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    Notice of Missed Interview

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    Notice of Missed Interview

    Uploaded by

    surenacadena
    19 views2 pages

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    19 views2 pages

    Notice of Missed Interview

    Uploaded by

    surenacadena

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

    Kinship COUNTY OF KERN


    PO BOX 511
    BAKERSFIELD, CA 93302-0511
    Date: 07/16/2024
    Case Name: VICTOR LOPEZ JR
    Case Number: 2112983
    Worker Name: Processing Team Twelve
    Worker ID: 15LS03U20V
    CALFRESH NOTICE OF MISSED INTERVIEW Worker Phone Number: (877) 410-8812

    Kinship
    VICTOR F LOPEZ JR
    PO BOX 511
    1525 BUSH ST
    BAKERSFIELD, CA 93302-0511
    ARVIN, CA 93203-2007

    Questions? Ask your worker.


    State Hearing: If you think this action is wrong, you can
    ask for a hearing. The back of this page tells you how.
    Your benefits may not be changed if you ask for a hearing
    before this action takes place.

    You were scheduled for an interview on 07/16/2024 , but you did not keep this appointment.

    If you still want CalFresh benefits, please contact your worker to schedule another interview.

    You must complete your interview with us by 07/31/2024 .

    You must be interviewed in order for us to determine your eligibility for CalFresh benefits. If you do not
    complete an interview, you will not be able to get CalFresh benefits.

    If you have any questions or want more information, please contact your worker.

    RULES: These rules apply: MPP Section(s) 63-300.4, 63-504.6. You may review them at your welfare office.

    CF 386 (2/14) REQUIRED FORM - SUBSTITUTE PERMITTED

    0000000508717270
    Page 1 of 2
    California Health & Human Services Agency California Department of Social Services

    YOUR HEARING RIGHTS


    YOUR HEARING RIGHTS (See also PUB 412 at www.cdss.ca.gov/inforesources/state-hearings )
    You can ask for a hearing if you disagree with a county/agency action or failure to act. You have 90 days to do so,
    starting the day after the date of the notice. After 90 days, you must prove you had a good reason for asking late. You
    can also ask for a hearing to review your benefits for the past 90 days. If you ask for a hearing before the date of the
    change, your benefits will continue unchanged. CalFresh will end if you don’t recertify when due.
    • Online at acms.dss.ca.gov Click "Create an account" to • Fill out this page, and deliver it by one of the following:
    have an ACMS account and get documents online; or click o In-person: Appeals Unit
    “Submit Appeal without Account” to file without an account Kern County Department of Human
    OR Services
    PO BOX 1261
    • Call toll free (800) 743-8525 (or TDD (800) 952-8349 ) OR BAKERSFIELD, CA 93302
    (800) 952-8349 / Fax: (833) 281-0905
    • Fax fill out this page/fax to (833) 281-0905 OR Toll Free: (800) 743-8525
    o Mail to: CDSS State Hearings Division, PO Box 944243,
    MS 21-37 Sacramento CA 94244-2430
    o Email to: [email protected]
    HEARING REQUEST
    1. My hearing issue involves (benefit program)
    and Kern County/Agency.
    2. I want a hearing because:

    3. Print name of person who needs a hearing: Birthdate:


    4. Mailing Address: Phone number:
    I want to get hearing notices from the State Hearing Division by email. Email Address:
    5. Name/Signature: Date Signed
    6. Interpreter: I want a free interpreter for the language or dialect.
    7. Disability Accommodation for hearing? No Yes (explain):
    8. Your Hearing will be scheduled by phone. If you want your hearing conducted by a different method, tell us how:
    By Telephone By Video (you see judge on your phone/computer) In person at the county hearing site
    I have no phone or internet access. I want to go and use the phone or video at hearing site for my hearing.
    9. I need a faster scheduled hearing due to Denial of CalWORKs or CalFresh emergency benefits
    Medical Emergency Eviction/homelessness Other (explain):
    10. If you timely appeal before the action listed in the notice takes place, your aid may stay the same. For CalWORKs
    (including Child Care) and CalFresh, if the county action was correct, you have to pay back any extra aid.
    Check to have your aid lowered or stopped pending the hearing for: CalWORKs Childcare CalFresh
    11. You can have a friend, relative, legal counsel or other person help with your hearing. If they have agreed:
    NAME: Email:
    Address: Phone:
    12. To Get Help: These groups below may be able to give you legal advice or represent you at the hearing:
    Greater Bakersfield Legal Assistance
    615 CALIFORNIA AVE
    BAKERSFIELD, CA 93304
    (661) 325-5943 / Fax: (661) 325-4482

    NA Back 9 (5/22) Required Form - No Substitute Permitted

    0000000508717270
    Page 2 of 2

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