ICE OF ACTION

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Coppa NTY

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***** ** ***

DATE ‘i

o9 FOOD ASSISTANCE CASE /ORKE ; GEO/ADMN

***/**** *** >» NO. WORKER NO be

aoe FOREST, JR

RD

BAY AL 36541-6343

_ YOU WILL RECEIVE $358 EN

EN APPROVED FOR FOOD STAMPS :

top CASE HAS if FIRST TIME. AFTER THE FIRST TIME, YOU WILL RECEIVE $250

TIFIED FROM 08/22 TO 11/22.

LOTMENT AMOUNT:

HE FOLLOWING MONTHLY FIGURES DETERMINED YOUR AL

HOUSEHOLD NO. : 1 EARNINGS : $0 RENT/MORT : $0

RESOURCES : $0 UNEARNED MONEY : $0 INS/TAXES : $0

MEDICAL : $0 DEPCARECOST : $0 UTILITIES: $0

CHILD SUP PAID : $0

INFORMATION CONCERNING YOUR RIGHTS REGARDING THIS ACTION:

“T THE OFFICE SHOWN OR HAVE YOUR AUTHORIZED

ENTATIVE, IF YOU ARE NOT

ASE CONT?

UR CASE WITH A COUNTY REPR NT s

ASSISTANCE HANDBOOK

Ip YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE

REPRESENTATIVE DO SO. YOU HAVE THE RIGHT TO DISC

SATISFIED WITH THE ACTION TAKEN OR YOU NEED FURTHER EXPLANATION. A COPY OF THE FOOD

ERENCE WITH COUNTY STAFF CAN BE

UILTY OF

MATERIAL Cee = ae OF TI ACTION IOWN IS AVAILABLE TO YOU. A CONE!

SCHEDULED IMMEDIATELY AND DOES NOT AFFECT YOUR RIG {T TO A FAIR HEARING. IF YOU HAVE BEEN FOUND G!

BAEINTaNTIONAL VIOLATION OF A PROGRAM RULE YOU ARE NOT ENTITLED TO A FAIR HEARING. YOU SHOULD INFORM THE

COUNTY OFFICE IF YOU HAVE BEEN DENIED FOOD ASSISTANCE AND YOU ARE LATER APPROVED FOR FAMILY ASSISTANCE

AND/OR SSL

(J [WANT A CONFERENCE ON MY FOOD ASSISTANCE. MAIL TO OR CALL THE OFFICE LISTED ON THIS NOTICE AT ONCE.

E NOT SATISFIED WITH THE RESULTS OF THE CONFERENCE YOU MAY REQUEST A REVIEW BY THE STATE

AYS FROM THE DATE ACTION WAS TAKEN ON YOUR CASE. ORAL OR WRITTEN REQUESTS FOR

E LOCAL FOOD ASSISTANCE OFFICE OR THE STATE DEPARTMENT. IF YOU CAN NOT MAKE

WYER OR LEGAL REPRESENTATIVE OR OTHER AUTHORIZED PERSON MAY DO IT FOR YOU. A

L BE MAILED TO YOU UPON RECEIPT OF YOUR REQUEST. YOU MAY PRESENT

ATTORNEY OR SPOKESPERSON OF YOUR CHOICE.

if YOU AR

DEPARTMENT WITHIN 90 D.

HEARINGS ARE ACCEPTED BY TH

THE REQUEST YOURSELF, YOUR LA’

STATEMENT OF HEARING PROCEDURES WIL!

INFORMATION YOURSELF OR BE REPRESENTED BY AN

IR HEARING ON MY FOOD ASSISTANCE CASE.

IEST THAT YOUR FOOD ALLOTMENT NOT BE CHANGED UNTIL THE HEARING IS HELD. HOWEVER, IF THE ACTION

TO BE CORRECT, YOU WILL HAVE TO REPAY BENEFITS YOU RECEIVED BECAUSE OF THE REQUEST.

URRENT OR FUTURE BENEFITS.

E BY WITHHOLDING C

ASSISTANCE BENEFITS [ NOW RECEIVE UNTIL THE HEARING.

EIVE UNTIL THE

CIEWANT AFA

YOU MAY REQU

BEING TAKEN IS FOUND

REPAYMENT MAY BE MAD)

FPWANT TO CONTINUE RECEIVING THE AMOUNT OF FOOD

AMOUNT OF FOOD ASSISTANCE BENEFITS NOW REC

HEARING.

THE ACTION CHECKED ON THIS NOTICE WILL BE TAKEN UNLESS YOU REQUEST A 1M x WITHIN Tana ys FROM THE

Fee oF sete NOTICE. VOU WANT TO'WITHORAW YOUR REQUEST BEFORE THE BARING, WRITE THE STATE i

DEPARTMENT TO DO SO. PLEASE GIVE YOUR REASON FOR WITHDRAWING. ign Gxnaia’

STANDARDS FOR PARTICIPATION ARE THE SAMY FOR ALL WITHOUT REGARD TO RACE, COLOR: ET ee

ORIGIN, POLITICAL BELIEFS, SEX, AGE OR HANDICAP.

TO OBTAIN FREE LEGAL ADVICE, CONTACT LEGAL SERVICES ALABAMA STATEWIDE INTAKE

4.866-***-**** OR AT THEIR STATEWIDE ONLINE INTAKE WEBSITE AT WWW.ALAB AMALEGALHED

ADDRESS OF gp aNnCE O

LOCAL FOOD ASS

DER pp sTE

MOBILE COUNTY.

3970 COTTAGE Hi'4749

3660

{(11D0 NOT WANT TO CONTINUE RECEIVING THE

NUMBER AT

Contact this candidate