CalWORKs Policy Handbook - Department of Human Services ...

CalWORKs 

Policy Handbook 

San Bernardino County

County of San Bernardino Human Services 

INTERIM INSTRUCTION NOTICE #13-021 

SUBJECT: SAWS 2 Case Correction List 

APRIL 18, 2013 

DISTRIBUTION: CalWORKs and CalFresh FILE: CalWORKs: In Front of Handbook 

CalFresh: In Front of Handbook 

OBSOLETE: May 31, 2013 

Overview In 9/12, System Change Request (SCR) 43654 was released by C-IV and 

changed how a Statement of Facts (SAWS 2) was saved in C-IV. 

Previously, staff could generate the form and it would save to a case 

automatically. Upon the release of this SCR, staff must generate the 

SAWS 2 and click the Save and Print Locally button at the bottom of the 

form in order to save it. Staff should not select the Print icon at the top of the 

page, as this only prints the form and does not save it. 

Corrective 

action and 

case list 

An issue has been identified with cases that have a missing SAWS 2 

(SAWS 2 was not saved when completed at application or Re-Evaluation 

(RE)/Recertification (RC)). These cases require corrective action by 

4/30/13. A SAWS 2 must be generated and saved in cases that have a(n): 

Application date in: 

– 4/13, or 

– 9/12 – 3/13 for Annual Reporting/Child Only (AR/CO) and Change 

Reporting cases. 

RE/RC due in: 

– 4/13, or 

– 9/12 – 3/13 for AR/CO and Change Reporting cases. 

A list of cases needing review and correction, titled “Missing SAWS 2,” is 

posted on the C-IV Resource Center; this list contains the following tabs: 

Applications – 1,381 cases. 

REs – 877 cases. 

Continued on next page 

IIN #13-021 (04/13) DM:EK:kc PAGE 1 OF 2

INTERIM INSTRUCTION NOTICE #13-021, Continued 

Case 

reconciliation 

Eligibility Workers (EWs) must review the cases on the “Missing SAWS 2” list 

and complete all actions as described below by 4/30/13. 

Step Action 

1 Review the Distributed Documents for the most recent application 

or RE/RC, and: 

If a SAWS 2 has… Then… 

Not been saved, Go to Step 2. 

Been saved, Go to Step 5. 

2 Generate a SAWS 2 as follows: 

Click Document Control on the Global Navigation Bar; the 

Template Repository Search page will appear. 

Enter SAWS 2 in the Form Number field and click Search. 

Click on Statement of Facts. 

Select the appropriate Customer Name and Program from the 

drop down boxes. 

Click Generate Form. 

3 Click the Save and Print Locally button at the bottom of the page. 

4 Close the “saved” SAWS 2 without printing it. 

5 Journal all actions taken. For cases requiring SAWS 2 generation, 

refer to the “Journal script” block in this Interim Instruction Notice (IIN) 

for the required verbiage. 

Journal script After generating a SAWS 2 to correct a case on the “Missing SAWS 2” list, the 

following verbiage must be included in the Journal entry: 

Tab Journal Entry 

Applications “Due to a missing SAWS 2 at application, a SAWS 2 was 

generated and saved this date for application (insert 

application date here).” 

REs “Due to a missing SAWS 2 at RE/RC, a SAWS 2 was 

generated and saved this date for the RE/RC completed 

(insert RE/RC month here).” 

Questions Questions regarding the information contained in this IIN should be directed 

to: Erika Kleespies, Program Specialist (PS) I at (909) 383-9709 or via e-mail 

at ekleespies@hss.sbcounty.gov. 

IIN #13-021 (04/13) DM:EK:kc PAGE 2 OF 2



APRIL 2, 2013 

SUBJECT: Administrative Transition From KidsNCare (KNC) to Child Care Resource 

Center (CCRC) 

DISTRIBUTION: Child Care, TAD Office 

Procedures, CalWORKs, 

Employment Services and 

Children & Family Services 

FILE: In Front of CCPHB, TOPHB, 

CWPHB, ESPHB and CFSHB 

OBSOLETE: 5/31/2013 

Overview This Interim Instruction Notice (IIN) provides information regarding the change 

in the administration of California Department of Education (CDE) Child Care 

programs in San Bernardino County from KidsNCare (KNC) to Child Care 

Resource Center (CCRC). 

CCRC Effective 4/12/13, KNC will no longer administer Child Care (CC) services to 

San Bernardino County. Beginning 4/15/13, CCRC will assume administrative 

responsibilities for the CDE contract of Stage Two, Stage Three and 

Alternative Payment (AP) CC programs and Resource and Referral (R&R) 

duties for San Bernardino County. CCRC will accept Stage One transfer 

packets from San Bernardino County Transitional Assistance 

Department (TAD) and allocate a percentage to the Pomona Unified School 

District (PUSD). 

CCRC 

locations and 

hours 

Stage One to 

Two transfers 

Additional 

information 

CCRC will retain the following office locations and office hours: 

1111 Mill Street, Suite 100, 

San Bernardino, CA 92408 

Hours: 8:00am to 5:00pm 

14397 Amargosa Road, 

Victorville, CA 92392 

Hours: 8:00am to 5:00pm 

Note: CCRC will not utilize the KNC Rancho Cucamonga office location. 

All Stage One to Stage Two transfers for the month of April must be 

completed as soon as possible. The Stage One CalWORKs Discontinued 

Report will be posted on the C-IV Resource Center for TAD staff on 4/4/13. 

Staff must review, complete and process Stage One transfers no later 

than 4/10/13. 

Note: These transfers will be sent to current KNC addresses, including the 

Rancho Cucamonga office location. 

Additional information regarding the change in CC administration will be 

issued prior to 5/1/13. 


IIN #13-019 (03/13) DM:SS:ker PAGE 1 OF 2


Questions Questions regarding the information contained in this IIN should be directed 

to: Steven Sablan, Program Specialist (PS) I at (909) 383-9860, or via 

e-mail at ssablan@hss.scounty.gov. 

IIN #13-019 (03/13) DM:SS:ker PAGE 2 OF 2



MARCH 12, 2013 

SUBJECT: Electronic Benefit Transfer (EBT) Electronic Theft 

DISTRIBUTION: CalWORKs and 

Quality Review Unit 

FILE: CWPHB – In Front of Handbook 

QRUHB – In Front of Handbook 

REFERENCE: Assembly Bill 2035 

OBSOLETE: April 30, 2013 

Overview This Interim Instruction Notice (IIN) provides information regarding Electronic 

Benefit Transfer (EBT) electronic theft. 

The California Department of Social Services (CDSS) issued interim 

instructions for restoring EBT CalWORKs benefits lost due to electronic theft 

as mandated by Assembly Bill (AB) 2035. AB 2035 requires the prompt 

restoration of lost benefits, effective 1/1/2013. 

CDSS will release detailed instructions at a later date, which will include: 

Notice of Action language, 

Claiming and tracking process, and 

Implementation regulations. 

Definition Electronic theft occurs when a customer has not lost physical possession of 

his/her EBT card and money is stolen electronically from the EBT account 

(also called skimming). 

