Form Fsp 2 - Family Stabilization Program Denial Notice
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COUNTY
CASE NAME
FAMILY STABILIZATION PROGRAM
DENIAL NOTICE
CASE NO.
CASE WORKER (CONTACT PERSON)
WORKER PHONE NUMBER
WORKER NUMBER
Questions? Ask your worker.
On _____________, _______________________________ requested help through the Family Stabilization Program.
(DATE)
(NAME)
Based on the facts in your case, the county made the following decision:
Your request for Family Stabilization services is DENIED. At this time your situation does not meet the criteria for Family
Stabilization. Your case worker may be able to provide assistance with your current situation through other services. Please
contact your case worker at the number above to discuss your situation. There are reasons you may not have to participate
in Welfare-to-Work activities (exemptions), or reasons that you may be excused from participating for a short time (good
cause). For example, these reasons may include taking care of a sick household member. If you are not already exempt
but think you should be, please contact your case worker right away.
Reason for Denial:
There isn’t anyone required to participate in Welfare-to-Work.
The person required to participate in Welfare-to-Work activities has no time left on their Welfare-to-Work 24-month
Time Clock.
The county does not have Family Stabilization services available that fit your need.
Your crisis does not meet your county’s Family Stabilization program plan based on the information you gave us.
Other ____________________________________
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.
Rules: The following rules apply and you may review them at your welfare office: Assembly Bill (AB) 74 (Chapter 21, Statutes
of 2013); Welfare & Institutions (W&I) Code Section 11325.24
FSP 2 (8/14) REQUIRED FORM - NO SUBSTITUTES PERMITTED
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