Department of Workforce Services PO BOX 143245 SALT LAKE CITY, UT 84114-3245 Date Mailed: 12-08-2016 Case Number: 7131026 PID: 020321289 RENEE ELISAMA VASQUEZ 756 S 200 E APT 225 SALT LAKE CITY, UT 84111-3880 NOTICE OF DECISION Dear RENEE ELISAMA VASQUEZ We have made a decision about your eligibility for benefits. Below is a summary of the eligibility results. Additional information after the Summary of Eligibility includes: Basis of decision Effective date(s) Additional information This information may continue to additional pages, be sure to read both sides of each page. SUMMARY OF ELIGIBILITY PROGRAM APPLICATION DATE BENEFIT MONTH ACTION TAKEN AMOUNT ISSUED Food Stamps 11-14-2016 November 2016 Approval $109.00 Food Stamps December 2016 Change $194.00 Food Stamps Household benefits for this Program are approved as shown in the Summary Table a bove. Please review the following information for details: Your Food Stamp assistance will be $109.00 for the month of November 2016. Your F ood Stamp assistance amount may change each month if your income and/or household size changes. Your Food Stamp assistance will be available on your Electronic Benefit Transfer Card (EBT) on the 15th of every month. If you do not have an EBT card please call 1-866-435-7414 to speak to an eligibility worker and request an EBT card. Based on the information on your case at this time, here are your benefit amount s: Toll free: 1-866-435-7414 Toll free FAX: 1-877-313-4717 Phone Number: 801-526-0950 FAX: 801-526-9500 Benefit Month Amount Issued November 2016 $109.00 December 2016 $194.00 January 2017 $194.00 February 2017 $194.00 March 2017 $194.00 April 2017 $194.00 Your eligibility period is from November 2016 to April 2017. Your eligibility for Food Stamp assistance will be reviewed in April 2017. If yo
u are approved for Food Stamps only
and later apply and are approved for another program, your review period will be terminated and a new review period will be assigned to match the new program approval. The review forms will be sen t to you in advance. THE CHILDREN IN YOUR HOUSEHOLD ARE ELIGIBLE TO RECEIVE FREE MEALS OR MILK IF THEY ATTEND A SCHOOL THAT PARTICIPATES IN THE NATIONAL SCHOOL LUNCH PROGRAM, SCHOOL BREAKFAST PROGRAM OR THE SPECIAL MILK PROGRAM. IF YOU WOULD LIKE YOUR CHILDREN TO RECEIVE FREE MEALS OR MILK, TAKE THIS NOTICE TO YOUR SCHOOL(S) OR SCHOOL DISTRICT OFFICE AS SOON AS POSSIBLE. If you are interested in learning about nutrition and managing your food budget, call 1-888-744-3232 or go to myCase at jobs.utah.gov/myCase. <0007> Food Stamps There has been a change to the Household benefits for this Program. Please revie w the following information for details: You will receive assistance for the full month versus the partial or prorated amo unt received last month. <0114>