Department of Human Services

Case Records Management Unit

P.O. Box 91560
Washington, DC 20090

LaJharus D Evans
3543 10TH ST NW
WASHINGTON, DC 20010

If you need help understanding this notice, please call (202) 727-5355. We will explain it to you in
your preferred language. You can also Fax us at (202) 671-4400.

ይህንን ማሳሰቢያ ለመረዳት እርዳታ የሚፈልጉ ከሆነ፣ እባኮን በ (202) 727-5355 ይደውሉ። በሚመርጡት ቐንቐ እናብራራሎታለን ::
በተጨማሪም፣ በ (202) 671-4400 ፋክስ ሊያደርጉልን ይችላሉ።

Si necesita ayuda para entender este aviso, por favor llamar al (202) 727-5355. Le explicaremos en
el idioma de su preferencia. También puede enviar un fax al (202) 671-4400.

Si vous avez des difficultés à comprendre cet avis, n’hésitez pas à appeler le (202) 727-5355. Nous
vous donnerons des explications dans votre langue préférée. Vous pouvez également nous
atteindre par fax au (202) 671-4400.

본 내용을 이해하는 데 도움이 필요하신 경우, (202) 727-5355 번으로 연락해 주십시오. 담 당직원이
원하시는 언어로 해당내용을 설명해드릴 것입니다. (202) 671-4400 번으로 팩스를 보내실 수도 있습
니다.

如果您需要帮助以理解本通知，请致电 (202) 727-5355。我们将采用您的首选语言向您解 释本通知。

您还可向我们发送传真：(202) 671-4400

如果您需要幫助以理解本通知，請致電 (202) 727-5355。我們將採用您的首選語言 向您解釋本通知。

您還可向我們發送傳真：(202) 671-4400。

Nếu cần được giúp đỡ để hiểu rõ thông báo này, xin gọi số (202) 727-5355. Chún tôi sẽ giải thích
thông báo này cho quý vị bằng ngôn ngữ quý vị chọn. Quý vị cũng có thể gởi điện sao (fax) đến
chúng tôi theo số (202) 671-4400.

MPI_F100
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF HUMAN SERVICES

Notice Date: 10/28/2023

Account ID: 50865330 Fort Davis Service Center
Person ID: 1018371668 3851 Alabama Avenue, SE
LaJharus D Evans Washington, DC 20011
3543 10TH ST NW Phone number: (202) 727-5355
WASHINGTON, DC 20010 Fax Number: (202) 671-4400

Subject: Supplemental Nutritional Assistance Program (SNAP) Approval

Dear LaJharus Evans,

Why am I receiving this letter?

Your application for District of Columbia (District) Supplemental Nutritional Assistance Program (SNAP),
which was received on 10/25/2023, was approved. Your SNAP certification period will begin on
10/25/2023 and end on 09/30/2024.

How much will your benefits be?

· The amount of your first month of SNAP benefits is calculated based on the date you submitted your
application.

· Because you applied after the first day of the month, your first month is a partial benefit. The partial
month amount for October 2023 is $65.00. This decision is supported by 7 CFR § 273.10(a)(1)(iii)(C).
For the period of 10/25/2023 through 10/31/2023 your benefit for each month will be as follows:

Total # of persons in household: 1

Gross Income before deductions: 0
Maximum SNAP Allotment for SNAP Household: $291.00
Net income: 0
Thirty Percent of Net Income: 0
Your Benefit Amount 65
For the period of 11/01/2023 through 09/30/2024 your benefit for each month will be as follows:

Total # of persons in household: 1

Gross Income before deductions: 0
 Page 2 of 2

Maximum SNAP Allotment for SNAP Household: $291.00

Net income: 0
Thirty Percent of Net Income: 0
Your Benefit Amount 291

What else do you need to know?

· If your circumstances change and you let us know, we will look at your case again and see if these
changes still apply.
· Note: Under SNAP rules, we count thirty (30) percent of your net income to calculate your monthly
SNAP allotment.
Where can you get more information?

If you have questions or need language assistance, please call (202)727-5355. If you are Hearing
Impaired, you may call TTY/TDD 711.

If You Think We Made a Mistake

If you do not agree with the decision we made, the household may request a fair hearing within 90 days
of the date of this notice. Read the attached Hearing Rights to learn how to request a hearing and for a
list of organizations that may provide free legal representation. You may request a hearing orally or in
writing.

