ZIDesILaytagsTV1 07086122003ASDDSHS07-086;"4j 8 B67E88T =c &,28>DJPV\bhntz6fSubmit 6 ::!v6Pλ6$64*02509107359060832jH") -(###) ###-####(000) 000-0000  , @@X ~ @@@@@@ @@@@@ *@@@@*lX *gX @hIgX  iI' \I' X  *( RxIiIXZxI wI~ {IdD~*( ɫD֫D4~~qrbDbOR.Z@@@  @0X N681&@(Dp6 this  SignatureVersion Data Vers$ Blue Keys*Graphics0Headeru06 FieldListxd< Form Infol LayoutProps ~ DesPathInfo"0() -(###) ###-####(000) 000-0000  , @@X = @@@@@@ @@@@@^N*\<`*\<`*^N*+^NhI+^N$( ^NiI\I^N^NARxIiIZxI^NwI=@{IdD=AɫD֫D\==mnbD\OR `@@@  @@X D\ @@@  @@X D\ @@@   @@X D\ @@RbD\OR@@X D\ LHNTTZN" T`@ NOTICE OF DISCHARGE    @ @  dTitle P  CLIENT NAME AND ADDRESS u @@ @  eTitle P# Our records show that you have neither requested nor received services from the Division of Developmental Disabilities (DDD) in over one year and you have not been in contact with our office during that time period. xxC xC  C,Arial (%jOur records show that you have neither requested nor received services from the Division of Developmental (%mDisabilities (DDD) in over one year and you have not been in contact with our office during that time period. H jTitle  @  Sincerely,  0 $P% -cc: Client Representative Client File 7e 7e  7e,Arial (J%cc: Client Representative (W% Client File+P,0` DSHS 07-086 (12/2003) L @ &DIVISION OF DEVELOPMENTAL DISABILITIES p@f@1dx@n@  &LEGAL REPRESENTATIVE NAME AND ADDRESS  @#p@  Title PP  TO:   PP  4In addition, you did not respond to our letter dated   P # "In which you were asked to contact    P$ us if you continue to be interested in DDD services. Based on these facts, we have determined that you no longer seek DDD services and that your eligibility for such services should be discontinued. hhFK hKF  FK,Arial (+%kus if you continue to be interested in DDD services. Based on these facts, we have determined that you no (8%\longer seek DDD services and that your eligibility for such services should be discontinued.PP$ 7>Based on this long-term inactivity, you will be discharged from DDD 30 days after the date on this letter unless you contact me and ask to remain eligible for DDD. Discharge from DDD results in termination of DDD eligibility, closure of your case, and deletion of your name from any DDD services waiting lists. $  PP# mOnce you are discharged from DDD, you may reapply at any time but will be required to submit a new application for eligibility and demonstrate that you continue to meet current eligibility requirements. Staff in our office will be available to assist you with a new application and will use the information in our current file that is relevant to your application. 44kI 4kI  kI,Arial (~%cOnce you are discharged from DDD, you may reapply at any time but will be required to submit a new (%rapplication for eligibility and demonstrate that you continue to meet current eligibility requirements. Staff in (%sour office will be available to assist you with a new application and will use the information in our current file (%%that is relevant to your application.P !You can reach me by telephone at     P@ Title   or by e-mail at  F !0@ Title tle case manager. @  Sincerely,  0  0! H  nTitle  0@! @H  oTitle  !@ !  DDD SIGNATURE >!@! DATE $P$ 4Enclosures: WAC and Request for Fair Hearing Notice   +P,0 SDSHS XX-XXX (11/2003) - PROPOSED FORM - DO NOT PRINT - KAT OSTERGARD (360) 664-6029;..` %DISTRIBUTION: Client Client File  @ &DIVISION OF DEVELOPMENTAL DISABILITIES p@f@1dx@n@N`3Submit 6l 07086122003@@1*t` *ASD` @hIDSHS` 07-086 of Discharge7ErXXjdVXXd'@Lʔ ^;?d68x8<e0dej  'Cell1Cell2Cell7Cell69Cell70Cell71QzX{_|f}m~t{j Cell1Cell2Cell7Cell36Cell37Cell38Cell39Cell40Cell41Cell42Cell43Cell44Cell45Cell46Cell47Cell48Cell49Cell50Cell51Cell53Cell54Cell55Cell56Cell57Cell58Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67Cell68Cell69Cell70Cell71Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67Cell688 0 "  d0IIIIII>GͻGͻHII  porpsila` porpsilaf<E porpsilar porpsilax9Datadej " p;ZBMZ6(d1$  f3f3̙f3fffff3ff333f3333f3f3f3̙f3fffff3ff333f3333f3f3̙̙̙f̙3̙̙̙f3fffff3ff333f3333f3fffff3fffffff3fff̙ffff3fffffffffff3ffff3f3f3ff3f33f3ffffff3ff333f3333333f33333̙33f3333f3f3f3ff33f3f3333333f3333333333f3333f3f3̙f3fffff3ff333f3333f3wUD"wUD"wUD"wwwUUUDDD"""VV+V+V++VVVVVVVV+VV+VVV+VV+VVV++++VV+VV+++VV+V+V++++V++VV+++VVVV++VVV+VVVVV+VV+++VVVVVV+V+VVV+V+VV++V+V+++VVV++VVVVVV++++VV++V++VVVVVV+++++++V++++++++++++++VV+VV+V++++++VVVVVVVVVVVV+++VVV+VV+V+VV+VVV+V++!=c~  0 "  d0IIIIII>GͻGͻHII  porpsila` porpsilaf<E porpsilar porpsilax9Datadej " ArialTimes New Roman  q NAME * $@w  r0# TELEPHONE NUMBER *M$@@  sA# INVOLVED DIVISION/ORGANIZATION *@$p ;TERMINATION OF FAMILY SUPPORT SERVICES REQUEST FOR HEARING   d[" d"[  d[",Arial (1xTERMINATION OF FAMILY (?SUPPORT SERVICES (MzREQUEST FOR HEARING @p *per Chapter 388-02 for DSHS hearing rules.     MAIL TO:   &   [OFFICE OF ADMINISTRATIVE HEARING (OAH), MAIL STOP: 42489 PO BOX 42489 OLYMPIA WA 98504-2489  dX Xd d[" dX,Arial (ub9OFFICE OF ADMINISTRATIVE HEARING (OAH), MAIL STOP: 42489 (b PO BOX 42489 (bOLYMPIA WA 98504-2489  P FAX:      0  360-586-6463   ;  ` " {I request a hearing because I disagree with the following decision by the Department of Social and Health Services (DSHS):   +  + dX +,Arial (*{I request a hearing because I disagree with the following decision by the Department of Social and He