STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
REFUGEE CASH ASSISTANCE (RCA)
ISSUE DATE:
NOTICE OF NO GOOD CAUSE
CASE NUMBER:
CASE NAME:
DETERMINATION AND COMPLIANCE
WORKER NAME:
WORKER NO.:
PLAN APPOINTMENT
If you have any questions, please call your worker.
TO:
_____________________________
_____________________________
_____________________________
There is a problem with your taking part in the RCA program. You must discuss your RCA participation problem with your worker and agree on
a RCA compliance plan. Otherwise, your cash aid will be sanctioned since you are a mandatory participant.
HERE’S WHY:
On _______________________, we decided you did not have a good reason for:
not participating in _________________________________________________________.
not going to a job interview.
not accepting a job.
quitting your job.
reducing your earnings.
other _____________________________
WHAT HAPPENS NEXT?
In order to help you correct any problems that have kept you from doing what RCA requires, we have scheduled an appointment with you on
______________ at _____________________ o'clock at ________________________________________________________________.
We will work with you on a plan for your participation in RCA.
If you cannot keep this appointment, please call your worker by _________________________________ to schedule another appointment.
YOU MAY RESCHEDULE THIS APPOINTMENT ONLY ONCE
AND THE INTERVIEW MUST BE CONDUCTED BY NO LATER THAN ____________________
COMPLIANCE PLAN
The proposed plan for you to do what RCA requires is:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
See back of this notice for more important information
RCA 44 (5/03) REQUIRED FORM
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