(b) If the eligibility agency determines a family eligible for subsidy upon initial application, at the time of redetermination or at a review of a reported change, the written notification must include all of the following:

1. (1) The amount of the copayment.
2. (2) The parent’s or caretaker’s responsibility to pay the copayment as specified in § 3042.91(e) (relating to general copayment requirements).
3. (3) The parent’s or caretaker’s responsibility to report changes as specified in § 3042.86 (relating to change reporting and processing).
4. (4) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
5. (5) The right of the parent or caretaker to appeal the decision and how to appeal as specified in § § 3042.152 and 3042.161 (relating to notice of right to appeal; and appealable actions).