îºÔºÎ²îì²Î²Ü ̲ÜàôòàôØ
âÇ Ñ³çáÕíáõ٠ѳëï³ï»É ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ (U.S.)
ù³Õ³ù³óÇáõÃÛáõÝÁ/³ÝÓÁ ѳëï³ï»É
§Social Security Administraton¦-Ç ÙÇçáóáí
State of California - Health and Human Services Agency
Department of Health Care Services
MC 239 DRA-6 Armenian (2/10)
Notice Date: _________________________________
Case Number: ________________________________
Worker Name: ________________________________
Worker Number: ______________________________
Worker Telephone Number: _____________________
Oce Hours: _________________________________
êàôÚÜ Ì²Üàôòزش îºÔºÎ²òÜàôØ ºÜø Òº¼, àð غ¼ âÆ Ð²æàÔìàôØ Ð²êî²îºÈ Òºð ØƲòÚ²È Ü²Ð²Ü¶ÜºðÆ
ø²Ô²ø²òÆàôÂÚàôÜÀ ºì вêî²îºÈ Òºð ²ÜÒÀ §SOCIAL SECURITY ADMINISTRATION¦-Æ (SSA) ØÆæàòàì: ¸²
ìºð²´ºðàôØ ¾ кîºìÚ²È ²ÜÒ²Üò.
²Ûëï»Õ Ýß»ù ³ÝáõÝ(Ý»ñ)Á
¸³ßݳÛÇÝ ûñ»ÝùÁ å³Ñ³ÝçáõÙ ¿, áñ §Medi-Cal¦-Ç ³ÛÝ ã³½³ïí³Í ¹ÇÙáñ¹Ý»ñÁ ¨ Ýå³ëï³éáõÝ»ñÁ, áíù»ñ ³ëáõÙ
»Ý, áñ Çñ»Ýù ²ØÜ ù³Õ³ù³óÇ Ï³Ù Ñå³ï³Ï »Ý, ²ØÜ ù³Õ³ù³óÇáõÃÛ³Ý/Ñå³ï³ÏáõÃÛ³Ý ¨ ÇÝùÝáõÃÛ³Ý ³å³óáõÛó
Ý»ñϳ۳óÝ»Ý: ¸ÇÙáñ¹Ý»ñÇ ¨ Ýå³ëï³éáõÝ»ñÇ Ù»Í Ù³ëÇ ¹»åùáõÙ` ¹³ ³ñíáõÙ ¿ SSA-Ç Ñ»ï Ýñ³Ýó ïíÛ³ÉÝ»ñÁ
ѳëï³ï»Éáõ ÙÇçáóáí: ê³Ï³ÛÝ SSA-Á ãÇ Ï³ñáÕ³ó»É ѳëï³ï»É, áñ ¸áõù ²ØÜ ù³Õ³ù³óÇ Ï³Ù Ñå³ï³Ï »ù:
90 ûñí³ ÁÝóóùáõÙ ¸áõù å»ïù ¿ Ò»ñ ·áñÍáí ½µ³ÕíáÕ ßñç³Ý³ÛÇÝ ³ß˳ï³ÏóÇÝ Ò»ñ ²ØÜ ù³Õ³ù³óÇáõÃÛáõÝÁ
¨ ÇÝùÝáõÃÛáõÝÁ ѳëï³ïáÕ ÁݹáõÝ»ÉÇ ÷³ëï³ÃÕûñ ïñ³Ù³¹ñ»ù: ¸³ ³ÝÑñ³Å»ßï ¿, áñå»ë½Ç ¸áõù ß³ñáõݳϻù
ÉdzñÅ»ù §Medi-Cal¦-Ç Ýå³ëïÝ»ñ ëï³Ý³É:
• 90-ûñÛ³ ųÙÏ»ïÁ ëÏëíáõÙ ¿ ³Ûë ͳÝáõóÙ³Ý ³Ùë³ÃíÇó Ûáà ûñ³óáõó³ÛÇÝ ûñ Ñ»ïá:
