Toll free: 1-866-435-7414 Toll free FAX: 1-877-313-4717

Phone Number: 801-526-0950 FAX: 801-526-9500

Department of Workforce Services
PO BOX 143245
SALT LAKE CITY, UT 84114-3245
Date Mailed: 12-08-2016 Case Number: 7131026
PID: 020321289
RENEE ELISAMA VASQUEZ
756 S 200 E
APT 225
SALT LAKE CITY, UT 84111-3880
NOTICE OF DECISION
Dear RENEE ELISAMA VASQUEZ
We have made a decision about your eligibility for benefits. Below is a summary
of the eligibility results.
Additional information after the Summary of Eligibility includes:
Basis of decision
Effective date(s)
Additional information
This information may continue to additional pages, be sure to read both sides of
each page.
SUMMARY OF ELIGIBILITY
PROGRAM APPLICATION DATE BENEFIT MONTH ACTION TAKEN AMOUNT ISSUED
Food Stamps 11-14-2016 November 2016 Approval $109.00
Food Stamps December 2016 Change $194.00
Food Stamps
Household benefits for this Program are approved as shown in the Summary Table a
bove. Please review the following
information for details:
Your Food Stamp assistance will be $109.00 for the month of November 2016. Your F
ood Stamp assistance amount
may change each month if your income and/or household size changes.
Your Food Stamp assistance will be available on your Electronic Benefit Transfer
Card (EBT) on the 15th of every
month. If you do not have an EBT card please call 1-866-435-7414 to speak to an
eligibility worker and request an
EBT card.
Based on the information on your case at this time, here are your benefit amount
s:
Toll free: 1-866-435-7414 Toll free FAX: 1-877-313-4717
Phone Number: 801-526-0950 FAX: 801-526-9500
Benefit Month Amount Issued
November 2016 $109.00
December 2016 $194.00
January 2017 $194.00
February 2017 $194.00
March 2017 $194.00
April 2017 $194.00
Your eligibility period is from November 2016 to April 2017.
Your eligibility for Food Stamp assistance will be reviewed in April 2017. If yo

u are approved for Food Stamps only

and later apply and are approved for another program, your review period will be
terminated and a new review period
will be assigned to match the new program approval. The review forms will be sen
t to you in advance.
THE CHILDREN IN YOUR HOUSEHOLD ARE ELIGIBLE TO RECEIVE FREE MEALS OR MILK IF
THEY ATTEND A SCHOOL THAT PARTICIPATES IN THE NATIONAL SCHOOL LUNCH PROGRAM,
SCHOOL BREAKFAST PROGRAM OR THE SPECIAL MILK PROGRAM.
IF YOU WOULD LIKE YOUR CHILDREN TO RECEIVE FREE MEALS OR MILK, TAKE THIS NOTICE
TO YOUR SCHOOL(S) OR SCHOOL DISTRICT OFFICE AS SOON AS POSSIBLE.
If you are interested in learning about nutrition and managing your food budget,
call 1-888-744-3232 or go to myCase
at jobs.utah.gov/myCase.
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Food Stamps
There has been a change to the Household benefits for this Program. Please revie
w the following information for details:
You will receive assistance for the full month versus the partial or prorated amo
unt received last month.
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