Get Temp 2175 (7/99) - Notice Of Action - California Department Of ...

Filling out the TEMP 2175 Notice of Action is an important step in addressing issues related to your Self-Initiated Program request in California. This guide provides clear, step-by-step instructions for completing the form online, ensuring that you can access and manage your benefits effectively.

Follow the steps to fill out the TEMP 2175 form online

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred form editor.
2. Begin by entering the county name where your case is processed in the designated field.
3. Input the notice date, which is the date you receive the form.
4. Fill in your name and case number in the appropriate sections to ensure accurate identification.
5. Provide the worker's name and worker number who is handling your case; this information is vital for correspondence.
6. Add your contact telephone number and address to allow for easy communication regarding your case.
7. In the section regarding problems with your Self-Initiated Program (SIP), clearly list each issue you’ve requested to be fixed.
8. Review the actions the county has approved to address your SIP problems and ensure accuracy in the noted details.
9. Note any back child care costs that have been approved, ensuring that you add the total amount as indicated by the form.
10. If you wish to request a hearing, make sure to fill in the necessary details, including the specific action you disagree with.
11. Complete the personal details at the end of the form, including your birth date, phone number, and address as prompted.
12. Once all fields are completed, save your changes, and use the options to download, print, or share the form as needed.

Complete your TEMP 2175 Notice of Action form online today for efficient handling of your benefits!