Interim 

process 

During the interim process, the customer is required to file a police report and 

complete form TEMP 2259 - Report of Electronic Theft of Cash Aid. The 

police report information will be included on the TEMP 2259. The customer 

is not required to attach a copy of the police report to the TEMP 2259. 

Counties may process the TEMP 2259 without the filing of a police report if: 

There is good cause for the police report or the police report number not 

being submitted, and 

CDSS has been consulted and approves the good cause. 

Note: Some police departments will only provide a police report number and 

not the actual report to the customer. 

CDSS contact When a customer completes the TEMP 2259 to request a restoration of stolen 

EBT benefits, the following CDSS staff will be contacted: 

Lucy Hildebrand at (916) 653-8421 or Lucy.Hildebrand@dss.ca.gov, or 

Daniel Brown at (916) 651-0674 or Daniel.Brown@dss.ca.gov. 

IIN #13-007 (03/13) DM:KA:gq PAGE 1 OF 4



Claim process The following process will be utilized when a customer reports possible 

electronic theft: 

Stage Description 

1 Customer: 

Calls the toll-free EBT Customer Service Helpline at 

(877) 326-9677 to file a Cash dispute claim, or 

Contacts the Eligibility Worker (EW). 

If the customer 

contacts the… 

Then the… 

EBT Customer Customer Service Representative will: 

Service Helpline, Explain the reporting process to the 

customer and refer the customer to the 

county for completion of the 

TEMP 2259 form, 

Deactivate the customer’s EBT card, and 

Issue a new card. 

EW, EW will: 

Explain the reporting process, 

Explain how to file a police report, 

Inform the customer benefits will not be 

replaced if the: 

– Card was lost or stolen, and/or 

– Personal Identification Number (PIN) 

and/or EBT card number was given to 

anyone, 

Provide the TEMP 2259 form to the 

customer for completion, 

Inform the customer to contact the EBT 

Customer Service Helpline to file a claim, 

Deactivate the customer’s card, and 

Issue a replacement card. 

2 Customer: 

Files a police report, 

Obtains a police report number, and 

Completes the form TEMP 2259. 

3 EW: 

Ensures the TEMP 2259 is completed correctly, 

Images the form and police report (if provided) into C-IV as: 

Document Category Type 

TEMP 2259 File EBT 

Police Report File Police Report 

Notifies Marlisa Stanton in the Program Integrity Division (PID) via 

e-mail the: 

– TEMP 2259 and police report (if provided) were received and 

imaged, and 

– Imaging location of the documents. 



Claim process (continued) 

Restoration of 

benefits 

process 



4 PID: 

Contacts CDSS to inform them of the claim (see “CDSS 

contact” block in this IIN), 

Monitors the status of the claim via Electronic Payment 

Processing and Information Control (EPPIC) or the Statewide 

Automated Reconciliation System (SARS) Claim Activity 

Report , and 

Restores benefits, as appropriate: 

– Immediately after Xerox’s denial of the claim has been 

received, or 

– Within 15 days of the receipt of the TEMP 2259 form, 

whichever is later. 

Note: Staff requiring assistance within EPPIC should refer to 

page 9-23 of the EPPIC Administrative User Guide located on the 

Program Development Division (PDD) Publications Portal for 

contact information. 

PID will check EPPIC or SARS daily to determine if the claim to restore 

stolen EBT benefits has been denied or approved by Xerox, and: 

If the claim is… Then PID will… 

Approved, Not restore benefits to the 

customer’s EBT card. 

Denied within the 15 business days 

after submission of the TEMP 2259, 

Not approved or denied within 15 

business days after submission of 

the TEMP 2259, 

Note: The customer will receive an 

automated call from Xerox informing 

him/her that the EBT account has 

been credited. 

Restore benefits to the customer’s 

EBT card immediately, if applicable. 

Restore benefits to the customer’s 

EBT card no later than the 15 th 

business day after submission of the 

TEMP 2259, if applicable. 

Overpayment In the event the customer’s claim is approved by Xerox and the customer’s 

benefits are restored by the county (customer receives duplicate payment), 

PID will compute an administratively caused overpayment for the duplicated 

issuance. 



Interim Instruction Notice #13-007, Continued 

Case Flag The Case Flag “2035 Payment” must be set on all cases in which benefits 

were restored by the county for electronic theft. 

Questions District Managers (DMs) with questions regarding this IIN may contact Karen 

Akparanta, Program Specialist (PS) I at (909) 383-9673 or 

kakparanta@hss.sbcounty.gov. 




JANUARY 24, 2013 

SUBJECT: Annual Reporting/Child Only (AR/CO) CalWORKs Cases – Phase 2 

DISTRIBUTION: CalWORKs, CalFresh FILE: CalWORKs: In Front of Handbook. 

CalFresh: In Front of Handbook 

REFERENCE: ACL 12-49 

OBSOLETE: When Information is Added 

to Handbook. 

Overview C-IV will release SCR 45912 – Implementation of Annual Reporting Child 

Only (AR/CO) Cases – Phase 2 on 1/28/13 to add functionality for 

automation of the AR/CO policy. This SCR will: 

Add the validation “Cannot run [Program] EDBC with [Run Reason] run 

reason” to the Run EDBC page when the: 

– QR 7 or QR 7/RE run reasons are selected for a month in which the 

CalWORKs program is Annual Reporting (AR) with a reporting reason 

of Child Only, and 

– QR 7, QR 7/RE, Elect regular/QR 7 or Elect Regular/QR 7/RE run 

reasons are selected for a month in which the CalFresh program is 

Change Reporting (CR), 

Update Notices of Action (NOAs) to include CalWORKs AR budget 

information, 

Add No Change NOAs for CalWORKs AR and CalFresh, 

Add the following forms to the template repository: 

– AR 2 – Reporting Changes For CalWORKs and CalFresh, 

– AR 3 – Mid-year Status Report For CalWORKs and CalFresh, and 

– NA 1239 AR – Notice of Action (Continued) Annual Reporting Budget, 

Skip benefits when the CalWORKs AR Re-Evaluation (RE) is not 

complete, and 

Allow CalWORKs mid-period changes to adjust grant amounts. 

The AR Income Reporting Threshold (IRT) will not be implemented in C-IV 

with the release of SCR 45912. The IRT will be implemented at a later date. 

The CalWORKs AR Notices of Action (NOAs) will not include the IRT 

amounts until the IRT functionality has been automated in C-IV. Eligibility 

Workers (EWs) will continue to send the AR 2 - Reporting Changes for 

CalWORKs and CalFresh to notify the customer of his/her IRT. 


IIN #13-005 (01/13) DM:KA:deg PAGE 1 OF 3


Mid-period 

decreases for 

household 

composition 

changes 

EDBC 

validation 

QR 7 

requirement 

when 

transitioning 

from AR to QR 

AR/CO customers are required to report changes in household composition. 

With the implementation of SCR 45912, decreases in CalWORKs benefits due 

to household composition changes will take effect mid-period, as appropriate. 

