Form CF377.1A LP "Notice of Approval for CalFresh Benefits - Large Print" - California

What Is Form CF377.1A 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 August 1, 2021;
  • 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 CF377.1A 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 CF377.1A LP "Notice of Approval for CalFresh Benefits - Large Print" - California

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State of California – Health and Human Services Agency
California Department of Social Services
NOTICE OF DENIAL
COUNTY OF
OR PENDING STATUS
__________________________________________
Notice Date
: _________________________
(Addressee)
Case Name
: _________________________
Case Number
: _______________________
Worker Name
: _______________________
Worker Number
: _____________________
Phone Number
: _____________________
Address
: ______________________________
Questions? Ask your Worker.
______________________________
State Hearing: If you think this action is wrong, you can ask
for a hearing. Pages three and four tell how. Your benefits
may not be changed if you ask for a hearing before this action
takes place.
DENIAL: INITIAL APPLICATION
…Your household’s application for CalFresh benefits has
been denied because:
…Your household’s application for CalFresh benefits will
be denied because you have not provided the requested
information listed below:
We asked you for the above information when you applied
for CalFresh benefits. You did not give us the information
within ten (10) days of the day it was requested, and you
did not ask us for help in getting the missing information.
…You must give us the information by
(30 days
__________________________
after your date of application) or your application will be
denied and you will not get another notice.
CF 377.1A LP (8/21) Required
Page 1 of 7
Form - No Substitute Permitted
State of California – Health and Human Services Agency
California Department of Social Services
NOTICE OF DENIAL
COUNTY OF
OR PENDING STATUS
__________________________________________
Notice Date
: _________________________
(Addressee)
Case Name
: _________________________
Case Number
: _______________________
Worker Name
: _______________________
Worker Number
: _____________________
Phone Number
: _____________________
Address
: ______________________________
Questions? Ask your Worker.
______________________________
State Hearing: If you think this action is wrong, you can ask
for a hearing. Pages three and four tell how. Your benefits
may not be changed if you ask for a hearing before this action
takes place.
DENIAL: INITIAL APPLICATION
…Your household’s application for CalFresh benefits has
been denied because:
…Your household’s application for CalFresh benefits will
be denied because you have not provided the requested
information listed below:
We asked you for the above information when you applied
for CalFresh benefits. You did not give us the information
within ten (10) days of the day it was requested, and you
did not ask us for help in getting the missing information.
…You must give us the information by
(30 days
__________________________
after your date of application) or your application will be
denied and you will not get another notice.
CF 377.1A LP (8/21) Required
Page 1 of 7
Form - No Substitute Permitted
State of California – Health and Human Services Agency
California Department of Social Services
…If the information is received before
(60 days
__________________________
after your date of application), your application will be
reopened and you will not need to reapply. If eligible, you
will be granted CalFresh benefits from the date we receive
the information.
PENDING STATUS:
…Your household’s application for CalFresh benefits is
pending. You have done what you needed to do. We are
still working on your case and you will hear from us soon.
…Your household’s application for CalFresh benefits is
pending because you have not provided the requested
information listed below:
We asked you for the above information when you applied
for CalFresh benefits. You did not give us the information
within ten (10) days from the day it was requested,
and you did not ask us for help in getting the missing
information.
…You must give us the information by
(30 days
___________________________
after the date of the initial request for verification).
…You must give us this information before
(60
_________________________
days after your application date), and if eligible, you will
be granted CalFresh benefits from the date you provide
the information. If you give us the information by the date
above, your application will be reopened and you will not
need to reapply.
CF 377.1A LP (8/21) Required
Page 2 of 7
Form - No Substitute Permitted
State of California – Health and Human Services Agency
California Department of Social Services
DENIAL: RECERTIFICATION APPLICATION
…Your household’s recertification application for CalFresh
benefits has been denied because:
…Your household’s recertification application for CalFresh
benefits has been denied because you did not provide the
requested information listed below:
We asked you for the above information when you
attempted to recertify for CalFresh benefits. You did not
give us the information within ten (10) days of the day it
was requested, and you did not ask us for help in getting
the missing information. If the information is received
on or before
(30 days after the end of the
______________________
certification period), your application will be reopened
and you will not need to reapply. If eligible, you will be
granted CalFresh benefits from the date we receive the
information.
If your household’s application for CalFresh benefits was
denied, please note that your CalFresh eligibility may change
if all household members begin receiving Supplemental
Security Income (SSI) benefits. Contact your county if all
members of the household begin receiving SSI benefits.
Rules: These rules apply:
You may review them at your welfare office.
For this form in another format, please call your county.
CF 377.1A LP (8/21) Required
Page 3 of 7
Form - No Substitute Permitted
YOUR HEARING RIGHTS
You have the right to ask for a hearing if you disagree
with any county action. You have only 90 days to ask
for a hearing. The 90 days started the day after the
county gave or mailed you this notice. If you have
good cause as to why you were not able to file for a
hearing within the 90 days, you may still file for a
hearing. If you provide good cause, a hearing may
still be scheduled.
If you ask for a hearing before an action on Cash Aid,
Medi-Cal, CalFresh, or Child Care takes place:
• Your Cash Aid or Medi-Cal will stay the same while you
wait for a hearing.
• Your Child Care Services may stay the same while you
wait for a hearing.
• Your CalFresh benefits will stay the same until the hearing
or the end of your certification period, whichever is earlier.
If the hearing decision says we are right, you will owe us
for any extra Cash Aid, CalFresh or Child Care Services
you got. To let us lower or stop your benefits before the
hearing, check below:
Yes, lower or stop:
Cash Aid
CalFresh
Child Care
While You Wait for a Hearing Decision for:
Welfare to Work:
You do not have to take part in the activities.
You may receive child care payments for employment and
for activities approved by the county before this notice.
If we told you your other supportive services payments will
stop, you will not get any more payments, even if you go to
your activity.
NA BACK 9 (Replaces NA BACK 8 And EP 5)
Page 4 of 7
(Revised 2/19) Required Form - No Substitute Permitted
If we told you we will pay your other supportive services,
they will be paid in the amount and in the way we told you in
this notice.
• To get those supportive services, you must go to the
activity the county told you to attend.
• If the amount of supportive services the county pays while
you wait for a hearing decision is not enough to allow you
to participate, you can stop going to the activity.
Cal-Learn:
• You cannot participate in the Cal-Learn Program if we told
you we cannot serve you.
• We will only pay for Cal-Learn supportive services for an
approved activity.
OTHER INFORMATION
Medi-Cal Managed Care Plan Members: The action on
this notice may stop you from getting services from your
managed care health plan. You may wish to contact your
health plan membership services if you have questions.
Child and/or Medical Support: The local child support
agency will help collect support at no cost even if you are
not on cash aid. If they now collect support for you, they will
keep doing so unless you tell them in writing to stop. They
will send you current support money collected but will keep
past due money collected that is owed to the county.
Family Planning: Your welfare office will give you
information when you ask for it.
Hearing File: If you ask for a hearing, the State Hearing
Division will set up a file. You have the right to see this file
before your hearing and to get a copy of the county’s written
position on your case at least two days before the
NA BACK 9 (Replaces NA BACK 8 And EP 5)
Page 5 of 7
(Revised 2/19) Required Form - No Substitute Permitted
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