When, as the result of an interim assistance agreement, the local agency receives an individual's retroactive supplemental security income (SSI) payment for initial or initial post-eligibility SSI benefits, the individual and authorized representative shall be provided written notice.

(A)The notice shall be mailed or personally delivered no later than ten working days following the local agency's receipt of the SSI payment.

(B)The notice shall contain a clear and understandable statement of the apportionment of the SSI payment and the reasons for it, cite the applicable regulations, explain the individual's right to and the method of obtaining a county conference and a state hearing, and contain a telephone number to call about free legal services.

(C)"Notice of Interim Assistance Reimbursement," JFS 07107 (rev. 4/2001), or its computer-generated equivalent, shall be used.