Free FoodShare Wisconsin Change Report (Hmong), HCF 16006H - Wisconsin

STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-16006H (07/08)

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FOODSHARE WISCONSIN CHANGE REPORT DAIM NTAWV QHIA TXOG KEV HLOOV HAUV FOODSHARE WISCONSIN
(Tag nrho cov Neeg Laus, Dig Muag los sis Ib Ce Tsis Meej Xeeb Pem)
Yog hais tias koj tau FoodShare Wisconsins, koj yuav tsum qhia txog kev hloov ntawm cov neeg hauv koj tsev neeg (yog hais tias muaj neeg tawm los sis nkag los hauv tsev neeg, leej twg sib yuav, cev xeeb tub, los sis tau me nyuam tshiab), chaw nyob, nqi tsev, nyiaj tau, los sis kev hloov ntawm kev ua hauj lwm li ntawm kaum hnub. Yog tias muaj cov kev hloov no, sau daim ntawv qhia no thiab xa tuaj, nqa tuaj rau ntawm lub chav fai uas qhia nram lub thawv hauv qab no, los sis nug tau rau koj tus neeg tuav ntaub ntawv yam uas hu xov tooj los sis ntsib nws txog cov kev hloov. Yog tias daim ntawv qhia no tsis muaj chaw txaus los sau cov kev hloov, muab ib daim ntawv ntxiv uas sau cov moj kab sim rau hauv daim ntawv qhia no. Kev muab los sis thov ib tug SSN yog los ntawm kev yeem thaj; tiam sis yog tias tus neeg uas xav tau nyiaj FoodShare tsis xav muab lawv tus SSN los sis thov ib tug yuav tsis tsim nyog rau cov kev pab. Tej yam xov qhia txog koj tug nkeej yog leej twg rua pub siv rau kev ntsuag kev tsim nyog hauv Foodshare Wisconsin xwb.

(Nroog Laj Fai Qhov Chaw Nyob)

Koj Lub Npe

Zauv Cim Ntawv (Case Number)

Tus Neeg Tuav Ntaub Ntawv Lub Npe (Worker)

Yog hais tias koj txhob txwm tsis qhia txog cov kev hloov los sis qhia cov moj kab sim dag koj yuav raug nplua, tau them cov nyiaj FoodShare uas koj tau txais rov qab, raug foob, los sis tag nrho peb qho.

Koj yuav tau muab ntawv pov thawj rau cov kev hloov uas koj qhia tuaj.
KEV HLOOV HAUV COV NYIAJ TAU
Koj yuav tsum qhia thiab muab ntawv ua pov thawj txog cov nyiaj tau tshiab. Tus neeg tau hauj lwm tshiab los sis nyiaj tshiab lub npe Them pes tsawg $ HAUJ LWM TSHIAB

Ib teev twg

Chaw ua hauj lwm

Ua tsawg teev txhua plua

Them pes tsawg zaus

Thawj hnub them

KEV HLOOV NTAWM COV NYIAJ TAU UAS TSIS YOG UA HAUJ LWM
Koj yuav tsum qhia cov · Nyiaj tau tshiab uas tsis yog nyiaj ua hauj lwm, · Nyiaj hloov ntau tshaj $100 txhua hli ntawm nyiaj tu me nyuam, los sis · Nyiaj hloov ntau tshaj $50 txhua hli ntawm lwm cov nyiaj xws li Nyiaj Raug Mob Tom Hauj Lwm, Nyiaj Poob Hauj Lwm, nyiaj Social Security los sis Nyiaj Veteran.

