Drug Test Referral (Mailed)

When Used: Used ONLY when mailing out a drug testing referral to a consumer.

Special Instruction: Use the V808, print it locally, and mail with the Collection Site Passport and Chain of Custody forms.

*FIRST AND LAST NAME* has met a Suspicion Based Drug Testing indicator (KEESM 2260) and is required to complete a drug test.

A photo ID is required when drug testing. The enclosed Collection Site Passport and Chain of Custody Form must also be taken to the test site.

*FIRST AND LAST NAME* shall report to the following location:

*COLLECTION SITE NAME*

*ADDRESS*

On*MM/DD/YYYY*

At *HH:MM*

Failure to complete this drug test will result in a disqualification (KEESM 2260.7). A disqualification will affect TANF and food assistance benefits for the individual required to test.