PURPOSE:
This form is used to contact participants and request they contact the IM caseworker about a QC review. It informs participants of the consequences if they do not cooperate.
NUMBER OF COPIES AND DISPOSITION:
Send one copy to the participant and retain one copy to be filed in the case record.
MANUAL REFERENCE
Food Stamp Manual section 1140.050.00, Quality Control Review Noncompliance
INSTRUCTIONS FOR COMPLETION:
FROM: Enter the caseworker’s name, telephone number, date, and county office address.
TO: Enter the participant’s name and address.
RE: Enter the case name and case number.
Line 3: Enter the date that is 10 days from the date of the notice.
Line 5: Enter the date the penalty will no longer be in effect. (95 days after the annual review period January 4 of the next Federal fiscal year).EXAMPLE: Mr. A does not cooperate with QC in June 2005. The QC sanction is entered and closes Mr. A’s food stamp case. He is not eligible to receive food stamp benefits again unless he cooperates with QC or until January 4, 2006.EXAMPLE: Ms. Smith does not cooperate with QC in January 2006. The QC sanction is entered and closes Mr. Smith’s food stamp case. She is not eligible to receive food stamp benefits again unless she cooperates with QC or until January 4, 2007.
Line 7: Enter the county’s /caseworker’s telephone number.
CASEWORKER SIGNATURE/CASELOAD/DATE
The caseworker who completes the form signs and enters the load number and date.