LAUDERDALE COUNTY DHS State of Mississippi

5224 VALLY ST Department of Human Services

MERIDIAN , MS 39307
COUNTY : 380
IDA G IRBY TELEPHONE : (601)483-3337
2331 48TH AVENUE CASE NUMBER: 151137946
MERIDIAN , MS 39307 WORKER : AYESHA COBBINS
DATE : 10/20/2020
Form: F300 SNAP CHANGE: DECREASE IN BENEFITS - F300

Your SNAP benefits are being decreased to $76.00 effective November 2020 . This is because YOU
ARE NONE COMPLIANT WITH CHILD SUPPORT .

__ If this block is checked, your SNAP benefits have been approved without allowing a deduction for
because we did not receive the requested verification. Future SNAP benefits could change if you
provide this verification.

__ If this block is checked, your SNAP benefits will be reduced by $ each month to recover the
amount of your SNAP overpayment.

__ If this block is checked, your SNAP benefits are being sanctioned. The reason for the sanction
is .

__ If this block is checked, the following individual(s) has failed to comply with Employment &
Training (E&T) requirements: . To avoid disqualification, the above individual(s) must contact the
case worker, and appear for an interview within 10 days from the date of this notice. A penalty
will not be imposed if good cause can be determined prior to the effective date of disqualification.

Your new benefit is based upon a household size of 1 , gross earned income of $0.00 , and gross
unearned income of $716.92 .

To request a fair hearing, call the county MDHS office at 601-483-3337 , or fill out and return the
form on the reverse side. You may continue to receive SNAP benefits at your current rate if you
request a hearing within 10 days from the date of this notice. However, you may owe us the value of
the benefits you receive depending on the outcome of the hearing. See the back of this notice for
your rights and responsibilities and reporting requirements for changes in household circumstances.

If you have any questions or need more information, please contact your local county office at
601-483-3337 .
REPORTING REQUIREMENTS FOR CHANGES IN HOUSEHOLD CIRCUMSTANCES: 07-01-19

Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) – You must report any of the
following changes in the household: more than $100 in the amount of earned or unearned income; source of income; household composition;
residence and any resulting changes in shelter costs; changes in the legal obligation to pay child support; a change in liquid resources, such as cash,
stocks, bonds, and bank accounts. All changes must be reported within 10 days of the date the change becomes known to the household (TANF
households must report within 5 days if the head of household moves out of state and when it is clear a child will be out of the home for more than 30
days). Additionally, all ABAWD households must report when their work hours fall below 20 hours per week, or an average of 80 hours monthly.

Note: If a SNAP household member receives lottery or gambling winnings equal to or greater than $3500, the household is ineligible to receive
SNAP. Ineligibility continues as long as the household’s resources exceed the resource limit.

SNAP/TANF Household Size and Gross Income Limits:

1 2 3 4 5 6 7 8 9 10

SNAP $1316 $1784 $2252 $2720 $3188 $3656 $4124 $4592 $5060 $5528

TANF $403 $542 $680 $819 $958 $1097 $1235 $1374 $1513 $1652
Note: If there are more than ten (10) SNAP household members, add $453 for each one; for more than ten (10) TANF household members contact your worker for the
total gross income level.
Note: Gross Income: (This is the amount before taxes and deductions are taken out.) Remember to add all income-wages, child support, social security,
unemployment, etc. to compare to the amount on the chart above.

National Voter Registration Act:

If you or any member of your household needs assistance with registering to vote please contact your local county office.

SECTION I: TANF APPEAL AND FAIR HEARING RIGHTS

If we have denied your TANF application, closed your case or you are not satisfied with the amount of your TANF benefit, you may use the space in
Section III below to request either an agency conference or state hearing to appeal our decision. If we don’t hear from you, we will know that you
understand the action taken and have no other information to give us.
You may request either an agency conference or state hearing within 90 days following the expiration of the advance notice period if your benefits
were reduced or within 90 days of the date your case was denied or closed. If you request an agency conference and that decision is not in your
favor, you may then request a state hearing. The Administrative Hearing Department may extend the time for filing the state hearing request if you
can show good cause for not having made a timely appeal request.
If your hearing request is made within 10 days from the date of this notice and the request is based on factors other than a change in law or policy, or
the expiration of the 60-month lifetime assistance period, your TANF benefits will be continued as they were prior to benefit reduction or case
closure until there is a decision. If your benefits are continued and the hearing decision is not in your favor, you will have to repay the total of any
benefits paid after the hearing request was made. If you do not request a hearing within 10 days from the date of this notice, your benefits cannot be
continued pending a hearing decision. You may bring a lawyer, relative or friend to the hearing, or you may speak for yourself.

