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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES CASE NUMBERCALFRESH REPAYMENT AGREEMENT FOR INADVERTENT HOUSEHOLD ERRORS ONLYWORKERNAMECASE NAMEADDRESSTERMS
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How to fill out calfresh repayment agreement

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How to fill out calfresh repayment agreement

01
Step 1: Obtain a copy of the CalFresh repayment agreement form from your local county office.
02
Step 2: Fill out your personal information at the top of the form, including your name, address, and contact information.
03
Step 3: Indicate the amount you owe and the reason for the overpayment in the designated sections.
04
Step 4: Read through the terms and conditions of the agreement carefully and make sure you understand them.
05
Step 5: Sign and date the form at the bottom to acknowledge your agreement to repay the overpayment.
06
Step 6: Make a copy of the completed form for your records and submit the original to your local county office.
07
Step 7: Follow any additional instructions provided by your caseworker or county office regarding payment arrangements and deadlines.
08
Step 8: Keep track of your payments and fulfill your repayment obligations according to the terms of the agreement.

Who needs calfresh repayment agreement?

01
Anyone who has received an overpayment of CalFresh benefits and has been notified by their local county office may need a CalFresh repayment agreement.
02
This agreement is typically required when an individual or household has received more benefits than they were eligible for and must repay the excess amount.
03
It is important to contact your county office and discuss your repayment options if you have been notified of an overpayment.
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The calfresh repayment agreement is a legal document outlining the terms and conditions for repaying overpaid benefits received from the CalFresh program.
Individuals who have received overpaid benefits from the CalFresh program are required to file a repayment agreement.
The calfresh repayment agreement can be filled out by providing personal information, details of the overpaid benefits, proposed repayment plan, and signature.
The purpose of the calfresh repayment agreement is to ensure that individuals repay the overpaid benefits to the CalFresh program in a timely manner.
The calfresh repayment agreement must include personal information, details of the overpaid benefits, proposed repayment plan, and signature.
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