AR/CO cases do not require a QR 7; therefore, CalWORKs and CalFresh 

Eligibility Determination and Benefit Calculations (EDBCs) cannot be run with 

a QR 7 or QR 7/RE Run Reason. With the implementation of SCR 45912, 

the validation “Cannot run [Program] EDBC with [Run Reason] run reason” 

will display on the Run EDBC page when the: 

QR 7 or QR 7/RE run reason is selected for a month in which the 

CalWORKs program is AR with a reporting reason of Child Only, and 

QR 7, QR 7/RE, Elect Regular/QR 7 or Elect Regular/QR 7/RE run 

reason is selected for a month in which the CalFresh program is Change 

Reporting (CR). 

The skipped issuance logic will be modified to begin requiring a QR 7 for a 

Quarterly Reporting (QR) CalWORKs Assistance Unit (AU) the first Submit 

Month following the month the AU transitions to QR. 

When the CalWORKs program transitions from AR to QR within the previous 

three months, the associated CalFresh program will not skip for an 

incomplete QR 7. 

Example: The AU’s quarter is July, August and September. The AU 

transitions from AR to QR on June 1 st . A QR 7 will be required for the Submit 

Month of September. 




Re-Evaluations/ 

Recertifications 

Forms and 

Notices of 

Action 

AR/CO cases require annual reporting via a Re-Evaluation (RE) and/or 

Recertification (RC). With the implementation of SCR 45912, a skipped 

issuance reason will be added for the CalWORKs program when the annual 

redetermination is not completed by the end of the RE due month. The 

following will be added: 

The CalWORKs issuance will skip when the latest RE month on the 

CalWORKs program is prior to the benefit month which is being issued. 

Only routine issuances will skip. 

The skipped issuance reason will state “CalWORKs 

Determination/Redetermination Not Complete”. 

The skipped issuance for REs not completed by the end of the due month 

applies to all CalWORKs cases (QR and AR). Benefits may be rushed when 

CalWORKs benefits are skipped for non-completion of the RE and the RE 

is/has been completed. 

AR budget information will be added to CalWORKs NOAs, and the following 

forms have been added to the template repository: 

Form Use 

AR 2 – Reporting Changes for Informs the customer of his/her IRT 

CalWORKs and CalFresh 

and reporting requirements. 

AR 3 – Mid-year Status Report for Customer completes to report 


mandatory or voluntary changes. 

Note: AR/CO cases with CalFresh 

must be provided the 

DFA 377.5 - CalFresh Household 

Change Report instead of the AR 3 

to report changes. 

Questions District Managers (DMs) with questions regarding this Interim Instruction 

Notice (IIN) may contact Karen Akparanta, Program Specialist (PS) I at 

(909) 383-9673 or kakparanta@hss.sbcounty.gov. 




DECEMBER 17, 2012 

SUBJECT: Annual Reporting/Child Only (AR/CO) Combined Instructions 

DISTRIBUTION: CalWORKs, CalFresh FILE: CWPHB – In Front of Handbook 

Overview This Interim Instruction Notice (IIN): 

CFPHB – In Front of Handbook 


OBSOLETE: When information is added 

to the handbooks 

Provides revised information regarding the policy for Annual 

Reporting/Child Only (AR/CO) CalWORKs cases, which was effective 

10/1/12, and 

Incorporates information regarding temporary instructions for required 

action on AR/CO cases into one IIN; these instructions were previously 

provided in the following IINs, which are now obsolete: 

- #12-059, 

- #12-060, and 

- #12-063 ERRATA. 

AR/CO case An AR/CO case is a case in which all adults in the Assistance Unit (AU) are: 

Timed-out, 

Drug felons, fleeing felons, or in violation of probation or parole, 

Ineligible due to citizenship status, 

Ineligible due to failure to provide a Social Security Number, 

Receiving Supplemental Security Income (SSI), 

Non-needy caretaker relatives, 

Strikers, 

Ineligible due to an Intentional Program Violation (IPV) conviction prior to 

July 1998, or 

Sanctioned for failure to comply with program requirements other than 

Welfare-to-Work (WTW). 


IIN #12-074 (12/12) DM:KA:ts PAGE 1 OF 29


Cases not 

considered 

AR/CO 

C-IV 

implementation 

Cases that are not considered AR/CO cases contain one or more adults and 

all adults are: 

Subject to a WTW sanction, 

Penalized, where the adult remains in the AU; however, his/her portion of 

the grant is removed (e.g. immunization/school attendance penalties), or 

An aided step-parent, Registered Domestic Partner (RDP) or optional 

person. 

C-IV is implementing the AR/CO policy in two phases: 

Phase One – Implemented on 10/24/12 with the release of SCR 45986, 

and 

Phase Two – Scheduled for implementation on 1/28/13 with the release of 

SCR 45912. 

Contents This IIN contains the following topics: 

Topic See Page 

C-IV Implementation: Phase One 3 

C-IV Implementation: Phase Two 9 

Reporting Requirements 10 

Requests for Discontinuance and County Initiated 

15 

Actions 

Income Budgeting 16 

Interface Between CalWORKs and CalFresh Cases 22 

Case Movement 24 

Conversion 27 


C-IV Implementation: Phase One 

Introduction C-IV implemented Phase One of the CalWORKs Annual Reporting/ 

Child Only (AR/CO) policy with the release of SCR 45986 on 10/24/12. SCR 

45986 updated the system with an alternate procedure until the full automation 

of AR/CO is implemented. Phase One: 

Eligibility 

Worker (EW) 

requirements 

Added the Reporting Type of Annual Reporting for CalWORKs. 

Updated the Eligibility Determination and Benefit Calculation (EDBC) 

to determine: 

- Annual Reporting with a Reporting Type Reason of Child Only, 

- Change Reporting with a Reporting Type Reason of Annual Reporting 

CalWORKs, and 

- Allowed EDBC override of the reporting type (from Quarterly Reporting 

(QR) to AR). 

Changed Active CalWORKs cases meeting the AR/CO criteria in October 

and November from QR to AR and the associated CalFresh program to 

Change Reporting (CR). 

Changed Active CalWORKs cases no longer meeting the AR/CO criteria in 

November 2012 to QR and the associated CalFresh program to QR, as is 

appropriate. 

In Phase One, Eligibility Workers (EWs) were required to: 

Take no action on the QR 7 Status for QR 7s mailed for the October 

Submit Month on cases identified as AR and CR. 

Re-run CalWORKs/CalFresh EDBC for the benefit month12/12 before 

12/20/12 on cases in which a 12/12 EDBC existed prior to 10/24/12. 

(Re-running the EDBC updated the Reporting Type and Reporting Type 

Reason.) 

Complete manual budgets for AR/CO cases receiving CalFresh benefits 

that reported a change and override the EDBC as needed. 

Override the EDBC as needed for cases affected by the Income Reporting 

Threshold (IRT) levels. 

Complete manual Notices of Action (NOAs) to inform customers of the 

new IRT amount. 



