TO:	Commissioners; TA Directors; FS Directors; Forms Coordinators; Staff Development Coordinators

FROM:	Patricia A. Stevens, Deputy Commissioner/PAS
	Division of Temporary Assistance/WMS

SUBJECT:	Correction of LDSS 4753- Request for Contact/Notice of Missed Interview

EFFECTIVE DATE:	Monday, December 31, 2001

CONTACT PERSON:	Eastern Regional Team @ 1-800-343-8859 ext. 3-1469

This is to advise districts that there was an error in the form number of the “Request for Contact/Notice of Missed Interview attachment to 01-ADM 08. Both the ADM and attachment refer to the new “Request for Contact/Notice of Missed Interview” as the  LDSS 4573. The correct form number is LDSS 4753. The notice is correctly posted on the OTDA intranet home page, LDSS E-forms link. 
Corrections are being made to 01 ADM-08,  “Changes in Food Stamp Application and Recertification Procedures and 01 ADM-16, “Transitional Benefit Alternative: Transitional Food Stamp Benefits for Family Assistance Leavers (TBA), to change all references from the LDSS 4573 to the LDSS 4753 “Request for Contact/Notice of Missed Interview”. 
Both corrected ADM’s will be posted on the OTDA intranet shortly and districts should print the corrected versions of the ADM’s and discard all old versions. 
The LDSS 4753-“ Request for Contact/Notice of Missed Interview” continues to be available through Document Services and may be ordered using the OTDA-876 Request for Forms or Publications.  Pending receipt of the supplies, districts may make photocopies of the LDSS-4753 from the OTDA intranet.