Form NA277 "Notice of Action - Continuation Page - Optional Persons Transfer of Property" - California

What Is Form NA277?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2000;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form NA277 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form NA277 "Notice of Action - Continuation Page - Optional Persons Transfer of Property" - California

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NOTICE OF ACTION
COUNTY OF
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
(Continued)
Notice Date
:
Optional Persons
:
Case
Name
:
Transfer of Property
Number
Worker
:
Name
Number
:
Telephone
:
Address
:
:
Fair Market Value . . . . . . . . . . . . . . . . . . . . . . . . $ ___________
Amount Received . . . . . . . . . . . . . . . . . . . . . . . . – ___________
(A) Transfer of Property Amount . . . . . . . . . . = ___________
Family Needs
Basic Need for ______ Persons . . . . . . . . . $ ___________
Special Needs . . . . . . . . . . . . . . . . . . . . . . . + ___________
(B) Family Needs . . . . . . . . . . . . . . . . . . . . . . . = ___________
Optional Person(s) Needs
Basic Need for ______ Persons . . . . . . . . . $ ___________
Special Needs . . . . . . . . . . . . . . . . . . . . . . . + ___________
(C) Optional Person(s) Needs . . . . . . . . . . . . = ___________
Differential
Family Needs . . . . . . . . . . . . . . . . . . . . . . .
___________
Optional Person(s) Needs . . . . . . . . . . . . . . - ___________
(D) Differential . . . . . . . . . . . . . . . . . . . . . . . . . = ___________
Ineligibility for Optional Persons
Your transfer of property amount (A)
minus the differential (D)
divided by the optional person(s) needs (C)
equals the number of ineligible months: . . .
___________
(# OF MONTHS)
Rules: These rules apply; you may review them at your Welfare Office:
MPP
State Hearing:
If you think this action is wrong, you can ask for a
hearing. The back of page 1 tells how.
Page _____ of _____
NA 277 (1/00) CONTINUATION PAGE - OPTIONAL PERSONS TRANSFER OF PROPERTY
NOTICE OF ACTION
COUNTY OF
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
(Continued)
Notice Date
:
Optional Persons
:
Case
Name
:
Transfer of Property
Number
Worker
:
Name
Number
:
Telephone
:
Address
:
:
Fair Market Value . . . . . . . . . . . . . . . . . . . . . . . . $ ___________
Amount Received . . . . . . . . . . . . . . . . . . . . . . . . – ___________
(A) Transfer of Property Amount . . . . . . . . . . = ___________
Family Needs
Basic Need for ______ Persons . . . . . . . . . $ ___________
Special Needs . . . . . . . . . . . . . . . . . . . . . . . + ___________
(B) Family Needs . . . . . . . . . . . . . . . . . . . . . . . = ___________
Optional Person(s) Needs
Basic Need for ______ Persons . . . . . . . . . $ ___________
Special Needs . . . . . . . . . . . . . . . . . . . . . . . + ___________
(C) Optional Person(s) Needs . . . . . . . . . . . . = ___________
Differential
Family Needs . . . . . . . . . . . . . . . . . . . . . . .
___________
Optional Person(s) Needs . . . . . . . . . . . . . . - ___________
(D) Differential . . . . . . . . . . . . . . . . . . . . . . . . . = ___________
Ineligibility for Optional Persons
Your transfer of property amount (A)
minus the differential (D)
divided by the optional person(s) needs (C)
equals the number of ineligible months: . . .
___________
(# OF MONTHS)
Rules: These rules apply; you may review them at your Welfare Office:
MPP
State Hearing:
If you think this action is wrong, you can ask for a
hearing. The back of page 1 tells how.
Page _____ of _____
NA 277 (1/00) CONTINUATION PAGE - OPTIONAL PERSONS TRANSFER OF PROPERTY