C-IV Implementation: Phase One, Continued 

Action on 

Intake cases 

prior to 

10/24/12 

EWs were instructed to take the following action on CalWORKs applications 

meeting the AR/CO criteria prior to 10/24/12: 

Step Action 

1 Review new applications taken 10/1/12 and ongoing for AR/CO 

eligibility. 

2 Screen for eligibility to Immediate Need (IN), Expedited 

Determination of Eligibility (EDE) and Expedited Services (ES). 

Issue IN, EDE and ES per current policy, and: 

If ES is issued… Then… 

With postponed 

verification, 

Without 

postponed 

verification, 

Reject the C-IV generated Notice of 

Action (NOA), 

Complete NOA DFA 377.1 QR indicating 

a one or two month certification period, 

based on the application date (see 

CFPHB page 1-43.1), and 

Correct the RC date in C-IV to one or two 

months. 

Accept the C-IV generated NOA. 

3 Complete: 

Intake interview, 

All appropriate Detail pages in C-IV, and 

Request for required verification per current policy. 

Note: If case is ready to work, do not run Eligibility 

Determination and Benefit Calculation (EDBC) until additional 

policy is provided. 

4 Set Case Flag, titled “AR/CO Case”. 

5 Journal actions taken, including the following: 

AR/CO determination, 

Outstanding verification, and 

Potential income. 

6 Assign case to designated AR/CO EW. 




Action on 

Intake cases 

effective 

10/24/12 

Re-Evaluations/ 


(REs/RCs) and 

QR 7s due in 

10/12 

Effective 10/24/12, intake cases meeting the AR/CO criteria were processed. 

When EDBC was run, C-IV identified the Reporting Type as: 

AR for the CalWORKs program, and 

CR for the associated CalFresh program. 

In the event the correct Reporting Type was not identified when EDBC was 

run, the EW was to take the following action: 

Step Action 

1 Override the Program Configuration. 

2 Select Annual or Change from the Reporting Type drop-down box 

as appropriate. 

3 Select Child Only or Annual Reporting CalWORKs from the 

Reporting Type Reason drop-down box as appropriate. 

4 Complete and send NOA to the customer. 

5 Journal all actions taken. 

Effective 10/3/12, the following instructions for taking action on QR 7s and the 

Re-Evaluations (REs) due in the month of 10/12 were provide: 

Step Action 

1 Review the RE to determine if the case meets the AR/CO criteria 

listed above, and: 

If the case is… Then… 

An AR/CO case, Go to Step 2. 

Not an AR/CO, Process the QR 7 and RE 

according to current policy. 

2 Complete: 

RE interview, 

All appropriate Detail pages in C-IV, and 

Request for required verification per current policy. 

Note: If case is ready to work, do not run EDBC until 

additional policy is provided. 

3 Have the customer complete the QR 7 (accept the QR 7 even if 

the customer does not have necessary required pay verification). 


5 Complete the RE Journal, including the following: 



Income determination. 




QR 7 due 10/12 

(no RE) – 

received 

complete 

procedure 

Effective 10/3/12, EWs were instructed to use the following procedure when 

processing a Complete QR 7 due in 10/12 when the RE was not due in 

10/12. 

Step Action 

1 Review the case and QR 7 to determine if the case meets the 

AR/CO criteria listed above, and: 



Not an AR/CO, Go to Step 3. 


3 Process the QR 7 according to current policy. 








QR 7 due 10/12 

(no RE) – 

received 

incomplete 

procedure 

Effective 10/3/12, the following instructions were provided for processing an 

Incomplete QR 7 due in 10/12 when the RE was not due in 10/12. 

Step Action 

1 Review the case and QR 7 to determine if the case meets the 

AR/CO criteria listed above, and: 



Not an AR/CO, Process the incomplete QR 7 

per current policy, and 

Go to Step 4. 

2 Determine the reason the QR 7 is incomplete, and: 

If the QR 7 is incomplete 

due to… 

A change in income or 

household composition, 

A reason other than an 

income or household 

composition change, 






Then… 

Do not send the NA 960 Y, 

Send the VER 100 – 

Verification Request List and 

allow the customer 10 days to 

provide the required 

verification, 

Identify the QR 7 status in C- 

IV as Received, 

Set the following Task: 

Verif Due, and 

Go to Step 3. 

Process the QR 7 as if 

complete, and 

Go to Step 3. 




Processing 

10/12 

QR 7 due 10/12 

(no RE) – 

received 

incomplete 

procedure 

On 10/12/12, a list of AR/CO cases with 10/12 REs/RCs identified was posted 

on the C-IV Resource Center and EWs were instructed to take the following 

action: 

Step Action 

1 Review the cases on the list with a RE due, and 

If the RE interview has… Then… 

Been completed, Go to step 2. 

Not been completed, Take action according to 

established policy. 

Note: If the RE is 

completed by the end of the 

month, proceed to Step 2. 

2 Evaluate the case for receipt of earned income, and 

If the Assistance Unit (AU) has 

earned income and… 

Then… 

Receives CalFresh benefits, Certify the CalFresh 

program for 6 months 

according to established 

Change Reporting (CR) 

policy, 

Send a DFA 377.5 - 

CalFresh Household 

Change Report to the 

customer, and 

Set the CalWORKs RE 

period for 12 months. 

Does not receive CalFresh Set the CalWORKs RE 

benefits, 

period for 12 months, and 

Send the AR 3 - 

Mid-Year Status Report 

For Cash Aid and 

CalFresh to the 

customer. 

Note: When the AU does not receive earned income or receives 

unearned income only the RE period is set for 12 months, and the 

RC period is set for 12 months, or 24 months when all adults in the 

CalFresh household are elderly or disabled. 

3 Process the RE/RC according to established policy. 

4 Send the DFA 377.5 or AR 3 to the customer as appropriate. 

5 Set the “AR/CO Case” case flag. 

6 Journal actions taken. 




Continuing 

cases 

With the release of SCR 45986 on 10/24/12, the Reporting Type for cases 

identified as AR/CO was changed to AR and the associated CalFresh cases 

was changed to CR. Because of the AR/CO Reporting types, cases will no 

longer discontinue for incomplete or no QR 7. Additionally, QR 7s will not be 

sent for AR/CR cases. 


C-IV Implementation: Phase Two 

Phase Two: 

effective 

1/28/13 

Phase Two will be implemented with the release of SCR 45912 on 1/28/13 

and will include: 

New IRT levels for CalWORKs and CalFresh, 

Update to the CalWORKs Eligibility Determination and Benefit Calculation 

(EDBC) that will allow changes in household composition to take effect 

during the Annual Reporting (AR) period (Annual Reporting/Child Only 

(AR/CO) cases only), and 

New forms and Notices of Action (NOAs) for the AR/CO policy added. 


Reporting Requirements 

Introduction Effective 10/1/12, Annual Reporting/Child Only (AR/CO) cases and CalFresh 

cases associated to these AR/CO cases are not subject to Quarterly 

Reporting (QR) requirements; therefore, a QR 7 is not required and will no 

longer be generated for these cases. Customers are required to report once 

a year by completing an annual Re-Evaluation/ Recertification (RE/RC). The 

associated CalFresh cases are required to report per Change Reporting (CR) 

rules. 