FOOD STAMPS PENALTY WARNINGS

Any member of your SNAP household who intentionally breaks any of the following rules can be
prevented from receiving SNAP for one year after the first violation, prevented for two years after the
second violation and permanently prevented for the third violation. The individual can also be fined up
to $250,000, imprisoned up to ten years, or both. A Court can also prevent an individual from
participating in the SNAP program for an additional 18 months for any violation. The individual may also
be subject to further prosecution under other related federal laws.

· Do not give false information, or hide information, to receive or continue to receive SNAP
benefits.

· Do not trade or sell SNAP benefits or authorization (EBT) cards.

· Do not alter authorization (EBT) cards to get food stamps that you are not entitled to receive.

· Do not use SNAP benefits to purchase ineligible items such as alcoholic beverages or tobacco.

· Do not use anyone else’s SNAP benefits or authorization (EBT) cards for your household.

WIC

Did you know that you may be eligible to receive WIC benefits? DC WIC provides food assistance,
nutrition education, breastfeeding support, and more to pregnant women, new moms, infants & children
under the age of five years. Children under the age of five may also be eligible if their caregivers are
fathers, grandparents, or foster parents. Please visit dcwic.org or call 202-442-9397 to learn more.
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF HUMAN SERVICES

District of Columbia Department of Human Services

Appeal Rights
If you do not agree with our decision about your benefits, you have the right to ask for a fair hearing.

In general, you can appeal any action taken by the agency on your public benefits case that you
disagree with or any inaction that affects your receipt, amount, conditions, termination, or kind of
public benefits. But, you are not necessarily entitled to appeal that your public benefits changed as a
result of a change in the law.

Once you appeal, you can go before an Administrative Law Judge and explain why you do not agree
with our decision.
You have 90 days following the postmark of the notice informing you of the eligibility decision, denial,
termination or change to appeal the decision stated in the notice you received. If you do not appeal
within 90 days, you may lose your right to appeal.

How to Request an Appeal

You may appeal through any of the following methods:

· Calling the ESA Call Center (202) 727-5355
· Completing a Request for Hearing form and fax it to (202) 724-2041, or e-mail to
DC.OARA@DC.GOV
· Go to any Department of Human Services Service Center to fill out a Request for Hearing.
o The Service Center Locations are found on the Service Center Address sheet attached.
· Go to the Office of Administrative Hearings Resource Center, located at 441 4th Street NW,
Suite 450-North, Washington, DC 20001 and fill out a Request for Hearing form.
· By having a representative request a hearing on your behalf so long as you submit a written
authorization, designating that person as your representative within 10 days of the hearing
request.

Your Eligibility during Your Appeal

If you ask for a hearing before an action on your benefits takes place, your benefits will continue until:

· you withdraw your request for the hearing,

· a change affecting your public benefits occurs while the hearing is pending and you fail to
request a hearing after notice of the change,
· a determination is made at the hearing that the sole issue is one of law and not of incorrect
grant computation, or
 · a hearing decision upholds the agency action to alter the amount or conditions of the public
benefit.
· If you have requested a continuation of IDA benefits while a hearing is pending, IDA benefits
may not be continued after a final federal Supplemental Security Income (SSI) eligibility
determination has been made.
· SNAP benefits may not be continued after the certification period expires unless you apply for
and receive benefits for a new certification period.

You may request your TANF, POWER, or GC benefits to remain at the level received prior to
receiving this notice. For SNAP, benefits will be continued automatically until the end of your
certification period unless you specifically waive continuation of SNAP benefits on your hearing
request form. If the hearing decision says the agency's proposed action to change or terminate your
benefits was correct, you will have to repay up to the difference in the funds received.

If you are requesting an appeal of a denial of a domestic violence waiver in the TANF program, if you
appeal the decision within 15 days, the waiver request shall be considered pending for the duration of
the appeal.

If the agency took action without giving you timely notice when timely notice is required by law, your
public benefits will be reinstated if you request a hearing within 10 days of the postmark of the written
notice of the action.

