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Department of Workforce Services

PO BOX 143245 SALT LAKE CITY, UT 84114-3245

Date Mailed: 12-08-2016

RENEE ELISAMA VASQUEZ 756 S 200 E APT 225 SALT LAKE CITY, UT 84111-3880

Dear RENEE ELISAMA VASQUEZ

Case Number: 7131026 PID: 020321289

NOTICE OF DECISION

Case Number: 7131026 PID: 020321289 NOTICE OF DECISION We have made a decision about your eligibility

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 above. Please review the following information for details:

· Your Food Stamp assistance will be $109.00 for the month of November 2016. Your Food 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 amounts:

Toll free:

Phone Number:

1-866-435-7414

801-526-0950

Toll free FAX: 1-877-313-4717

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 you 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 sent 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.

Food Stamps

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There has been a change to the Household benefits for this Program. Please review the following information for details:

· You will receive assistance for the full month versus the partial or prorated amount received last month.

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Toll free:

Phone Number:

1-866-435-7414

801-526-0950

Toll free FAX: 1-877-313-4717

FAX: 801-526-9500