Re-Evaluation/ 

Recertification 

In AR/CO cases, the RE/RC must be completed in month 12, the final month 

of the AR/CO benefit period. Information regarding the RE/RC forms and any 

additional information provided by the Assistance Unit (AU) will be used to 

determine continuing eligibility and future benefit amounts based on all 

eligibility conditions. 

During the RE/RC interview, the Eligibility Worker (EW) must ask the 

customer about any known changes to the income reported on the SAWS 2 - 

Statement of Facts and request verification to ensure that the correct income 

is used to prospectively budget benefit and grant amounts for the annual 

benefit period. EWs will Journal all factors used in determining current 

income along with any reasonably anticipated changes. 

EWs will inform customers about: 

CalFresh CR requirements during the certification period and provide the 

DFA 377.5 – CalFresh Household Change Report to the customer, and 

Reporting decreases in income along with providing verification of the 

decrease any time throughout the year so that benefits may be 

recalculated and increased if appropriate. 

Example: An AR/CO case has a RE/RC due in January 2013. During the 

RE/RC, the customer reports and verifies earned income on the RE/RC forms 

and does not anticipate any changes to the income. The EW would use this 

income information to determine the grant allotment amount for the following 

annual AR/CO benefit period, which begins February 1, 2013. The new 

AR/CO benefit period will be February 2013 through January 2014. The new 

CalFresh RC period will be February 2013 through July 2013, because the 

customer has earned income (see the “Recertification for CalFresh 

households associated with the AR/CO case” block in this section of the IIN). 



Reporting Requirements, Continued 


for CalFresh 

households 

associated 

with the AR/CO 

case 

Mandatory 

mid-year 

report: AR/CO 

CalFresh households associated with CalWORKs AR/CO cases are subject to 

Change Reporting (CR) requirements. CR households with earned income 

are required to be certified for a six-month period. Customers will be 

recertified for six months following the RE/RC. 

CalFresh households associated with AR/CO cases in which all adult 

members are elderly or disabled that are assigned 24-month certification 

periods are not impacted. These CalFresh households will continue to be 

certified for 24 months. The 12 th month contact required for these cases will 

be met when the AR/CO CalWORKs RE is completed. 

The chart below explains the different CR certification periods: 

If the CR CalFresh Household 

has… 

Then the Certification Period is… 

Earned income, Six months. 

No income, or 

12 months. 

Unearned income only, 

All elderly or disabled adult 

24 months (With contact required at 

members, 

12 months, which can be met at the 

CalWORKs RE). 

AR/CO customers are required to report the following mid-year changes, 

verbally or in writing, within 10 days of the change: 

Income exceeding the Income reporting threshold (IRT), 

Address changes, 

Changes in household composition, 

Drug felony convictions, 

Fleeing felon status, or 

Violations of conditions of probation or parole. 

Customers may use the AR 3 – Mid-Year Status Report For Cash Aid and 

CalFresh to report changes that occur since the last RE/RC in writing during 

the year. 




Mandatory 

mid-year 

reports: QR vs 

AR 

Action on 

mandatory 

mid-year 

reports: AR/CO 

AR/CO customers must report mandatory mid-year changes within 10 days. 

The table below provides a comparison of the mandatory reporting 

requirements for CalWORKs QR and Annual Reporting (AR). 

QR - CalWORKs AR/CO - CalWORKs 

Income exceeding the IRT, 




Violations of conditions of 

probation or parole. 




Fleeing felon status, 


probation or parole, or 

Changes in household 

composition. 

Note: In addition to previous mandatory reports, AR/CO customers must now 

report changes to household composition. 

EWs must take action on all mandatorily reported changes. Customers 

determined to be ineligible based on an increase in income over IRT or a 

change in household composition are discontinued with a 10-day Notice of 

Action (NOA), effective the end of the month in which the change occurred. 

When a customer’s grant would decrease based on an increase in income 

over IRT or a change in household composition: 

Decrease the grant with a ten-day NOA for the remainder of the RE/RC 

period effective the first of the month following the month in which the 

change occurred, and 

Compute an overpayment when a 10-day NOA for the first of the month 

following the month in which the change occurred cannot be provided. 

Reports of an increase in income over IRT or a change in household 

composition during the RE/RC in month 12 must be used to determine the 

grant amount for the following RE/RC period. 




Mandatory 

mid-year 

reports: 

Change 

Reporting (CR) 

Voluntary 

mid-year 

reports 

In accordance with CalFresh CR rules, AR/CO cases also receiving CalFresh 

benefits must report the following changes: 

Increase or decrease in earned income of $100 or more. 

Increase or decrease of unearned income of $50 or more. (Exception: 

CalWORKs, General Relief and/or Social Security Cost of Living 

Adjustments (COLAs)). 

Household composition, such as someone moves into or out of the home. 

Address changes and resulting changes in shelter expense. 

Amount of child support payments made to a non-household member, 

and/or a change in the legal obligation to pay child support. 

Additionally, CR customers must report when any household member is a: 

Fleeing felon, and/or 

Drug felon (convicted of a drug-related felony after August 22, 1996 for 

manufacturing, sale or distribution of a controlled substance(s). 

Customers may voluntarily report, verbally or in writing, any changes which 

may increase their CalWORKs grant or CalFresh benefits. If a decrease in 

income is reported mid-year, EWs must redetermine the benefit amount for 

the current month and any remaining months in the RE/RC period, and 

increase benefits for the current and subsequent months, if applicable. 

Voluntary reports that result in a decrease in benefits are not acted on midyear 

in CalWORKs; however all reported changes must be acted on in 

CalFresh. 

Example 1: AR/CO case has an RE/RC due in April 2013. The customer 

reports a decrease in earned income on December 28, 2012, and provides 

verification of the decrease. The EW will redetermine the benefit amount for 

the current month (December) and the remaining months in the CalWORKs 

RE period and the CalFresh six-month RC period. 

Example 2: AR/CO case has an RE/RC due in August 2013. On August 3, 

2013, the customer reports a decrease in earned income and provides 

verification of the decrease. The EW would use this information to 

redetermine the grant for August and issue a supplement, if appropriate. The 

decreased income would also be used to determine the benefit amount for the 

next CalWORKs RE period and the CalFresh six-month RC period. 

Example 3: AR/CO case has an RE/RC due in November 2013. In April 

2013, the customer reports a $40 increase in earned income. The new 

income amount is not over the IRT. The EW will take no action on the 

CalWORKs case because this is a voluntary mid-year report; however, the 

EW must issue a No-Change NOA. For CalFresh, the change must be acted 

on as per CR rules. 

Note: See the “Interface Between CalWORKs AR/CO and CalFresh Cases” 

section of this IIN for processing CalFresh changes in C-IV. 




Voluntary/ 

mandatory 

reports 

received via 

QR 7 

Due to the delay in AR/CO C-IV functionality implementation, some customers 

may receive and submit a QR 7 after October 1, 2012. In the event a 

customer submits a QR 7 that includes a change, treat the change as a 

voluntary or mandatory report, as appropriate. 