What Happens When You Appeal

Administrative Review - Once your appeal is received, you will be scheduled for an Administrative
Review Conference at the Office of Administrative Review and Appeals (OARA). This is a voluntary
meeting with a Hearing Examiner from the District of Columbia Department of Human Services (DHS)
to identify and discuss your concerns. This meeting will not delay or replace the Fair Hearing process.
You can bring your own representative if you choose to have one. Your representative may, but does
not have to be, an attorney. Your representative may not be an employee of the District. At the
meeting, your representative shall serve only in an advisory capacity.

Please bring documents related to your case to the conference. This will help the DHS Hearing
Examiner identify and understand your concerns. After the conference, the DHS Hearing Examiner
will review your case and try to resolve your issues. You will receive a written decision from the DHS
Hearing Examiner regarding the issues of your case, including a summary of facts. If you agree with
the written decision and write a statement that you wish to withdraw your hearing request, your
request for a Fair Hearing will be considered formally withdrawn. If you do not agree with the DHS
Hearing Examiner's written decision, your appeal still continues to a Fair Hearing.

If you decide not to attend the DHS Administrative Review, the conference will not occur and your
case will continue on to a Fair Hearing before an Administrative Law Judge who is not an employee of
DHS. The Fair Hearing will take place at the DC Office of Administrative Hearings (OAH) at 441 4th
Street NW, Suite 450-North, Washington, DC 20001.
OAH will contact you and tell you when and where your Fair Hearing will take place. OAH will send
you a scheduling notice. That notice will tell you when your Fair Hearing will take place.

At the Fair Hearing, you can testify, have others testify for you, and submit documents. At the hearing,
DC agency representatives will also be able to ask questions of you or other people who testify. The
DC agency representatives will be permitted to present testimony and documents. You will be able to
ask questions of the DC agency representative if you want. Finally, the Administrative Law Judge will
make a decision in writing, a final order, after the completion of the Fair Hearing, and will send it to
you. That decision will also tell you what you can do if you do not agree with the final order.

Any decisions by OARA or OAH about your eligibility for benefits might also change the
eligibility of other people in your household.

Reasonable expenses related to the hearing, such as transportation costs for the claimant and his or
her witnesses, may be paid by DHS.
Getting Representation

You have the right to represent yourself or have a lawyer, family member, or friend represent you at
the Administrative Review and at the Fair Hearing. Your representative may not be an employee of
the District.

If you would like to talk to a lawyer who will represent you for free, you can call any of the following
places to see if they can help you. There is no guarantee that you will be able to get legal help. Even
if you do not get legal help, there will still be a Fair Hearing held and a decision made.

Bread for the City Legal Clinic Bread for the City Legal Clinic
1525 Seventh Street, NW 1640 Good Hope Road, SE
(202) 265-2400 (202) 561-8587

Neighborhood Legal Services Legal Aid Society of the District of Columbia

1213 Good Hope Road 1331 H St. NW Suite 350
(202) 678-2000 (202) 628-1161

Legal Aid Society of the District of Columbia Legal Aid Society of the District of Columbia
2041 Martin Luther King Jr. Ave. SE, Suite LL-1 Friendship Baptist Church,
(202) 628-1161 900 Delaware Ave., SW
(202) 628-1161

Legal Counsel for the Elderly Washington Legal Clinic for the Homeless
(for people age 60 and older) 1200 U Street, NW
Building A, 4th Floor (202) 328-5500
601 E St. NW
(202) 434-2120

Ending Your Appeal Early

You may withdraw your request for a Fair Hearing at any time before the Administrative Law Judge
makes a final written decision. You may withdraw through any of the methods available for requesting
an appeal (described above). If you withdraw your request for a Fair Hearing because of the meeting
with the Office of Administrative Review and Appeals, or because the agency has promised to change
its decision, we will make a new decision and it will be based on the changes agreed to by the
agency.

If you stop your appeal before the agency has changed its decision, the denial, termination, or
change will be implemented as it is written in the notice you first received before you filed
your appeal.
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF HUMAN SERVICES

USDA Nondiscrimination Statement

SNAP and FDPIR Nondiscrimination Statement for Joint Application Form

In accordance with federal civil rights laws and U.S. Department of Agriculture (USDA)
civil rights regulations and policies, the USDA, its agencies, offices, and employees, and
institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, sex (including gender identity and
sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation
for prior civil rights activity in any program or activity conducted or funded by USDA.
Programs that receive federal financial assistance from the U.S. Department of Health
and Human Services (HHS), such as Temporary Assistance for Needy Families (TANF),
and programs HHS directly operates are also prohibited from discrimination under federal
civil rights laws and HHS regulations.

