CalFresh Certification Expiration Notice for Elders
This file contains essential information regarding the expiration of CalFresh certification for households with elderly or disabled adults. It outlines the steps to ensure that benefits continue, interview requirements, and the recertification process. Use this document to stay informed and maintain your assistance without breaks.
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How do I fill this out?
To fill out this form, start by providing your personal information, including your case number and worker details. Next, ensure you answer all questions accurately and include any required proofs of changes. Finally, submit the application by the specified date to avoid interruptions in your benefits.

How to fill out the CalFresh Certification Expiration Notice for Elders?
1
Review the form carefully to understand all requirements.
2
Fill out your personal information accurately.
3
Attach any necessary proof of changes.
4
Sign the form where required.
5
Submit the completed form by the deadline.
Who needs the CalFresh Certification Expiration Notice for Elders?
1
Elderly individuals receiving CalFresh benefits.
2
Disabled persons requiring assistance to fill the forms.
3
Caregivers helping elderly adults with paperwork.
4
Families that need to report changes in income or circumstances.
5
Social workers assisting clients in maintaining benefits.
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What are the instructions for submitting this form?
To submit this form, you can either mail it to the designated county office, or fax it using the number provided on the notice. Additionally, it can be submitted in person at your local welfare department. Ensure all fields are filled accurately and include any required attachments before submission. For immediate assistance, consider reaching out to your assigned case worker.
What are the important dates for this form in 2024 and 2025?
2024: Submit applications by December 15 to avoid interruptions. 2025: Ensure required documentation is provided no later than the last day of your certification period to maintain benefits.

What is the purpose of this form?
The purpose of this form is to provide essential information regarding CalFresh certification expiration, guiding users to complete their recertification timely. It outlines the responsibilities of the beneficiaries and the procedures involved in maintaining their benefits. Understanding this form ensures that households can continue to receive vital food assistance without interruptions.

Tell me about this form and its components and fields line-by-line.

- 1. Case Name: The name of the person applying for benefits.
- 2. Case Number: A unique identifier for the case.
- 3. Worker Name: The name of the case worker assigned.
- 4. Worker Number: Contact number of the assigned worker.
- 5. Telephone Number: Your phone number for follow-up.
- 6. Address: Your current address.
What happens if I fail to submit this form?
If you fail to submit this form, your CalFresh benefits may be suspended or terminated. It's crucial to adhere to the submission deadlines to avoid loss of assistance. Ensure that all required documentation accompanies your submission to prevent delays.
- Delay in Benefits: Failure to submit can result in delays to your food assistance.
- Loss of Eligibility: Not submitting might lead to a complete loss of eligibility for benefits.
- Need for Resubmission: Missing deadlines may require you to fill out forms again, causing additional inconvenience.
How do I know when to use this form?

- 1. Recertification: To apply for continued benefits after the certification period ends.
- 2. Changes in Circumstances: If there's a change in household income or composition.
- 3. New Applicants: For those needing to apply for CalFresh benefits for the first time.
Frequently Asked Questions
What is this CalFresh notice about?
This notice informs recipients about the expiration of their CalFresh certification and guides them on how to recertify.
How can I edit this PDF?
You can edit this PDF using PrintFriendly's editing tools, allowing for easy modifications.
What should I do if my benefits are about to expire?
Complete the recertification form provided in the notice before the deadline to maintain your benefits.
Can I submit this form online?
Yes, you can use PrintFriendly to edit and then download the form for submission.
Is there a deadline for submitting this form?
Yes, the completed form must be submitted by the first day of the last month of your certification period.
Who can assist me in filling out this form?
Caregivers, family members, or social workers can help you understand and fill out this form.
What happens if I miss the submission deadline?
If you miss the deadline, your benefits may be delayed or stopped until a new application is processed.
How can I check the status of my recertification?
You can contact your case worker using the contact number provided in the notice.
What information do I need to provide with this form?
You should include proof of any changes in income or household circumstances along with the application.
Can I get a hearing if I disagree with a decision?
Yes, you have the right to request a hearing if you disagree with any county action regarding your benefits.
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