55 Pa. Code § 3042.158 – Notice confirming a change in copayment.

(a) The eligibility agency shall, by written notice to the parent or caretaker, confirm a change in the family copayment amount.
(b) The notice confirming a change in copayment must be on a form provided by the Department.
(c) The written notice confirming a change in copayment must include all of the following:
1. (1) The decision.
2. (2) The reason for the decision.
3. (3) A citation, and brief explanation in simple, nontechnical language, of the applicable section of this chapter or other applicable law that was the basis for the decision.
4. (4) The amount of the copayment and the date the change in copayment will become effective.
5. (5) The name, address and telephone number of the local legal services office where the parent or caretaker may obtain free legal representation.
6. (6) 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).