Notice of Missed Interview
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vickwalkinsNotice of Missed Interview
Uploaded by
vickwalkinsSTATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
007 South Special COUNTY OF LOS ANGELES
1500 HUGHES WAY STE A100
LONG BEACH, CA 90810-1882
Date: 04/04/2025
Case Name: VICTOR WALKER
Case Number: L2364D2
Worker Name: Customer Service
Worker ID: 19DP07LR0G
CALFRESH NOTICE OF MISSED INTERVIEW Worker Phone Number: (866) 613-3777
007 South Special
VICTOR L WALKER II
1500 HUGHES WAY STE A100
9446 PACIFIC AVE APT 4
LONG BEACH, CA 90810-1882
BELLFLOWER, CA 90706-4587
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.
You were scheduled for an interview on 04/04/2025 , but you did not keep this appointment.
If you still want CalFresh benefits, please contact your worker to schedule another interview.
You must complete your interview with us by 04/30/2025 .
You must be interviewed in order for us to determine your eligibility for CalFresh benefits. If you do not
complete an interview, you will not be able to get CalFresh benefits.
If you have any questions or want more information, please contact your worker.
RULES: These rules apply: MPP Section(s) 63-300.4, 63-504.6. You may review them at your welfare office.
CF 386 (2/14) REQUIRED FORM - SUBSTITUTE PERMITTED
0000000598903144
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YOUR HEARING RIGHTS
YOUR HEARING RIGHTS (See also PUB 412 at www.cdss.ca.gov/inforesources/state-hearings )
You can ask for a hearing if you disagree with a county/agency action or failure to act. You have 90 days to do so,
starting the day after the date of the notice. After 90 days, you must prove you had a good reason for asking late. You
can also ask for a hearing to review your benefits for the past 90 days. If you ask for a hearing before the date of the
change, your benefits will continue unchanged. CalFresh will end if you don’t recertify when due.
Online at acms.dss.ca.gov Click "Create an account" to Fill out this page, and deliver it by one of the following:
have an ACMS account and get documents online; or click In-person: Appeals and State Hearings Section
“Submit Appeal without Account” to file without an account 3833 S. Vermont Ave.
OR 4th Floor
Los Angeles, CA 90037
Call toll free (800) 743-8525 (or TDD (800) 952-8349 ) OR (800) 952-8349 / Fax: (833) 281-0905
Toll Free: (800) 743-8525
Fax fill out this page/fax to (833) 281-0905 OR
Mail to: CDSS State Hearings Division, PO Box 944243,
MS 21-37 Sacramento CA 94244-2430
Email to: [email protected]
HEARING REQUEST
My hearing issue involves (benefit program)
and Los Angeles County/Agency.
I want a hearing because:
Print name of person who needs a hearing: Birthdate:
Mailing Address: Phone number:
I want to get hearing notices from the State Hearing Division by email. Email Address:
Name/Signature: Date Signed
Interpreter: I want a free interpreter for the language or dialect.
Disability Accommodation for hearing? No Yes (explain):
Your Hearing will be scheduled by phone. If you want your hearing conducted by a different method, tell us how:
By Telephone By Video (you see judge on your phone/computer) In person at the county hearing site
I have no phone or internet access. I want to go and use the phone or video at hearing site for my hearing.
I need a faster scheduled hearing due to Denial of CalWORKs or CalFresh emergency benefits
Medical Emergency Eviction/homelessness Other (explain):
If you timely appeal before the action listed in the notice takes place, your aid may stay the same. For CalWORKs
(including Child Care) and CalFresh, if the county action was correct, you have to pay back any extra aid.
Check to have your aid lowered or stopped pending the hearing for: CalWORKs Childcare CalFresh
You can have a friend, relative, legal counsel or other person help with your hearing. If they have agreed:
NAME: Email:
Address: Phone:
To Get Help: These groups below may be able to give you legal advice or represent you at the hearing:
Legal Aid Foundation of Los Angeles (LAFLA) Welfare Rights Office
(800) 399-4529 4513 E. Compton Blvd.
Compton, CA 90221
(310) 603-3341
NA Back 9 (5/22) Required Form - No Substitute Permitted
0000000598903144
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