Requests for Discontinuance and County Initiated Actions 

Voluntary 

requests for 

discontinuance 

of benefits 

County 

initiated 

mid-year 

actions 

Customers may request discontinuance of a program at any time during the 

Annual Reporting (AR) period. When the customer requests discontinuance: 

Verbally – 10-day notice must be provided prior to the discontinuance. 

In writing: 

- Adequate notice is provided, and 

- Discontinuance will be completed at the end of the month in which the 

request was made. 

County initiated actions may occur at any time during the 

Re-evaluation/Recertification (RE/RC) period. County initiated changes in 

eligibility status must be acted on at the end of the month in which timely and 

adequate notice can be provided. County-initiated actions include, but are not 

limited to, the following: 

Child is/becomes ineligible due to age, 

Sanction or penalty is imposed or removed, 

Child is placed in Foster Care (FC), 

Aid is approved for a child or individual who is currently being aided in 

another Assistance Unit (AU), 

AU is no longer a California resident, 

Person becomes incarcerated, 

Overpayment/Overissuance (OP/OI) occur, 

Customer failed to cooperate with Income Eligibility and Verification 

System (IEVS) requirements, 

AU member is deceased, 

Young adult transferred into his/her own AU, 

State hearing decision results in a mandatory change, and 

Changes known to the agency (e.g. PVS 40, New Hire, etc.). 


Income Budgeting 

Prospective 

budgeting 

Prospective budgeting requires the Eligibility Worker (EW) to use income the 

customer anticipates, with reasonable certainty, will be received in the 

upcoming annual period. Current income information obtained at application 

or Re-Evaluation/Recertification (RE/RC) and any reasonably anticipated 

changes in income will be used as an indicator of the income that will be 

available to the customer for the Annual Reporting (AR) period. 

Income changes that the customer anticipates within the upcoming year are 

treated differently in CalWORKs and CalFresh: 

CalWORKs – Income changes, including income starting/stopping, can be 

budgeted for the upcoming RE/RC period. 

CalFresh – Income changes must be reported at the time of the change 

and will be budgeted as appropriate. 

Example: In January, an intake Annual Reporting/Child Only (AR/CO) 

customer reports she/he is working a temporary job and expects the job to 

end in March. Both the customer and the EW agree that the income is 

reasonably anticipated. Therefore, the income is used in the CalWORKs 

budget for January through March. In CalFresh, the income will be used 

beginning in January, but the income cannot be stopped until the customer 

reports the change. Customers must be advised to report all changes in 

income within 10 days of the occurrence (per Change reporting (CR) 

requirements). 

Note: For CalFresh, if the customer fails to report within 10 days of the 

income stopping, the income will continue to be used to determine CalFresh 

benefits. 



Income Budgeting, Continued 

Reasonably 

anticipated 

income 

Income is reasonably anticipated when the customer and the Eligibility 

Worker (EW) determine it is reasonably certain that the customer will receive a 

specified amount of monthly income in the Annual Reporting /Child Only 

(AR/CO) period. If either the amount of income or date it will be received is 

uncertain, the portion of the Assistance Unit’s (AU’s) income that is uncertain 

shall not be counted. 

Additionally, customers are not required to report an exact amount of 

anticipated monthly income for each month of the AR/CO period. CalWORKs 

customers are required to provide information about current income and any 

anticipated changes in the following RE period. CalFresh customers are 

required to report changes to income within 10 days of the occurrence (per CR 

requirements). The income reported on the SAWS 2 will be considered 

reasonably anticipated and will be used in the budget calculation unless the 

customer reports that he/she anticipates a change in the upcoming AR/CO 

period for CalWORKs. Anticipated income shall only be considered 

reasonably anticipated if the EW determines that the: 

Customer verified the income has been or will be approved or authorized 

within the upcoming AR/CO period or he/she is otherwise reasonably 

certain the income will be received within the AR/CO period. 

Anticipated amount of the income is known and verified, or the customer is 

otherwise reasonably certain of the amount of the income. 

Start date of the income is known and verified, or the customer is 

otherwise reasonably certain of the start date of the income. 

If a customer anticipates receipt of new income in the upcoming AR/CO 

period, but does not have reasonable certainty of the dates and amounts 

expected to be received, this income cannot be considered reasonably 

anticipated and, therefore, will not be used in determining the benefits for the 

upcoming AR/CO period. If new income exceeds the Income Reporting 

Threshold (IRT) mid-year, then the customer must report the income and 

benefits will be discontinued or recalculated as required. 

Note: EWs must Journal how income was projected in determining benefit 

calculations. 




Income 

averaging 

Income 

budgeting 

examples 

Prospective 

budgeting 

exception 

Unlike Quarterly Reporting (QR), income is not averaged over the next 

12-month period (see the “Prospective budgeting exception” block in this IIN 

for more information regarding income averaging). When income fluctuates, 

income must be budgeted in the months it is anticipated to be received, and a 

full grant allowed in the months in which the customer anticipates receiving no 

income. 

Examples of budgeting income in AR/CO cases follow: 

Example 1: A mother of two applies for CalWORKs and CalFresh in 

November and has no income for November; however, she anticipates income 

(and provides verification) from a job she is due to begin in December. She 

expects to receive $245 each week beginning in December and ending in 

April. The weekly amount is converted to a monthly amount using the 

conversion factor of 4.33 and budgeted for the months of December through 

April only. For CalFresh, budget the income as anticipated, but the customer 

must report when the income ends. 

Example 2: A customer with an AR/CO case receiving CalFresh benefits 

completes the RE/RC. The customer reports income that fluctuates from 

month to month but agrees that she generally gets $300 per month. In this 

instance, the$300 income can be reasonably anticipated for the following 

RE/RC period. 

CalFresh households with a CalWORKs AR/CO case receiving income for a 

period of time shorter than one year either by contract or self-employment are 

exempt from prospective budgeting. The CalFresh household’s income shall 

be averaged over the 12-month period, provided the income is not received on 

an hourly or piecework basis. The income is also budgeted in this manner for 

the associated CalWORKs AR/CO case. 

For AR/CO cases not in receipt of CalFresh benefits, the contract/ 

self-employment income will be calculated using prospective budgeting and 

reasonably anticipated income rules and is not averaged over the RE period. 

Example: An AR/CO customer receiving CalFresh is employed at a school 

cafeteria from the middle of September through the middle of June. During 

the July RE/RC, she reports her job ended in the middle of June. The EW 

looks at the case record for prior work information and determines the 

customer always has a break in employment during the summer months. The 

EW clarifies with the customer that her job will resume in September. The 

income which the customer anticipates to receive in September through June 

is added together and then averaged over the 12-month AR/CO period, 

August through July, for both the CalWORKs and CalFresh programs. 




Income 

Reporting 

Threshold (IRT) 


AR/CO IRT 

Customers must be informed of their Income Reporting Threshold (IRT): 

At application, 

At each RE/RC, and 

When their IRT changes. 