Persons with disabilities who require alternative means of communication for program
information (e.g., Braille, large print, audiotape, American Sign Language), should contact
the agency (state or local) where they applied for benefits. Individuals who are deaf, hard
of hearing or who have speech disabilities may contact USDA through the Federal Relay
Service at (800) 877-8339. Additionally, program information may be made available in
languages other than English.

CIVIL RIGHTS COMPLAINTS INVOLVING USDA PROGRAMS

USDA provides federal financial assistance for many food security and hunger reduction
programs such as the Supplemental Nutrition Assistance Program (SNAP), the Food
Distribution Program on Indian Reservations (FDPIR) and others. To file a program
complaint of discrimination, complete the Program Discrimination Complaint Form, (AD-
3027) found online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR
P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, and at any USDA office or
write a letter addressed to USDA and provide in the letter all of the information requested
in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your
completed form or letter to USDA by:
 1. mail:
Food and Nutrition Service, USDA
1320 Braddock Place, Room 334, Alexandria, VA 22314; or
2. fax: (833) 256-1665 or (202) 690-7442; or
3. phone: (833) 620-1071; or
4. email: FNSCIVILRIGHTSCOMPLAINTS@usda.gov

For any other information regarding SNAP issues, persons should either contact the
USDA SNAP hotline number at (800) 221-5689, which is also in Spanish, or call the state
information/hotline numbers (click the link for a listing of hotline numbers by state); found
online at: SNAP hotline.

CIVIL RIGHTS COMPLAINTS INVOLVING HHS PROGRAMS

HHS provides federal financial assistance for many programs to enhance health and well-
being, including TANF, Head Start, the Low Income Home Energy Assistance Program
(LIHEAP), and others. If you believe that you have been discriminated against because
of your race, color, national origin, disability, age, sex (including pregnancy, sexual
orientation, and gender identity), or religion in programs or activities that HHS directly
operates or to which HHS provides federal financial assistance, you may file a complaint
with the Office for Civil Rights (OCR) for yourself or for someone else.

To file a complaint of discrimination for yourself or someone else regarding a program

receiving federal financial assistance through HHS, complete the form on line through
OCR’s Complaint Portal at https://ocrportal.hhs.gov/ocr/. You may also contact OCR via
mail at: Centralized Case Management Operations, U.S. Department of Health and
Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington,
D.C. 20201; fax: (202) 619-3818; or email: OCRmail@hhs.gov. For faster processing, we
encourage you to use the OCR online portal to file complaints rather than filing via mail.
Persons who need assistance with filing a civil rights complaint can email OCR at
OCRMail@hhs.gov or call OCR toll-free at 1-800-368-1019, TDD 1-800-537-7697. For
persons who are deaf, hard of hearing, or have speech difficulties, please dial 7-1-1 to
access telecommunications relay services. We also provide alternative formats (such as
Braille and large print), auxiliary aids and language assistance services free of charge for
filing a complaint.

This institution is an equal opportunity provider.

 GOVERNMENT OF THE DISTRICT OF COLUMBIA

DEPARTMENT OF HUMAN SERVICES

District of Columbia (DC) Department of Human Services (DHS)

Economic Security Administration (ESA) Service Center List

In Person: You can visit any of the DHS ESA Service Centers for assistance between
the hours of 7:30 AM and 4:45 PM, Monday through Friday:

Fort Davis Service Center Anacostia Service Center

3851 Alabama Avenue, SE 2100 Martin Luther King Avenue, SE
Washington, DC 20020 Washington, DC 20020
Fax :( 202) 645-6205 Fax: (202)727-3527

Congress Heights Service Center Taylor Street Service Center

4049 South Capitol Street, SW 1207 Taylor Street, NW
Washington, DC 20032 Washington, DC 20011
Fax: (202) 645-4524 Fax: (202) 576-8740

H Street Service Center

645 H Street, NE
Washington, DC 20002
Fax: (202) 724-8964

OR

Phone: You can call the DHS ESA Public Benefits Call Center for assistance, general
questions about DHS benefits, or a notice or form you received at (202) 727-5355,
Monday-Friday, 7:30am – 4:45pm, TTY/TDD: 711.
If there is a long wait,, you will have the option to request an automated callback.
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF HUMAN SERVICES

Important Information About Your Electronic Benefit Transfer (EBT) Card

KEEP YOUR EBT CARD SECURE AT ALL TIMES.

