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Get Na 692 - California Department Of Social Services - State Of California

Mber Worker Name : Number : : Telephone : Address : (ADDRESSEE) Questions? Ask your Worker. State Hearing: If you think this action is wrong, you can ask for a hearing. The back of this page tells you .how. Your benefits may not be changed if you ask for a hearing before this action takes place. CHANGE IN BENEFITS: Effective , your CAPI payments are changed Comments: (month/day/year) from $ to $ because: Your income, or the income.

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