January 7, 2009



Food Stamp Program Guide Letter #538







ACIN I-83-08; ACL 06-31; ACIN I-96-06; MPP 63-501.3(r); MPP 89-130



Effective Date

Upon receipt




The purpose of this letter is to issue the new Food Stamp Program (FSP) Restricted Account form FS 28 (10/08).


The FS 28 form will be utilized by the Human Services Specialist (HSS) to help Non-Assistance Food Stamp (NAFS) households understand the rules, responsibilities and documentation required when requesting a Restricted Account.




The Farm Security and Rural Investment Act (Farm Bill of 2008) made certain options available to states to simplify and improve the FSP. One option allowed food stamp recipients to exclude Restricted Accounts as a resource just as they are excluded as property in the CalWORKs program.


Restricted Accounts are excluded as a resource when households save money for specific purposes, such as buying a home to live in, starting a business, or for education/job training.


Implementation of Restricted Accounts in the FSP was effective on November 1, 2006 with the release of Food Stamp Program Guide (FSPG) Special Notice 06-19, Implementation of Food Stamp Simplification Options.


NOTE: FSPG Special Notice 06-19 has been incorporated into the FSPG and the Restricted Account section can be found in FSPG 63-203.18.



HSS Action and Description of Form

When a FS recipient is requesting to exempt a Restricted Account, the HSS will provide the:


Restricted Account Coversheet (FS 28)


The FS 28 Coversheet is an informational form. It explains what a Restricted Account is and the rules for owning an account. The form also describes the purposes for Restricted Accounts, how to report withdrawals, what constitutes an allowable withdrawal, and what is required to verify a Restricted Account.


Restricted Account Agreement Part A (FS 28A)


Section FS 28A of the form is intended to inform the household of the Restricted Account rules and responsibilities by having the head of household or Authorized Representative initial each item on the form and sign the form to signify that they understand what is involved with ownership of a Restricted Account.


Restricted Account Agreement Part B (FS 28B)


Section FS 28B of the form is used to identify the account designated as a Restricted Account. The Head of Household or Authorized Representative must also sign this section of the form.



Form Impact

The FS 28 has been:


  Uploaded and is available for ordering at iWAY (Xerox), and


  Added to the Forms Matrix in the S:\ENTERPRISE|State Food Stamp Forms folder. The form is currently available in English only. The Matrix will be updated once the form is translated into other languages.


NOTE: All three parts of the form will be identified and distributed stapled as one whole form, (FS 28 FSP Restricted Account Agreement).



FSPG Changes

The FSPG has been updated with the following changes:


FSPG Section




Restricted Accounts: Written Agreement

This section of the FSPG has been updated to explain the requirement to use the FS 28 form when a FS recipient (not applicant) requests to exempt a Restricted Account.



Quality Assurance (QA) Impact

Quality Assurance (QA) will cite the appropriate error when the changes implemented in this letter are not applied or are applied incorrectly.



Assistant Deputy Director

(Original Signed 12/07/2008)






Assistant Deputy Director

Self-Sufficiency Programs

Strategic Planning & Operational Support