Tribal Agency Name
Food Distribution Program
City, Alaska Zip
NOTICE OF ADVERSE ACTION OF INELIGIBILITY OR
REDUCTION IN FOOD DISTRIBUTION BENEFITS
This letter is to inform you that there has been a change affecting your household’s Food
Distribution Program on Indian Reservations (FDPIR) benefits. Your benefits will discontinue
. The reason(s) for this action is listed below:
State of Alaska records indicate a member of your household (name/names):
is/are receiving State of Alaska Supplemental Nutrition Assistance
Program benefits (Food Stamps). Dual participation in both FDPIR and SNAP within the
same month is prohibited.
A reported change in household income has made your household ineligible due to exceeding
FDPIR’s household income limits, and/or loss of the Shelter/Utility/Fuel Deduction.
A reported change in permanent residence has made your household ineligible due to not
meeting (your tr