The AR 2 – Reporting Changes For Cash Aid and CalFresh will be used to 

notify AR/CO customers of their IRT. 

Customers must report within 10 days when the total combined earned and 

unearned income exceeds the IRT, even if the income is received mid-year. 

The IRT for AR/CO CalWORKs cases is the amount of income likely to render 

the recipient ineligible for CalWORKs benefits (see “CalWORKs AR/CO IRT” 

block). 

AR/CO cases with income over the IRT will result in discontinuance of the 

CalWORKs program at the end of the month following timely and adequate 

notice. 

The CalWORKs AR/CO IRT is the level likely to render an AU ineligible for 

CalWORKs benefits as listed in the following chart: 

Assistance 

Unit Size 

(AU) 

Maximum Earned 

Income Limit - 

Non-Exempt 



Exempt 

0 $113 $113 

1 $712 $780 

2 $1,092 $1,212 

3 $1,328 $1,474 

4 $1,562 $1,730 

5 $1,762 $1,958 

6 $1,964 $2,182 

7 $2,144 $2,386 

8 $2,330 $2,590 

9 $2,508 $2,792 

10 

or more 

$2,684 $2,990 

Note: AR/CO cases discontinued for over IRT will be evaluated for 

Transitional CalFresh (TCF) per established policy when appropriate. 




Excess IRT 

examples 

Procedure for 

discontinuing 


when over IRT 

Following are examples of AR/CO cases exceeding the IRT: 

Example 1: A customer with a CalWORKs AR/CO case reports mid-year and 

verifies income over IRT. The income is expected to continue. The EW 

determines the case is ineligible for CalWORKs. The AR/CO case is given 

10-day notice for the discontinuance. 

Example 2: A customer with an AR/CO and CalFresh case reports and 

verifies income over IRT for the current month only. The income will not 

continue and will be below the IRT the following month. The EW will not take 

any action on the CalWORKs case other than to provide the AU with a 

No-Change Notice of Action (NOA). The EW must take action on the 

CalFresh case because any information reported from a CR household must 

be acted on. 

When the CalWORKs program is ineligible for being over the IRT, the EW will 

take the following action to discontinue the program: 

Step Action 

1 Navigate to the Negative Action Detail page in C-IV, and for the 

appropriate benefit month: 

If the AU… Then… 

Receives CalFresh, Select the Run EDBC for 

this program box for the 

CalFresh program, and 

Complete the Negative 

Action Detail for the 

CalWORKs using 

Negative Action Reason 

of Transferred Income. 

Go to Step 2. 

Note: C-IV will auto-test for 

Transitional CalFresh (TCF) 

when the CalFresh and 

CalWORKs EDBCs are run 

together. 

Does not receive CalFresh, Go to Step 2. 

2 Override the CalWORKs EDBC Program Configuration for each 

person with: 

Role Reason = Over IRT, and 

Status Reason = Over IRT 

3 Run, Accept and Save the EDBC. 

4 Send a manual NOA (NA 200A) to the customer. 





Overpayment/ 

Overissuance 

CalWORKs Overpayments (OPs) and CalFresh Overissuances (OIs) will be 

established based on the following: 

Customer failure to report any mandatorily required information, 

County error, 

Customer late reporting, and 

Inability to issue correct benefits due to insufficient time to issue a 10-day 

notice. 

CalFresh Overissuances (OIs) will be established based on : 

Customer failure to report, 

County error, and 

Customer failure to report a mandatory report within 10 days of the 

change, resulting in the inability to issue correct benefits due to insufficient 

time to issue a 10-day notice. 


Interface Between CalWORKs AR/CO and CalFresh Cases 

Interface 

between 


AR/CO and 

CalFresh 

cases 

Action must be taken on all mandatorily reported changes; however, as a 

reminder, while CalFresh Change Reporting (CR) rules have additional 

reporting requirements, if the change is not required to be reported for the 

CalWORKs Annual Reporting/Child Only (AR/CO) case, this information will 

be treated as a voluntary report in CalWORKs and the Eligibility Worker (EW) 

may not decrease or discontinue the CalWORKs grant/case mid-year. EWs 

may only act on reports in CalWORKs if the report results in an increase to the 

grant. Additionally, because the Assistance Unit (AU)/household reported the 

change to comply with CalFresh CR rules, if the EW is not taking action to 

change the CalWORKs grant, the EW must send a No-Change Notice of 

Action (NOA) to the customer. 


reports a change midyear 

in… 

Earned Income of 

$100 or less, or 

Unearned income 

of $50 or less, 

Note: Income must be 

verified if from a new 

source or if over $50. 

Earned Income 

more than $100, or 


more than $50, 

Note: Income must be 

verified if from a new 

source or if over $50. 

And the income 

is… 

Under the 


Income 

Reporting 

Threshold (IRT), 

Under the 

CalWORKs IRT, 

Over the 


Then the report is… 

Voluntary for both CalWORKs and 

CalFresh. For: 

CalWORKs: If the change 

results in a(n): 

- Decrease to the grant, 

send a No Change NOA. 

- Increase to the grant, 

make the changes as 

appropriate. 

CalFresh: Budget and change 

the income for the appropriate 

months. 

Voluntary for CalWORKs and 

mandatory for CalFresh. For: 


results in a(n) 

- Decrease to the grant, 


- Increase to the grant, 


appropriate. 

CalFresh: Budget and change 

the income for the appropriate 

months. 

Mandatory for both 

CalWORKs and CalFresh. 

The EW will send a10-day 

notice for discontinuance of 

CalWORKs and CalFresh to 

the customer. 



Interface Between CalWORKs AR/CO and CalFresh Cases, 

Continued 

Examples of 

the impact of 

CalFresh 

mandatory 

mid-year 

report on 


AR/CO cases 

Income report 

affects 

CalFresh case 

only 

Following are examples of processing a mid-year report that is mandatory for 

CalFresh and voluntary for CalWORKs: 

Example 1: A customer with a CalWORKs AR/CO case with CalFresh makes 

a mandated report of an increase in earned income of $150 (not exceeding 

the CalWORKs IRT). The EW will take action to adjust the household’s 

CalFresh allotment only. Because the change in income is not over the AU’s 

IRT, this will be treated as a voluntary mid-year report for CalWORKs and the 

grant will not be changed. The EW would be required to issue a No-Change 

NOA and a 377.5 to the customer for CalWORKs. 


a CalFresh mandatory report that the household received an increase in 

unearned income of more than $100. The change in income does not exceed 

the CalWORKs IRT. The EW will take action to adjust the household’s 

CalFresh allotment, as per Change Reporting (CR) rules. The change in 

income is treated as a voluntary report for the AR/CO case and the 

CalWORKs grant will be unchanged. A No-Change NOA for CalWORKs will 

be sent to the customer. 

When an income change affects the CalFresh case but not the CalWORKs 

AR/CO case, EWs will take the following action: 

Step Action 

1 Complete a manual budget using the appropriate CalFresh Budget 

Worksheet or the online CalWORKs/CalFresh budget to determine 

the new CalFresh benefit amount. 

