Author: barinur
Last saved by: pellerp
Company: State of Florida

NOTICE:  CASH ASSISTANCE TIME LIMIT ENDING
Assessment and Review Appointment Letter

Date:	*SSN:

Participant Name: 	 RFA: 

Participant’s Address:	

Dear ____________,

Based on the information received from the Department of Children and Families, your last month of Temporary Cash Assistance is:  ___________________________________.

We must meet with you to assess your employment progress and barriers to becoming employed.  Together we will identify the steps necessary for you to become employed before your cash assistance ends.  Your appointment date and time is:

         DATE:	
	
         TIME:

         ADDRESS: 	

During this meeting, you will be given an opportunity to request an extension of your time limits through the hardship extension process.  If you cannot keep this appointment, you must call to reschedule.  If you do not call, you may lose your cash assistance and/or food assistance.

If you have applied for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI), you may be eligible for an extension to your time limits while you are awaiting a final decision.  The application must be current, including appeals.  Please bring documentation regarding the status of your application. You can obtain a statement regarding the status of your application from your local Social Security Administration Office.

You are required to attend this appointment.  If you have any questions about your Obligations and Opportunities as a participant in the Welfare Transition Program, please see the back of this letter.  You may also call me at the above phone number.

Sincerely,

RWB Provider:		Phone:	

*You have not been asked to provide your social security number on this form.  For your information however, the Social Security Act (42 U.S.C. 1137) provides that your social security number may be used to administer the program, including determination of eligibility, attributing the receipt of services, correspondence and participation, as well as for reporting purposes.

OPPORTUNITIES AND OBLIGATIONS

YOUR OPPORTUNITIES | YOUR OBLIGATIONS
You have the opportunity to: | You are required to:
•	Receive help paying for support services (if approved) in order to find employment, education, or other assigned activity (ies), unless you are able to make these arrangements on your own. Support services may include, but are not limited to: child care, transportation, tools, clothing, uniforms, etc. (This help is based on your assigned activity and the availability of funding.) | •	Participate in, document and complete assigned program activities.
•	Have decisions about your case reviewed by a supervisor at the Regional Workforce Board. | •	Respond to all contacts from the Regional Workforce Board or other agencies you are referred to.
•	Request a hearing if you disagree with a decision about your temporary cash assistance. | •	Inform the Regional Workforce Board of changes in participation, employment, family circumstances including change of address, telephone number, child care needs, transportation problems, health problems, etc
•	Be excused from or rescheduled for an activity if you have good cause.  Good cause is determined by the Regional Workforce Board. | •	Apply for and seek employment.
•	Request Cash Assistance Severance Benefit. | •	Accept any reasonable offer of suitable employment.
•	Request Relocation assistance. | •	Remain employed.  Must contact the Regional Workforce Board prior to reducing your hours or quitting.

•	Receive the following services, if eligible:
o	Mental Health Counseling
o	Domestic Violence Counseling/Services and/or
o	Substance Abuse Counseling/Services

•	Report good cause reasons for failure to participate immediately.

•	Receive transitional benefits, if eligible, after you are no longer receiving temporary cash assistance, based on funding availability, such as:
o	Child care
o	Transportation
o	Education and Training

•	Receive Medicaid and food assistance benefits based on eligibility requirements. |

CONSEQUENCES FOR FAILURE TO PARTICIPATE
CASH ASSISTANCE PENALTIES | FOOD ASSISTANCE PENALTIES
•	1st Penalty:  Cash assistance terminated for entire family for a minimum of 10 days or until the individual complies, whichever is later. | •	1^st Penalty:  Loss of food assistance for one month or until compliance, whichever is longer.
•	2nd Penalty:  Cash assistance terminated for entire family for one month or until the individual who failed to comply does so, whichever is later. | •	2nd Penalty:  Loss of food assistance for three months or until compliance, whichever is longer.
•	3^rd Penalty:  Cash assistance terminated for entire family for three months or until the individual who failed to comply does so, whichever is later. | •	3^rd Penalty:  Loss of food assistance for six months or until compliance, whichever is longer.
•	NOTE:  Cash assistance may be continued on a level two or three penalty for children under age 16 through a protective payee. | •	NOTE:  If the non-compliant individual is the head of household, food assistance for the entire assistance group will be terminated unless that individual meets a food assistance exemption.

DEO-WTP 0004, March 2013 (Replaces DEO-WTP 0004, October 2011)

An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephone numbers on this document may be reached by persons using TTY/TDD equipment via the Florida Relay Service at 711.