HAR §17-685.4-3. electronically or via the U

S. postal service. If the tenth calendar day falls on a weekend or holiday, then the household unit may submit the attestation the next business day. The attestation shall include the following information: (1) Full name of the head of the household unit; (2) The household unit's case number and the client identification number of the affected household member if the stolen benefits include child care subsidy or FTW supportive service payments; (3) The last four digits of the social security number for the head of the household unit; (4) The last four digits of each EBT card number given to the household unit; (5) The household unit's address and telephone number; (6) The date of discovery of the electronic benefits theft; and (7) Description of loss or theft of benefits, including the name and address of the retailer or ATM, if applicable. (d) The attestation shall be signed by the head of the household unit and acknowledges that: (1) The household unit's benefits replacement claim may be approved or denied; (2) There is a limit to the amount of benefits that may be replaced; (3) The household unit has the right to request an administrative hearing if the household unit does not agree with the department's denial of a claim for replacement of stolen benefits; and (4) Under penalty of law that all information as stated on the attestation and any other information submitted is true and correct. (e) The household unit shall be provided up to ten calendar days from the date of the department's request to provide additional information or evidentiary support of its electronic benefits theft claim. If the tenth calendar day falls on a weekend 685.4-6 3606