Form Na 1276 - Notice Of Action - Welfare-To-Work 24-Month Time Clock Limit Notice
Download a blank fillable Form Na 1276 - Notice Of Action - Welfare-To-Work 24-Month Time Clock Limit Notice in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Na 1276 - Notice Of Action - Welfare-To-Work 24-Month Time Clock Limit Notice with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2NOTICE OF ACTION
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Welfare-to-Work
Notice Date :
Case
24-Month Time Clock Limit
Name
:
Number
:
Notice
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. 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.
As of _____________________________________________, you,
CONTACT YOUR WORKER RIGHT AWAY IF YOU DISAGREE
WITH THE INFORMATION ON THIS NOTICE.
___________________________________________, have used a
total of _____ months of your Welfare-to-Work 24-Month Time Clock.
Worker’s Name: _______________________________________
Starting __________________, your Welfare-to-Work participation
status will be changed. You will need to meet CalWORKs federal
Telephone Number:____________________________________
standards in order to continue receiving cash aid, unless you qualify
for more time on your Welfare-to-Work 24-Month Time Clock (an
extension), or do not have to do Welfare-to-Work (an exemption).
You should have already received an appointment notice and met
DO YOU NEED FREE LEGAL HELP? You can get free help with
with your worker to make sure your participation meets CalWORKs
this problem from:
federal standards. If you have not met with your worker for this
Local Legal Aid Office
review appointment you must contact your worker immediately and
(_____)___________________________________________
make sure your participation meets CalWORKs federal standards,
or find out if you can get more time on of your Welfare-to-Work 24-
State Welfare Rights Organization
Month Time Clock, or do not have to do Welfare-to-Work to
remain on aid.
(_____)__________________________________________
If you have already met with your worker and signed an adjusted
Welfare-to-Work plan that meets CalWORKs federal standards, or
have been granted an extension or exemption, you are not required
to contact your worker about this notice.
If you do not meet CalWORKs federal standards, your family’s cash
aid may be lowered.
Medi-Cal: This notice DOES NOT change or stop Medi-Cal Benefits.
Keep using your plastic Benefits Identification Card(s). You will
get another notice telling you about any changes to your health
benefits.
CalFresh: This notice DOES NOT stop or change your CalFresh
benefits. You will get a separate notice telling you about any changes
to your CalFresh benefits.
Receiving Medi-Cal and/or CalFresh only DOES NOT count against
your cash aid time limits.
Rules: These rules apply:
Welfare and Institutions Code Section 11322.85(a)
NA 1276 (1/15) REQUIRED FORM - SUBSTITUTE PERMITTED
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal