Form CF377.7D2 LP "CalFresh Repayment Final Notice - County Administrative Error (AE)" - California

What Is Form CF377.7D2 LP?

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 February 1, 2018;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of Form CF377.7D2 LP 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 CF377.7D2 LP "CalFresh Repayment Final Notice - County Administrative Error (AE)" - California

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State Of California - Health And Human Services Agency
California Department Of Social Services
CALFRESH REPAYMENT FINAL NOTICE
COUNTY ADMINISTRATIVE ERROR (AE)
COUNTY OF _____________________
Notice Date: ________
(ADDRESSEE)
Case Name:
___________________
Case Number:
___________________
Worker Name:
___________________
Worker Number:
State Hearing: If you think this action
___________________
is wrong, you can ask for a hearing
Worker Telephone:
unless you already had a hearing on
the amount you owe. If you ask for
___________________
a hearing before ____________ your
Worker Address:
benefits will not be changed before
___________________
the hearing. Page 7 tells you how.
___________________
Questions? Ask your
Worker.
Warning: If you think we are wrong, this is your last chance to
ask for a hearing. If you stay on CalFresh the county can lower
your CalFresh benefits to collect the overissuance. If you go off
CalFresh before the overissuance is paid back, the county may
take what you owe out of your income tax refund.
IMPORTANT - MORE INFORMATION ON PAGE 2.
Page 1 of 8
CF 377.7D2 LP (2/18)
Required Form - No Substitute Permitted
State Of California - Health And Human Services Agency
California Department Of Social Services
CALFRESH REPAYMENT FINAL NOTICE
COUNTY ADMINISTRATIVE ERROR (AE)
COUNTY OF _____________________
Notice Date: ________
(ADDRESSEE)
Case Name:
___________________
Case Number:
___________________
Worker Name:
___________________
Worker Number:
State Hearing: If you think this action
___________________
is wrong, you can ask for a hearing
Worker Telephone:
unless you already had a hearing on
the amount you owe. If you ask for
___________________
a hearing before ____________ your
Worker Address:
benefits will not be changed before
___________________
the hearing. Page 7 tells you how.
___________________
Questions? Ask your
Worker.
Warning: If you think we are wrong, this is your last chance to
ask for a hearing. If you stay on CalFresh the county can lower
your CalFresh benefits to collect the overissuance. If you go off
CalFresh before the overissuance is paid back, the county may
take what you owe out of your income tax refund.
IMPORTANT - MORE INFORMATION ON PAGE 2.
Page 1 of 8
CF 377.7D2 LP (2/18)
Required Form - No Substitute Permitted
State Of California - Health And Human Services Agency
California Department Of Social Services
1. We told you
You still owe $ __________ because
before that we
we overissued from ____________ to
paid you too
___________. Please see page 3 for your
much CalFresh.
options to repay.
2. The county made a mistake. Here’s why this happened:
IMPORTANT - MORE INFORMATION ON PAGE 3.
Page 2 of 8
CF 377.7D2 LP (2/18)
Required Form - No Substitute Permitted
State Of California - Health And Human Services Agency
California Department Of Social Services
3. You did not agree to repay OR did not repay as agreed.
Your options to repay:
YES
NO
Are you still receiving CalFresh?
1. Pay in full
1. Pay in full
OR
OR
2. Join the 5% or $10
2. Agree to a repayment plan
repayment plan
Fill out and return the included
If you don’t respond by ___________,
repayment form by __________.
we’ll assume you agree to a 5% or
You must tell us when you
$10 reduction (whichever is more) in
cannot pay as agreed. If your
your CalFresh benefits for up to 36
ability to pay changes, explain
months. This will start on _________.
why you cannot pay and contact
OR
the county about changing your
3. Agree to another
monthly payments.
repayment plan
OR
Fill out and return the included
3. Ask for a state hearing
repayment form by ____________.
If you disagree with us, this is
You must tell us when you cannot
your last chance to ask for a
pay as agreed. If your ability to pay
state hearing by filling out
changes, explain why you cannot
pages 5-8 and returning them
pay and contact the county about
by ___________.
changing your monthly payments.
If you are NO LONGER
OR
receiving CalFresh, we MUST
4. Ask for a state hearing
hear from you. If we do not
If you disagree with us, this is your
hear from you by ___________,
we may take your income tax
last chance to ask for a state
hearing by filling out pages 5-8 and
refund, or use other ways of
returning them by ____________.
collecting the amount owed.
IMPORTANT - MORE INFORMATION ON PAGE 4.
Page 3 of 8
CF 377.7D2 LP (2/18)
Required Form - No Substitute Permitted
State Of California - Health And Human Services Agency
California Department Of Social Services
Note: • You do not have to use SSI benefits to pay back the
overissuance.
• Collection will be from all adults in the household when
the overissuance occurred.
• You may review and copy the county’s records related to
this overissuance.
• If you stop receiving CalFresh before the overissuance is
paid back, we may take what you owe out of your income
tax refund.
• If you do not pay back the overissuance, agree to a
repayment plan, or have your benefits reduced, the county
may use other ways of collecting the amount owed such
as through the courts or federal government collection
action.
• If the claim becomes past due or the household is sued,
you may have to pay court or other costs.
• Your repayment agreement will be based on your current
ability to pay. If your ability to pay changes, contact the
county about changing your monthly payments.
• Lomeli v. Saenz: Federal law requires us to forgive any
part of your claim if we believe you are unable to repay.
We will collect the amount above by reducing your
monthly allotment by 5% or $10.00, whichever is greater,
for up to a total of 36 months. Any remaining balance will
be forgiven.
These rules apply: MPP 63-801.21. You may review them online at
cdss.ca.gov or at your local county office.
Page 4 of 8
CF 377.7D2 LP (2/18)
Required Form - No Substitute Permitted
State Of California - Health And Human Services Agency
California Department Of Social Services
YOUR HEARING RIGHTS
If the hearing decision says we
You have the right to ask
are right, you will owe us for
for a hearing if you disagree
any extra Cash Aid, CalFresh
with any county action. You
or Child Care Services you
have only 90 days to ask for a
got. To let us lower or stop your
hearing. The 90 days started
benefits before the hearing,
the day after the county gave
check below:
or mailed you this notice. If
Yes, lower or stop:
you have good cause as to why
you were not able to file for
Cash Aid
CalFresh
n
n
a hearing within the 90 days,
Child Care
n
you may still file for a hearing.
If you provide good cause, a
While You Wait for a Hearing
hearing may still be scheduled.
Decision for:
If you ask for a hearing before
Welfare to Work:
an action on Cash Aid, Medi-
You do not have to take part in
Cal, CalFresh, or Child Care
the activities.
takes place:
You may receive child care
• Your Cash Aid or Medi-Cal
payments for employment and for
will stay the same while you
activities approved by the county
wait for a hearing.
before this notice.
• Your Child Care Services
If we told you your other
may stay the same while you
supportive services payments will
wait for a hearing.
stop, you will not get any more
payments, even if you go to your
• Your CalFresh benefits
activity.
will stay the same until
the hearing or the end of
your certification period,
whichever is earlier.
YOUR HEARING RIGHTS ARE
CONTINUED ON PAGE 6.
NA BACK 9 (Replaces NA BACK 8 And EP 5)
Page 5 of 8
(2/18) Required Form - No Substitute Permitted