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									Olympia CSO
PO Box 1908
Olympia, WA 98507-1908
                                                                     Phone #(360)753-5983
                                                                 TTY/TDD# (360)586-0226
                                                                  Toll Free # (800)555-1234
00/00/00                                                               Client ID #1234567

Client Name
Client Address
Client Address
Client Address
Client Address

0201000
Dear A++++++++++++++++++++++++++++++++A

0502001
The following people in your household cannot get food assistance benefits at this time:

*List of Denied Individuals*

0502002
If there are people in your household who are not listed above, you will get a separate
letter to tell you if they are eligible.

0401002
The reasons for this decision are:
*Reason Code and WAC*
0401003
You can check these rules online at http://slc.leg.wa.gov/wacbytitle.htm or view them at
your public library reference desk. If you can’t find this information, please call our
office.
*Mandatory Free Form Text*
CT 0402005
You may be able to get food assistance again if you do one of the following within any
30-day period:
 Work 80 hours or more.
 Participate in and comply with a work program for 80 hours or more; or
 Participate in a workfare program the required number of hours.
After you have completed one of the above, you should immediately reapply for
assistance if you want benefits.
You may not have to meet the above requirements if you are:
 Caring for a child.
 Caring for an incapacitated person.


005/02 Food Assistance Denial for Individual                             Client ID #12345678
   Unable to work.
   Receiving Unemployment Compensation.
   Attending an institution of higher education.
   Pregnant.
   Under 18 or over 50 years old; or
   Taking part in an alcohol or drug abuse treatment program.

0201010
If you disagree with any of our decisions, you may ask to have your case reviewed. You
can also ask for a fair hearing. Your fair hearing rights are included in this letter.

0201011
Where can you receive automated information about your case?
 You can call The Answer Phone at 1-877-980-9220.
 When you call you will need to enter your client ID number, which can be found in
   the bottom right hand corner of this letter.


*Optional Free Form Text*

0201012
Please call me if you have any questions about this letter.


<Case Worker Name>
<Case Worker Phone Number>
<Email>




005/02 Food Assistance Denial for Individual                          Client ID #12345678

								
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