When Used: When a participating individual on the Food Assistance program is disqualified due to Fraud
Special Instruction: Use the V808
This is to inform you that *NAME OF DISQUALIFIED INDIVIDUAL* is disqualified from the food assistance program effective *MM/DD/YYYY* as indicated by the item checked below:
(__) 1) The individual named above has been found guilty of committing fraud by a court of appropriate jurisdiction.
(__) 2) The individual named above has signed a food assistance disqualification consent agreement.
Since this is the *NUMBER* violation, *NAME OF DISQUALIFIED INDIVIDUAL* will be ineligible to receive food assistance for *NUMBER* months from *MM/DD/YYYY* through *MM/DD/YYYY*. Your household's new benefit amount will be *BENEFIT AMOUNT*.
The Kansas Department for Children and Families (DCF) is owed $ *CLAIM AMOUNT* as a result of this over issuance. If the individual named above has not already signed a repayment agreement, one will be sent separately which must be completed and returned.
At the end of the disqualification period, *NAME OF DISQUALIFED INDIVIDUAL* may be added to the case if eligible, and if the remaining household members are eligible.
This action is based on Kansas Economic and Employment Services Manual.