Federal Law 7CFR273.12(b)

FoodShare Wisconsin Change Report Form F-16006H (07/08)

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Hom nyiaj dab tsi

Tus neeg tau cov nyiaj uas tsis yog ua hauj lwm lub npe KEV HLOOV NYIAJ TSIS YOG UA HAUJ LWM TAU

Puas yog hloov cov nyiaj tau

Yog

Tsis yog

Nyiaj tau txhua hli

Hnub cov nyiaj tau hloov

KEV HLOOV CHAW NYOB THIAB HLOOV NQI TSEV Yog tias koj tsiv tsev, koj yuav tsum qhia koj qhov chaw nyob tshiab. Thaum uas koj tsiv tsev koj yuav tsum qhia
yog tias koj nqi tsev los sis lwm cov nqi siv hauv tsev (nqi nkes, hluav taws xob, dej, lwm yam) nce los sis txo. HLOOV CHAW NYOB Chaw nyob tshiab Xov tooj tshiab

Hnub hloov

Koj puas yog nyob tsev luam? HLOOV HAUV NQI TSEV YUAV HLOOV HAUV NQI TSEV

Lub nqi tsev tshiab txhua hli

Yog

Tsis yog

Yog hais tias tsis nrog hauv lub nqi tsev, sau cov nqi ntawm: Se ntawm thaj chaw

Nqi tsev tshiab txhua hli

Tswv tsev npe, chaw nyob & xov tooj

Kev tuav pov hwm

Sau cov nqi siv hauv tsev uas koj yuav tsum tau them

Cov nqi siv hauv tsev uas koj yuav tsum tau them

KEV HLOOV HAUV TSEV NEEG
Koj yuav tsum qhia yog tias leej twg: · Tawm los sis nkag hauv koj tsev neeg · Leej twg sib yuav · Cev xeeb tub · Tau me nyuam tshiab (sau moj kab sim txog tus neeg tau me nyuam thiab tus me nyuam tshiab) Npe Qhia qhov hloov

Hnub yug

Hnub hloov

Zauv Pua Cev (SSN)

Kev txheeb rau tus Thawj Hau Hauv Tsev

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FoodShare Wisconsin Change Report Form F-16006H (07/08)

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KEV HLOOV HAUV KEV THEM NQI TU ME NYUAM
Koj yuav tsum qhia txog cov kev hloov hauv qhov uas yuav tsum tau them nqi tu me nyuam. Tus neeg uas yuav tsum tau them nqi tu me nyuam lub npe Tsev Hais Plaub Kom Ua Tus Zauv Qib Txam (Court Order Number)

Tus nqi yuav tau them rau nqi tus me nyuam

Hnub uas tsev hais plaub kom ua los sis hnub uas qhov kom ua no hloov

LWM COV KEV HLOOV?
Qhia lwm cov kev hloov uas yuav muaj feem rau koj qhov kev tsim nyog. Ib co piv txwv txog lwm cov kev hloov muaj xws li ib tug neeg ib ce tsis meej xeeb pem los sis ib ce meej xeeb pem lawm, ib tug neeg uas tsis kawm ntawv lawm, lwm yam. Sau cov hnub uas hloov ntawv.

Koj puas xav tias cov kev hloov hauv daim ntawv qhia no yuav nyob li no rau lwm lub hlis? Yog tias Tsis xav, thov qhia me ntsis.

Xav

Tsis xav

LUS CEEB TOOM TXOG KEV NPLUA NTAWM FOODSHARE WISCONSIN Tus neeg twg hauv koj tsev neeg txhob txwm rhuav cov cai hauv qab no yuav tsis tau txais kev pab los ntawm FoodShare Wisconsin li ntawm 12 lub hlis tom qab ua txhaum thawj zaug, 24 hlis tom qab ua txhaum zaum ob los sis txhaum thawj zaug yog tias siv yeeb siv tshuaj, thiab mus tas li yog tias txhaum zaum peb: · · · · Muab moj kab sim dag los sis zais moj kab sim kom tau los sis txais nyiaj FoodShare ntxiv mus, Pauv, muag, los sis kho nyiaj FoodShare, Siv nyiaj FoodShare los yuav khoom uas tsis yog khoom noj, xws li dej cawv los sis luam yeeb, los sis Siv lwm tus cov nyiaj FoodShare, yuaj duab cim neeg (identification card) los sis lwm cov ntaub ntawv.

