Notification to Food Stamps Letter

This letter is sent to Food Stamps advising them of vendors disqualified from WIC for one of the 7 WIC/Food Stamps reciprocal abuses.

This letter is generated by the Send Letter screen. The following actions display the screen to generate this letter:

• The Send button is selected on the Send Form Letters screen and the Notification to Food Stamps Letter is selected on the Send Letter screen

• The Letter Sent event is selected on the Events screen and the Notification to Food Stamps Letter is selected on the Send Letter screen.

• The Letter Sent follow-up activity is selected on the Follow-up Activities screen and the Notification to Food Stamps Letter is selected on the Send Letter screen.

Date of Termination

This value is the date of the vendor termination from the WIC program. The value comes from the Termination-Date column of the TERMDISQUALIFICATION table. The value will print in MM/DD/CCYY format.

Contract End Date

This value is the date that the vendor contract expires. The value comes from the Contract-End-Date column of the VENDOR table. The value will print in MM/DD/CCYY format.

VAddressLine1

This value is the first line of the vendor physical address. The value comes from the Address1 column of the ADDRESS table.

VAddressLine2

This value is the second line of the vendor physical address. The value comes from the Address2 column of the ADDRESS table.

VCity

This value is the city in which the vendor resides. The value comes from the City column of the ADDRESS table.

VState

This value is the State in which the vendor resides. The value comes from the StateCd column of the ADDRESS table.

VZIP Code

This value is the ZIP code in which the vendor resides. The value comes from the ZIPCode column of the ADDRESS table.

<<LetterDate>>

Recipient <<Person>>

<<Vendor>>

<<AddressLine1>>

<<AddressLine2>>

<<City>>, <<ST>> <<ZIPCode>>

SUBJECT: Notification to Food Stamps of WIC Disqualification

Dear <<Salutation>> <<LastName>>:

This is to inform you that the following WIC/Food Stamps store has been disqualified from the WIC program effective <<Date of Termination>> through <<Contract End Date>>.

<<Vendor>>

<<VAddressLine1>>

<<VAddressLine2>>

<<VCity>>, <<VState>> <<VZIPCode>>

It is our judgment (as documented in the enclosed disqualification notice) that disqualification from WIC was based on the violations outlined in Section 278.1 (O) of the Food Stamp Program Retailer Regulations.

We are sending this information in accordance with Section II.D. of the WIC/Food Stamp Agreement. Also enclosed is a copy of the vendor disqualification letter, vendor agreement, and decision rendered by the Appeals Board. We hope it will assist you in making a determination regarding withdrawal of FSP authorization.

If you have any questions regarding this disqualification action or require further documentation, please contact me at the State WIC Program at (000) 000-0000.

Sincerely,

WIC Coordinator Name

Coordinator

State WIC Services

cc:USDA

SC/<<userid>>

Enclosures