When Used: When a participating household on the Food Assistance program receives an overpayment due to agency or consumer error
Special Instruction: Use the V808
Your household has received *RECOVERY ACCOUNT AMOUNT* in food assistance benefits which you were not eligible to get for the month(s) of: *MM/YYYY*.
The overpayment was due to *AGENCY/CLIENT ERROR* and was the result of: *REASON*.
You owe all of the food assistance benefits listed above and full repayment is requested.
Check one of the following methods of repayment. Then sign, date and return this agreement within 10 days of the date of this notice or we will automatically reduce your food assistance benefits to repay this overpayment.
☐ I agree to repay you in one lump sum payment of *RECOVERY ACCOUNT AMOUNT*. Payment will be made by
☐ I agree to have my benefits reduced by 10% or $10 per month, whichever is greater, to repay this overpayment.
____________________________________ _______________________________
Signature Date
NOTE: DO NOT SEND CASH THROUGH THE MAIL
If you do not make payments, this overpayment may be collected from your federal income tax refund or certain other federal payments. This overpayment may also be collected from your State of Kansas income tax refund or from other State of Kansas payments. Other collection methods may also be used to collect this overpayment. We will tell you before this happens.