SECTION II: SNAP APPEAL AND FAIR HEARING RIGHTS

You have the right to request a hearing on any action by the agency or loss of benefits which occurred in the last 90 days. You may do this by
contacting the local DHS office or by indicating your request for a hearing by signing your name below and returning this notice to the local office.
Your case may be presented by a household member or a representative, such as legal counsel, a relative, a friend or other spokesperson.
If you request a hearing within 10 days from the date of this notice, you can receive SNAP until your hearing is decided or your certification period
ends, whichever comes first. If, however, the hearing finds that our decision was correct, your household will owe us the value of the extra benefits
you received. You can still request a hearing after 10 days, but you will not be able to receive SNAP at your current rate.

SECTION III: I want to request a hearing to discuss my ☐TANF ☐SNAP case.

The kind of hearing I want is: ☐An agency conference with a member of the county staff other than my worker.
☐A state hearing with a state office staff member.
I want a hearing to discuss my ☐TANF and/or ☐SNAP case because _______________________________________________________.
☐ I do ☐ do not want my ☐TANF and/or ☐SNAP benefits to continue until the hearing is decided or my certification/review period ends.
I understand if I have not checked either block, this means I have chosen to have my benefits continue.

Signature Date Signed __________________________

 Page 3
Issued 04-01-2017 ABWD2

SNAP regulations limit eligibility for Able-bodied Adults without Dependents (ABAWD) to any 3 months
in a 36-month period unless that individual meets the ABAWD work requirement or is exempt from the
work requirement. In addition to the 3-month time limit, ABAWDs are required to participate in
employment and training activities. Failure to participate in an employment and training activity will
result in suspension of SNAP benefits, whether or not the 3-month time limit has passed.

ABAWDs can meet the work requirement and continue to receive SNAP benefits by:

 Working 80 hours per month or an average of 20 or more hours a week; or

 Participating in an allowable work activity for 80 hours per month or an average of 20 or more
hours a week; or
 Combining work and participation in a work activity for 80 hours per month or an average of 20
or more hours a week; or
 Participating in a workfare program (community service assignments at public or private non-
profit employers) for the required number of hours each month; or
 Participating in a comparable workfare program (self-initiated) for the required number of hours
each month.

The 3-month time limit does not apply to individuals who are:
 Younger than 18 or age 50 or older; or
 Responsible for a dependent child under age 18 residing with a household member; or
 Exempt from SNAP work requirements; or
 Pregnant; or
 Certified as physically or mentally unable to work by a social worker or medical professional.

ABAWDs who have exhausted their 3 countable months may regain eligibility at any time by meeting an
ABAWD work requirement for 30 consecutive days, meeting an exemption from the ABAWD work
requirement, or when their 36-month period expires. ABAWDs may also regain eligibility if they can
verify they will meet the work requirement within 30 days from the date of application.

Please notify this office if you become eligible for Supplemental Security Income (SSI) or public
assistance benefits.

If you need free legal services, call this toll free number at 1-800-498-1804.
 COVID-19 Social Distancing Statement
The Mississippi Department of Human Services (MDHS) is offering options for social
distancing to help protect applicants and recipients of Supplemental Nutrition Assistance
Program (SNAP) and Temporary Assistance for Needy Families (TANF) and our staff
from the exposure to and/or the threat of the Coronavirus (COVID-19). MDHS will
continue to receive and process SNAP and TANF applications. The lobbies to our county
offices will remain open for the submission of required information; however, face-to-face
interviews will be temporarily suspended unless specifically requested. Staff will also
conduct telephone orientation interviews for TANF Work Program and SNAP
Employment and Training applicants.
MDHS is encouraging clients to submit documentation electronically. Applications may
be submitted online at www.access.ms.gov. Information requested by a case worker to
support the completion of a SNAP or TANF application may be submitted to the county
office by email. Each county office has an email address that is monitored daily. The email
addresses are set up following the same format for each county; dfo . countyname county
@ mdhs . ms . gov ([email protected]). You may submit your
information by taking a clear, legible picture of the document and sending it to the
corresponding email address, including your case number, first and last name, and a
working telephone number. Please allow 48 hours for confirmation. If you do not receive
confirmation of your email during this timeframe, please contact your local office. If you
have any questions regarding the email address or the submission of information, you may
contact your local county office for further guidance.
NOTE: When information is submitted through email, please include your case number
(located on your EBT card underneath your name or MDHS correspondences), first name
and last name, county of residence, and a working phone number.
Below are examples of county email address:
[email protected]
[email protected]
[email protected]
[email protected]
Information requested for the completion of an Elderly Simplified Application Project
(ESAP) or Mississippi Combined Application Project (MSCAP) recipient may be
submitted to the following email address or by other means listed above.
[email protected]