Nyob ntawm seb dag siv cov nyiaj ntau npaum li cas, tus neeg tej zaum yuav raug nplua tau txog $250,000, kaw txog li ntawm 20 xyoo, los sis ob qho tag nrog. Tsev hais plaub yuav txwv tau ib tug neeg ntawm qhov kev pab li 18 lub hlis ntxiv los tau. Koj yuav tsis tsim nyog tau mus tas li yog tias pom tau hais tias koj siv cov nyiaj FoodShare yam tsis raug cai txog li ntawm $500 los sis ntau dua. Koj yuav tsis tsim nyog tau kev pab li ntawm 10 xyoo yog tias pom tau hais tias tau hais dag los sis muab pov thawj dag yam tias yus yog tus neeg ntawv thiab chaw nyob kom tau kev pab ntau rau ib lub sij hawm. Cov neeg khiav ntawm txoj cai/ua txhaum cai yuav tsis tsim nyog rau qhov kev pab. Tus neeg tej zaum yuav raug foob nyob hauv lwm cov tsoom fwv cov cai uas muaj feem. Nuj nqi: Kuv nkag siab tias cov nuj nqi uas kuv qhia xws li nqi tsev, nqi siv hauv tsev, nqi zov me nyuam, nqi them tu me nyuam, los sis nqi kho mob yuav muaj feem rau cov theem ntawm FoodShare uas kuv tsev neeg yuav tau txais. Kuv nkag siab tias yog tsis qhia los sis muab pov thawj txog cov nuj nqis txhais tau hais tias kuv tsis xav tau kev pab txo nqi rau cov nuj nqis no. Txo Cov Nyiaj Tau: Kuv nkag siab tias tsis tim tsum kom kuv qhia kev txo hauv cov nyiaj tau los sis tsis tau nyiaj ntxiv lawm; tiam sis, kuv yuav tau nyiaj FoodShare ntau zog yog hais tias kuv qhia. Kuv nkag siab hais tias yog kuv tsis qhia qhov kev txo hauv cov nyiaj tau txhua hli ntawm kuv tsev neeg los sis kev tsis tau nyiaj ntxiv lawm, kuv yuav tsis tau kev nce nyiaj li cas ntxiv hauv kuv cov nyiaj FoodShare.

FoodShare Wisconsin Change Report Form F-16006H (07/08)

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Kuv nkag siab tias muaj kev nplua yog npog moj kab sim los sis muab moj kab sim dag. Kuv tseem nkag siab ntxiv tias kuv yuav tau them rov qab cov nyiaj uas kuv tau vim kuv tsis qhia kom tag txog kuv. Kuv pom zoo muab ntawv pov thawj rau cov kev hloov, yog tias nug txog. Kuv cov lus teb hauv daim ntawv no yeej muaj tseeb thiab meej raws li kuv paub. Moj kab sim txog SSN yuav siv rau kev khiav laj fai hauv FoodShare Wisconsin. Koj tus SSN cia kaib lawj ceem (computer) soj ntsuam txog koj cov moj kab sim nrog tsoom fwv cov laj fai xws li Internal Revenue Service (IRS), Social Security Administration (SSA) thiab Department of Workforce Development, thiab tseem nrog rau School Lunch Program. Zauv pua cev yuav siv los xyuas tus neeg ntawm cov neeg hauv tsev thiab los xyuas cov nyiaj tau xws li los ntawm chaw ua hauj lwm, tuam txhab tso nyiaj thiab lwm qhov chaw.

XYEEM NPE­ Tus tau kev pab

Hnub xyeem npe

Xov Tooj Nruab Hnub ( )

KHAWS DAIM NTAWV SAU MEEJ RAU HAUV COV NTAUB NTAWV

RESET FORM

Sab 4