Get State Form Dfa 842

Filling out the State Form Dfa 842 online is a straightforward process that allows users to report claim determinations efficiently. This guide provides step-by-step instructions to help you navigate each section of the form with ease and accuracy.

Follow the steps to complete the State Form Dfa 842 online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred digital editing tool.
2. Enter the case name in the appropriate field. Ensure that the name matches the details on your documentation.
3. Fill in the case number next to 'Case Number' as listed on any previous correspondence or documentation regarding your claim.
4. Provide the social security number (SSN) for the primary individual involved in this case.
5. If applicable, add the date of discovery in the designated format. This is the date you identified the claim issue.
6. Complete the fields for another adult’s information, including their name and SSN, if relevant to the case.
7. Input the address details including street address, city, and ZIP code for the primary member of the household.
8. Indicate the CF case status by selecting either 'Active' or 'Discontinued' as appropriate for your situation.
9. In the section for the basis of claim determination, select all applicable options such as administrative error or inadvertent household error.
10. If overissuance has occurred, provide an explanation that includes the date the change occurred and the date it was reported.
11. Summarize the CalFresh overissuance by specifying the actual basis for issuance and the correct basis for issuance.
12. Calculate the total CalFresh overissuance by entering the adjusted income and household size as required.
13. Complete the details for the claim offset of lost benefits by entering the respective amounts as required.
14. Ensure that all signatures are included — both eligibility worker and supervisor — along with their respective dates.
15. Once all fields are completed and verified, save changes to the document, and prepare to download or print it for final submission.

Complete your documents online today to streamline the process.