November 7, 2011

CalFresh_Color_Eng.jpg Program Guide Letter #566



Release of Disaster CalFresh Approval/Denial Notice (DFA 390),  and Revised Application Form (DFA 385)



All County Information Notice I-66-11; Disaster-SNAP Guidance



To inform staff of the:

·     Release of the new Notice of Approval/Denial Disaster CalFresh notice DFA 390;

·     Revision to the:

o  Application for Disaster CalFresh form DFA 385, and

o  Affidavit of Support 09-93 HHSA; and

·     Merging of the CalFresh Replacement approval and denial notices 09-91 HHSA and 09-92 HHSA into one joint approval/denial notice 09-95 HHSA.


Effective Date

Upon receipt.



State regulations did not require counties to use a specific form when notifying Disaster CalFresh households of their approval or denial for Disaster CalFresh benefits.  Some counties have been using the Notice of Approval DFA 377.1.  However, San Diego County developed and has been using since 2004 the Disaster CalFresh approval and denial notices 09-89 HHSA and 09-90 HHSA.

At the request of counties, California Department of Social Services (CDSS), developed the DFA 390 to ensure a uniform statewide response for notifying disaster victims of their eligibility status for Disaster CalFresh benefits.

The Application for Disaster CalFresh, formerly entitled the Application for Emergency Food Stamp Assistance, has been revised to accurately reflect the Disaster Supplemental Nutrition Assistance Application sample form provided by the United States Department of Agriculture, Food and Nutrition Service and to reflect the program name change from Food Stamps to CalFresh.


Summary of Changes

CDSS Forms

Effective upon receipt of this letter, the DFA 390 and the revised DFA 385 are State required forms and shall be used in the event of a disaster.

San Diego County Forms

·     CalFresh approval and denial Replacement of benefits notices 09-91 HHSA and 09-92 HHSA are being revised and combined into one notice: 09-95 HHSA, CalFresh Replacement Approval/Denial notice.

·     Affidavit of Support form 09-93 HHSA has been revised.  The 09-93 shall be used:

o  In conjunction with the “Replacement Affidavit/ Authorization DFA 303 to request replacement of food purchased with CalFresh benefits lost or spoiled because of a “household misfortune” or

o  When applying for Disaster CalFresh, and loss of food is the only adverse effect claimed by the Disaster CalFresh applicant.

Disaster CalFresh notices 09-89 and 09-90, and CalFresh Replacement notices 09-91 and 09-92 are now obsolete.


CalFresh Program Guide Changes

Revised CalFresh Program Guide sections:


Section Title



Disaster CalFresh Desk Aid

Updated Disaster CalFresh Desk Aid to 10/11 version.


Disaster CalFresh Application Form

Deleted references to iWAY and forms folder.


Replacement of Food

·     Revised section;

·      Added new Replacement notice.


Summary of Disaster CalFresh and Replacement Forms and Notices

·     Updated table to include new and revised forms;

·     Deleted obsolete forms.


Application Disposition

Added requirement to explain during the interview: civil and criminal penalties, post-disaster review and the webpage to apply for regular CalFresh.


Disaster CalFresh Notice of Action

Changed section name “Notices of Action” to: “Disaster CalFresh Notice of Action.”


Adverse Effect

Clarified disaster related expenses and added link to 63-503.3.


CDSS Forms and Notices Matrix

Added new Disaster Application form to CDSS Matrix.


County Forms

Added revised Replacement Approval/Denial notice 09-95 and Affidavit of Loss form 09-93 to the County Forms table.


Forms Impact

The new and revised forms DFA 385, DFA 390, 09-95 HHSA, and 09-93 HHSA can be accessed by clicking the link in the corresponding Program Guide sections.  The forms have also been uploaded and are available for ordering via the Xerox Print Center.

Translations to other languages of CDSS forms DFA 385 and DFA 390 will be uploaded in the S:\ENTERPRISE\Food Stamp State Forms\Other Languages Forms folder as soon as CDSS provides the translations.


Automation Impact

No impact.



No impact.


Other Programs Impact

No impact.


Operational Impact

No impact


Manager Approval




SYLVIA MELENA, Assistant Deputy Director

Self-Sufficiency Programs

Strategic Planning & Operational Support