Form Na 693 - Notice Of Approval - Cash Assistance Program For Immigrants (Capi)
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1
2NOTICE OF APPROVAL
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CASH ASSISTANCE PROGRAM
FOR IMMIGRANTS (CAPI)
Notice Date :
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone :
Address :
(ADDRESSEE)
Questions? Ask your Worker.
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.
Your application for the Cash Assistance Program for
Immigrants (CAPI) dated ________________________
(month/day/year)
has been approved.
The cash aid payment for your first month of aid
is $_____________________.
Your first day of cash aid is _____________________
(month/day/year)
Comments:
REPORTING RESPONSIBILITIES
The amount of your CAPI payment is based on all the
information we received. You must tell the county every
time there is any change, including changes in income,
resources or living arrangements for yourself, or your
spouse, parent or child who lives with you, or your sponsor
and their spouse regardless of where they live.
You must tell us about any change within 10 days of the
change. Remember, a change may make your CAPI
monthly payment bigger or smaller. You may need to pay
back any overpayments you receive.
Rules: These rules apply; you may review them at your welfare
office: Welfare and Institutions Code, Division 9, Par t 6,
Chapter 10.3, Sections 18937 through 18944.
Page 1 of ____
NA 693 (4/99)
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