Benefits are loaded onto this card every month you are eligible.
Hold onto this card because benefits may be re-loaded after gaps in eligibility.

Fidelity Information Services (FIS) is the District’s EBT card company. Please look for mail from FIS which
may contain important information or your new EBT card.

If you do not already have an EBT card…

You will be provided with an EBT card to use your food, cash, and/or energy benefits. Your EBT card will be
mailed to the mailing address that the District has on file and will be pre-loaded with your benefits. The mailing
address on file for your household is the address this notice was mailed to. Your new EBT card should arrive in
5 to 7 business days.

Once you receive your EBT card in the mail from FIS, you need to activate the card and create a personal
identification number (PIN). Please read the instructions about activating your card below carefully.

Call FIS at (888) 304-9167 to activate your card. Enter the following information when asked:
· Primary Cardholder’s Date of Birth
· Last 4 Digits of the Primary Cardholder’s Social Security Number
· Primary Cardholder’s Zip Code

If you already have an EBT card…

Your food or cash assistance benefits will be automatically loaded onto your existing EBT card.

Check Your Balance

Know your balance before you go shopping. The amount of EBT benefits on your card will be printed on your
receipt. You can also check your balance on the internet at www.ebtedge.com or download the EBT Edge
Mobile app from the Apple or Google Play store to see transaction history, account balances, or to find stores
that accept EBT cards. You can also check your balance by calling FIS at (888) 304-9167.

Lost, Stolen, Damaged EBT Card

It is important that you always keep your EBT card secure to avoid delays in accessing your benefits. If you
lose your card, it is stolen, or becomes damaged and you need a replacement, call FIS at (888) 304-9167.

Changing your PIN or Report a Stolen PIN

Keep your PIN secure and never share it with anyone. If you cannot remember your PIN or if someone finds
out your PIN, call the FIS at (888) 304-9167 to select a new PIN.
Misuse/Abuse of EBT Card and Benefits
It is a crime to defraud the system or misuse your card. State and/or Federal authorities will
investigate misuse or abuse, which may result in disqualification, recovery of benefits, and referral for
criminal prosecution. Benefits are non-transferable.

FOOD ASSISTANCE CUSTOMERS

(SNAP)

Where can I use my EBT card?

Your EBT card is just like a debit card for food purchases. You can use it at any store or farmers’
market that accepts Supplemental Nutrition Assistance Program (SNAP) benefits to purchase food
only. To find a store near you, visit https://www.fns.usda.gov/snap/retailer-locator. You can also
purchase food online for delivery at Amazon by visiting https://www.amazon.com/snap-ebt.
You will need to enter your PIN that you created when you make your purchase.
What are eligible food items?
EBT benefits can only be used to purchase eligible food items. Eligible food items include:
· Fruits and vegetables;
· Meat, poultry, and fish;
· Dairy products;
· Breads and cereals;
· Other foods such as snack foods and non-alcoholic beverages; and
· Seeds and plants, which produce food for the household to eat.

CASH ASSISTANCE CUSTOMERS

(TANF, IDA, GENERAL ASSISTANCE FOR CHILDREN, LIHEAP, & REFUGEE CASH
ASSISTANCE)
Where can I use my EBT card?
Your EBT card is just like a debit card. You can use your EBT card to make purchases at
participating stores and approved vendors. You can also use your EBT card to get cash back on
purchases. When you are ready to pay for your purchase you may need to enter your PIN that you
created.

Can I withdrawal cash from by EBT card?

You can withdraw cash from participating ATMs. The first 2 ATM withdrawals are free, any additional
withdrawals will be charged $0.85 each.

For questions about your EBT card please call FIS at (888) 304-9167.

It is important that DHS always has your current mailing address on file to ensure no
interruption to benefit receipt and that all notifications are received.

To update your address call the Call Center at (202) 727-5355 or visit an open DHS Service Center
(dhs.dc.gov/service/find-service-center-near-you).