M E M O R A N D U M

IM-33  2/26/01  ADVERSE ACTION NOTICE (IM-80)  F M R #10


SUBJECT:
ADVERSE ACTION NOTICE (IM-80)
FORMS MANUAL REVISION #10
 
DISCUSSION:
Attached is a copy of the revised Adverse Action Notice (IM-80) (.pdf 27kb, 1 pg; Warning! This form is .pdf format Legal Size paper).  This form revision accommodates the following information for the Temporary Assistance Program.  The following statement has been added.
  • You may choose to stop your cash benefits to save your 60-month lifetime limit, without losing your healthcare benefits.  Contact you worker for further information.
 
NECESSARY ACTION:
  • Discuss this memorandum with all appropriate staff.
  • Upon depletion of existing supply, begin using the revised IM-80
  • New forms may be ordered from the warehouses in Kansas City, St. Louis City, and Jefferson City.
  • Remove form IM-80 dated 11/99 from the Forms Manual and replace it with IM-80 dated 02/01.
GZ
Distribution #2
Form not yet available on the intranet


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