This government document is issued by Aging & Independence Services for use in San Diego County, CA
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https://www.google.com/url?client=internal-element-cse&cx=015466730696295969998:wokiau6kw8k&q=https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/ais/documents/08-2018_PSA%2520%252323%2520-%2520UPDATE%25201819%2520%2526%2520Letter%2520of%2520T%2520(Adj).pdf&sa=U&ved=2ahUKEwj6r8HN98z4AhVjkosKHUXeB6M4RhAWegQIBBAC&usg=AOvVaw0Ft1WGsYwC7iXNYUR8tf6X