Case Name: Jaime White

Case Number: 115280298

KALAMAZOO COUNTY DHS
Date: 05/13/2022
427 E ALCOTT ST
MDHHS Office: KALAMAZOO COUNTY DHS
KALAMAZOO MI 49001
Specialist: J. Zonts
Save time - go online! Phone: (269) 271-7903
Go to www.michigan.gov/mibridges/ to Fax: (517) 346-9888
access your case online, or call (888) 642-7434. Specialist ID: zontsj

JAIME KYLENE WHITE

LT 220 KALAMAZOO COUNTY DHS
11338 MILL CRK 427 E ALCOTT ST
GALESBURG MI 49053 KALAMAZOO MI 49001

NOTICE OF CASE ACTION

Please read each page of this notice carefully.

We have reviewed your application or case. The actions that affect your case are listed in this notice.

Benefit Summary
(more information about your benefits follows this summary)
CASH PROGRAM

Period Action Benefit Household Size

06/01/2022 - Ongoing Denied $ 0.00 0

More Information About Benefits

Cash Program Details
Cash Assistance is DENIED

For the month(s) of: Benefits are: Amount Who's Included

06/01/2022 - Ongoing DENIED $ 0.00 All Persons in the group

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Reason(s) why Cash Program is closed/denied/reduced:

For the month(s) of: Individual(s): Reason(s) why program is closed/denied/reduced:

06/01/2022 - Ongoing Bailey Ann White Your group is not eligible for FIP benefits because the
member(s) listed below are not compliant with school
attendance requirements. Manual Item BEM 240, 245

HEARING RIGHTS

You have the right to request a hearing if you do not agree with any action or decision the department makes
(including failure to act with reasonable promptness). You can ask for a hearing for FAP by phone. Hearings for
all other programs must be requested in writing. At the hearing you can explain why you disagree with the action
or decision and present evidence.

The request should include your name, address and case number. Attach a copy of this notice if possible. Go to
www.michigan.gov/documents/FIA-Pub18_14356_7.pdf to download a form to use or contact local MDHHS
office shown on the first page of this notice to request a form.

- Keep a copy of the request and any other document you attach for yourself.
- MDHHS must receive your request for appeal within 90 days of the mailing date of this notice. Your request
must be received on or before 08/11/2022 or you will not be granted a hearing.
- MDHHS must receive your request for an appeal within 10 days of the mailing date of this notice to continue
receiving your benefits. Return your request on or before 05/24/2022.

You may be required to repay any assistance that you receive while your appeal is pending if 1) the
department's proposed action is upheld in the hearing decision, or 2) your request for appeal is withdrawn, or 3)
you or your authorized representative do not attend this hearing.

You may choose anyone to represent you. If that person is not a lawyer or is not appointed by a court, you must
give us your signed authorization. Attach a copy of the court's order if the person is court appointed to help you.
The Michigan Administrative Hearing System (MAHS) will deny the request for an administrative hearing made
by the representative if you do not provide proof of authorization. The authorized hearing representative needs
to be authorized before they can make the request.

This institution is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex
and in some cases religion or political beliefs.

The U.S. Department of Agriculture also prohibits discrimination based on race, color, national origin, sex,
religious creed, disability, age, political beliefs or reprisal or retaliation for prior civil rights activity in any program
or activity conducted or funded by USDA.

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Persons with disabilities who require alternative means of communication for program information (e.g. Braille,
large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they
applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA
through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available
in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,
(AD-3027), found online at:
http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to
USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint
form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410

(2) fax: (202) 690-7442; or

(3) email: program.intake@usda.gov.

For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons
should either contact the USDA SNAP Hotline Number at (800) 221-5689, which is also in Spanish or call the
State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at:
http://www.fns.usda.gov/.

To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S.
Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200
Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (800) 537-7697 (TTY).

This institution is an equal opportunity provider.

The Michigan Department of Health and Human Services (MDHHS) will not discriminate against any individual
or group because of race, sex, religion, age, national origin, color, height, weight, marital status, sexual
orientation, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans
with Disabilities Act, you are invited to make your needs known to a MDHHS office in your area.

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 Important Information - Please Read

MiBridges Client Self-Service

The Michigan Department of Health and Human Services offers two client self-service options:

* Applicants and recipients can obtain information about their case, review benefits and report changes directly
to their MDHHS specialist on-line by visiting www.michigan.gov/mibridges.
* In addition, case information can be obtained 24 hours a day by calling the automated information line at
1-888-MiBridges (642-7434).

Reporting Changes
If you receive benefits for a cash assistance program, food assistance program, or child care it is your
responsibility (or that of the person acting for you) to notify this office within 10 days of any changes in your
circumstances which may affect your eligibility for assistance. This includes changes in employment, income,
assets and health insurance premiums for you or members of your family, the number of persons living in your
home, college student status, and change of address. Failure to report changes may make you liable to
penalties provided by law for fraud. Your MDHHS specialist will tell you if different reporting rules apply to you,
such as simplified reporting.

Free School Meals

School-aged children who get FIP and/or FAP can also get free school meals if the school participates in the
U.S. Department of Agriculture National School Lunch Program. Show this notice (Notice of Case Action) to
school officials to verify your eligibility when asked, or to apply for free school meals.

WIC (Women, Infants, and Children)

If you are pregnant, recently had a baby or have children under the age of 5, your household may be eligible for
WIC. Contact your local health department or call 1-800-942-1636 for more information.

Domestic Violence
You are authorized to receive domestic violence comprehensive services. Contact the MDHHS office in your
area or your MDHHS specialist for more information. To access these services visit www.michigan.gov/
domesticviolence, or www.michigan.gov/dhs-publications to view MDHHS Publication-859, Is someone hurting
you or your children?

Bridge Card Information

After you receive your first replacement card, your benefits may be reduced to cover the cost of replacing any
additional cards.

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