• ²Ûë ͳÝáõóÙ³ÝÁ ÏÇó ï»Õ»ÏáõÃÛáõÝ ¿ áõÕ³ñÏíáõÙ ³ÛÝ Ù³ëÇÝ, û ÇÝã ÷³ëï³ÃÕûñ »Ý ÁݹáõÝ»ÉÇ: ÊݹñáõÙ
»Ýù ϳñ¹³É §²ØÜ-Ç ³ÛÝ ù³Õ³ù³óÇÝ»ñÁ, áíù»ñ ¹ÇÙáõÙ »Ý §Medi-Cal¦-Ç Ñ³Ù³ñ, å»ïù ¿ ù³Õ³ù³óÇáõÃÛ³Ý ¨
ÇÝùÝáõÃÛ³Ý ³å³óáõÛó Ý»ñϳ۳óÝ»Ý (DHCS 0001)¦ ϳ٠§ø³Õ³ù³óÇáõÃÛ³Ý ¨ ÇÝùÝáõÃÛ³Ý ³å³óáõÛóÁ. Ýáñ
å³Ñ³ÝçÝ»ñ §Medi-Cal¦-Ç ³ÛÝ Ýå³ëï³éáõÝ»ñÇ Ñ³Ù³ñ, áíù»ñ ²ØÜ ù³Õ³ù³óÇ Ï³Ù Ñå³ï³Ï »Ý (DHCS
0002)¦:
• ºÃ» Ùݳó³Í ã³÷³ÝÇßÝ»ñáí ¸áõù ѳٳå³ï³ë˳ÝáõÙ »ù ÉdzñÅ»ù §Medi-Cal¦-Ç Ýå³ëïÝ»ñ ëï³Ý³Éáõ
å³Ñ³ÝçÝ»ñÇÝ, ³å³ ³Û¹ 90-ûñÛ³ ųÙÏ»ïáõÙ ¸áõù Ïëï³Ý³ù ³Û¹ Ýå³ëïÝ»ñÁ:
• ºÃ» ßñç³ÝÁ Ò»½³ÝÇó ÁݹáõÝ»ÉÇ ÷³ëï³ÃÕûñ ãëï³Ý³, ³å³ 90-ûñÛ³ ųÙÏ»ïÇ ³í³ñïÇó Ñ»ïá Ò»ñ
Ýå³ëïÝ»ñÁ ÏÏñ׳ïí»Ý ¨ Ϲ³éÝ³Ý ë³Ñٳݳ÷³Ï Ýå³ëïÝ»ñ: ²ÛÅÙ Ù»Ýù âºÜø Ïñ׳ïáõÙ Ò»ñ Ýå³ëïÝ»ñÁ:
ºÃ» ³å³·³ÛáõÙ Ò»ñ Ýå³ëïÝ»ñÁ Ïñ׳ïí»Ý, ³Û¹ Ù³ëÇÝ Ù»Ï ³ÛÉ Í³ÝáõóáõÙ ÏáõÕ³ñÏíÇ:
ê³Ñٳݳ÷³Ï Ýå³ëïÝ»ñÁ Ý»ñ³éáõÙ »Ý ÙdzÛÝ ßï³å µáõÅû·ÝáõÃÛ³Ý, ÑÕÇáõÃÛ³Ý Ñ»ï ϳåí³Í ¨ »ñϳñ³ï¨
ËݳÙùÇ Í³é³ÛáõÃÛáõÝÝ»ñÁ: ºÃ» ¸áõù ѳÙá½í³Í ã»ù ³ÛÝ µ³ÝáõÙ, û ³ñ¹Ûáù áñ¨¿ ͳé³ÛáõÃÛáõÝ ßï³å
µáõÅû·ÝáõÃÛ³Ý, ÑÕÇáõÃÛ³Ý Ñ»ï ϳåí³Í ϳ٠»ñϳñ³ï¨ ËݳÙùÇ Í³é³ÛáõÃÛáõÝ ¿, ¹ÇÙ»ù Ò»ñ µáõÅëå³ë³ñÏáÕÇÝ:
²Ûë ѳñóÁ ϳñ·³íáñ»Éáõ ѳٳñ ¸áõù ϳñáÕ »ù ݳ¨ ¹ÇÙ»É SSA-Ç ·ñ³ë»ÝÛ³Ï: ºÃ» SSA-Á ѳٳӳÛÝÇ
÷á÷áËáõÃÛáõÝ Ï³ï³ñ»É Çñ ïíÛ³ÉÝ»ñÇ Ù»ç, áñ ¹ñ³Ýù óáõÛó ï³Ý Ò»ñ ²ØÜ ù³Õ³ù³óÇáõÃÛáõÝÁ ¨ ÇÝùÝáõÃÛáõÝÁ, ¸áõù
å»ïù ¿ ³Û¹ Ù³ëÇÝ ï»ÕÛ³Ï å³Ñ»ù Ò»ñ ·áñÍáí ½µ³ÕíáÕ ßñç³Ý³ÛÇÝ ³ß˳ï³ÏóÇÝ: ¸ñ³ÝÇó Ñ»ïá ßñç³ÝÁ ÏñÏÇÝ
ѳñóáõÙ ÏáõÕ³ñÏÇ Ò»ñ ²ØÜ ù³Õ³ù³óÇáõÃÛ³Ý ¨ ÇÝùÝáõÃÛ³Ý Ñ³ëï³ïÙ³Ý Ù³ëÇÝ:
êáõÛÝ Í³ÝáõóáõÙÁ å³Ñ³ÝçíáõÙ ¿ §Welfare and Institutions Code¦-Ç section 14011.2-Ç Ñ³Ù³Ó³ÛÝ:
