FA Fraud Disqualification-Non-Participating Individual

When Used: Use in place of the F827 when a client is being discontinued from FA due to Fraud.

Special Instructions: Use the V808; do not send the F827

This is to inform you that *NAME OF DISQUALIFIED INDIVIDUAL* is being disqualified from the Food Assistance program effective *MM/DD/YYYY*. The reason:

*Copy and Paste the applicable reason*

☐ This person has been found guilty of committing fraud by a court of appropriate jurisdiction.

☐ This person has signed a Food Assistance disqualification consent agreement.

Since this is the *NUMBER OF DISQUALIFICATIONS* violation, *NAME OF DISQUALIFIED INDIVIDUAL* will be ineligible to receive Food Assistance for *NUMBER OF MONTHS* from *MM/DD/YYYY to MM/DD/YYYY of disqualification period*.

The Department for Children and Families is owed $*OVERPAYMENT AMOUNT* as a result of this overpayment.

If the individual named above has not already signed a repayment agreement, one will be sent separately which must be completed and returned.

This action is based on Kansas Economic and Employment Services Manual Sections.

Spanish Translation:

Esto es para informarle que  *NAME OF DISQUALIFIED INDIVIDUAL* queda inhabilitado para el Programa de Asistencia Alimentaria a partir del *MM/DD/YYYY*. El motivo:

☐ Un tribunal con competencia jurisdiccional encontró a esta persona culpable de cometer un fraude.

☐ Esta persona firmó un acuerdo de consentimiento de inhabilitación para recibir Asistencia Alimentaria.

 

Debido a que esta es la infracción *NUMBER OF DISQUALIFICATIONS*, *NAME OF DISQUALIFIED INDIVIDUAL* no será elegible para recibir Asistencia Alimentaria por *NUMBER OF MONTHS* desde *MM/DD/YYYY to MM/DD/YYYY.

Se le adeuda al Departamento para los Niños y las Familias $ *OVERPAYMENT AMOUNT* como consecuencia de este sobrepago.

Si el individuo nombrado arriba no ha firmado ya un acuerdo de devolución, se enviará uno por separado, que deberá ser completado y enviado de regreso.

Esta medida se basa en secciones del Manual de Servicios Económicos y de Empleo de Kansas.