1. Your monthly payment of $amount for your prescription co-pays will be reduced to $amount effective mm/dd/yy based on the reduced monthly costs you provided on mm/dd/yy. 2. Your monthly payment of $amount for a personal incidental and room and board allowance will be reduced to $amount effective mm/dd/yy because of you have had an increase in your countable income. Special Needs Denial 1. You are not eligible to receive a payment for food for your guide dog or special assistance animal because your animal is a companion animal and has not been specifically trained to perform tasks to meet your specific medical needs or specific physical tasks that you are unable to do in order to sustain your independence. 2. You are not eligible for a monthly laundry allowance of $insert amount because: You do not receive SSI and your adjusted income is not below the OSIPM income standard You do not receive OSIPM You do not have proven excessive coin-operated laundry facility costs You have moved to a location where laundry service is provided to you for no charge or you have your own laundry facilities 3a.
1. Your monthly payment of $amount for your prescription co-pays will be reduced to $amount effective mm/dd/yy based on the reduced monthly costs you provided on mm/dd/yy. 2. Your monthly payment of $amount for a personal incidental and room and board allowance will be reduced to $amount effective mm/dd/yy because of you have had an increase in your countable income. Special Needs Denial 1. You are not eligible to receive a payment for food for your guide dog or special assistance animal because your animal is a companion animal and has not been specifically trained to perform tasks to meet your specific medical needs or specific physical tasks that you are unable to do in order to sustain your independence. 2. You are not eligible for a monthly laundry allowance of $insert amount because: You do not receive SSI and your adjusted income is not below the OSIPM income standard You do not receive OSIPM You do not have proven excessive coin-operated laundry facility costs You have moved to a location where laundry service is provided to you for no charge or you have your own laundry facilities 3a.
G9_English.docx