Form Na 801 - Notice Of Action Gain (Manual Process)
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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:
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.
Rules: These rules apply. You may review them at your welfare
office:
NA 801 (11/99)
Page 1 of ____
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Parent category: Legal