilization because you
you want to be back in Family Stabilization: Then you must
did not have a good reason for not doing what you agreed
follow your Family Stabilization plan.
to in your Family Stabilization plan. You agreed to:
TO CONTACT THE COUNTY ABOUT GETTING BACK IN
FAMILY STABILIZATION, CALL
.
WE NEED TO TALK TO YOU
An appointment has been made for you on
,
DO YOU NEED FREE LEGAL HELP? You can get free
at
o’clock, at
to sign a
help with this problem from:
Welfare-to-Work Plan. If you need transportation or child
care to go to this meeting, call your Welfare-to-Work case
Local Legal Aid Office: (
)
worker at the telephone number listed below.
Welfare-to-Work Case Worker’s name:
State Welfare Rights Organization: (
)
Telephone Number:
Rules: The following rules apply and you may review
them at your local office: Assembly Bill (AB) 74 (Chapter
If you cannot go to this meeting, you must call your case
21, Statutes of 2013); Welfare & Institutions (W&I) Code
worker to set a new time. Unless you have a good reason,
Section 11325.24
you can change this meeting only once. You can also call
your case worker to talk about the problem instead of going
to the meeting. You must call your case worker to set a new
time to meet, or talk about your problem by telephone, by
.
FSP 3 (8/14) REQUIRED FORM – NO SUBSTITUTES PERMITTED

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