2 Run CalFresh EDBC, and 

Override the EDBC to issue correct benefits, 

Ensure the Reporting Type is Change Reporting, and 

Accept and Save the EDBC. 

3 Send a: 

NOA to the customer informing of the new CalFresh benefit 

amount, and 

No-change NOA for the CalWORKs grant. 

4 Image the manual budget into C-IV. 



Case Movement 

Case 

movement 

between 

AR/CO – CR 

and QR 

Transition 

between 

AR/CO and QR 

Transition 

between CR 

and QR 

Under some circumstances, a case will transition between Annual 

Reporting/Child Only (AR/CO)/Change Reporting (CR) and Quarterly 

Reporting (QR). Eligibility Workers (EWs) must provide notice to the customer 

when a case transitions from AR/CO and CR to QR, or vice versa. When a 

case transitions from QR to AR/CO and CR, or vice-versa, the case retains 

the same QR cycle and Re-Evaluation/Recertification (RE/RC) due date. 

The Submit Months are not changed. 

Note: Upon the transition to QR, the EW must inform the customer of the QR 

rules and provide the new Income Reporting Threshold (IRT) to the customer 

(QR 2 – Reporting Changes for Your Cash Aid And Food Stamp Household). 

In cases where an adult is added back to the Assistance Unit (AU) and the 

case goes from AR/CO to QR, the QR 7 cannot be due in the same month in 

which the adult is added. Further, in scenarios where the adult has a QR 7 

due in one month but transitions to AR/CO the following month, the case will 

not be discontinued if the customer fails to submit the QR 7. In such 

scenarios, the grant will remain the same (notwithstanding mandatory 

mid-year reports, etc.) until the next RE/RC. 

The change in status for CalFresh households transitioning from CR to QR is 

effective the first of the month in which the CalWORKs AU transitions from AR 

to QR. The EW must not require the household to submit a QR 7 for any 

month in which the household was subject to CR requirements. If a case 

transitions from QR to CR, the EW must notify the household within 10 days of 

the date the EW becomes aware of the change that the household has 

become exempt from QR and is no longer required to submit any future 

QR 7s. 

The change in status for the CalWORKs AR/CO case will not always impact 

the associated CalFresh case because some households may have CR status 

(e.g., CalFresh households in which all adult members are elderly or 

disabled). 



Case Movement, Continued 

Case 

movement 

between 

AR/CO and 

QR: Examples 

AR/CO case 

moves to QR: 

C-IV 

procedures 

Following are examples of action taken when a case transitions between 

AR/CR and QR: 

Example 1: A mother applies for CalWORKs for herself and two children on 

March 1. The mother refuses to assign support rights during intake. 

CalWORKs is approved for the two children and the mother is sanctioned. A 

Notice of Action (NOA) is sent to the AU advising of the sanction and the 

AR/CO case status. On May 25, the mother agrees to assign support rights. 

The sanction is removed and the mother is added back to the AU effective 

June 1. Notice must be sent to the mother advising that the AU is now subject 

to QR rules. The QR cycle and RE/RC month are based on the application 

date. The next QR 7 would be due in August for the July Data Month. 

Example 2: Effective June 1, a CalWORKs timed-out mother in an AR/CO 

case is added back to the AU due to child support reimbursement. The case 

is now subject to QR rules. Because there was no break in aid, the case will 

retain the QR cycle established prior to becoming an AR/CO case. Notice 

must be sent to the mother advising that the AU is now subject to QR rules. 

When an AR/CO case transitions to QR, there are specific procedures the EW 

is required to follow in C-IV as described in the chart below: 

If the AR/CO case transitions 

to QR in the month… 

Then the EW will… 

Prior to the start of the next QR Run EDBC for CalWORKs and 

cycle, 

CalFresh together (if appropriate) for 

each month of the next QR cycle, 

and 

Rush the benefits on the first 

business day of each month of the 

next QR cycle. 

Prior to the QR 7 Submit Month, Manually generate a QR 7. 

Note: If the case transitions to QR two months prior to the QR 7 Submit 

Month, the QR 7 will be sent via the regularly scheduled QR 7 batch process. 



Case Movement, Continued 

Time Limit 

review results 

in AR/CO case 

transitioning to 

QR 

CalWORKs 48-month Time Limit reviews may result in a timed-out adult being 

added back to the CalWORKs program due to child support recoupment. In 

many cases, the timed-out adult is added back for one or two months, which 

would result in the CalWORKs AR/CO and CalFresh CR cases transitioning to 

QR for those months only. When the CalFresh CR household has earned 

income and has a six month certification period, the following will be 

completed: 


1 The Quality Review Unit (QRU) will: 

Complete Time Limit Review, 

Run EDBC to add the person back to the case, 

and 

E-mail the EW/ Master Assignment Queue (MAQ) Inbox to 

review for AR/CO status. 

2 The EW/MAQ will: 

Not change the six month CalFresh certification period to 

twelve months, and. 

Journal all actions taken. 


Conversion 

Conversion Customers with cases converting from Quarterly Reporting (QR) to Annual 

Reporting/Child Only (AR/CO) in October 2012 were to be: 

Informed that QR 7s are no longer required while the case is AR/CO, 

Provided with the new Income Reporting Threshold, and 

Provided with an AR 3 - Mid-Year Status Report For Cash Aid and 

CalFresh (CalWORKs cases only) or a DFA 377.5 - CalFresh Household 

Change Report (combination CalWORKs/CalFresh cases). 

Customers with AR/CO cases will have provided their final QR 7 to the 

Eligibility Worker (EW) in July, August or September 2012, depending on the 

existing Quarterly Reporting (QR) cycle. The grant level determined based on 

the final QR 7 will remain in effect until the end of the month in which the 

Re-Evaluation/Recertification (RE/RC) is due unless a mandatory mid-year 

report is provided or a County-initiated action is taken after October 1, 2012. 

Information reported during RE/RCs for October 2012 will be used to 

determine the benefit level for the following RE/RC period, unless a: 

Mandatory mid-year report is provided, 

County-initiated action is taken prior to the next RE/RC, or 

CalFresh change is reported (action must be taken on all reported 

CalFresh changes). 

The RE/RC months for all cases transitioned to AR/CO shall remain the same 

as that established under QR. Because the RC period cannot be shortened, 

and some Public Assistance (PA) CalFresh cases are not aligned with respect 

to the RE/RC dates, EWs must change the RE date when necessary to align 

with the RC date. 

Example: A CalWORKs/CalFresh case with a March RE/RC converted to 

AR/CO effective October 1, 2012. The final QR 7 was submitted on 

September 5, 2012. Information from the Data Month of August used to 

determine eligibility and grant amount for the remainder of the benefit period 

until the RE/RC is due in March 2013, provided there are no CalWORKs 

and/or CalFresh mid-year reports that result in a change to the benefit 

amount. 

Note: AR/CO cases cannot be discontinued for non-receipt of complete 

QR 7s after October 1, 2012. 



Conversion, Continued 

Forms The following forms were/are used for the implementation of AR/CO: 

Form Number Form Name Description 

TEMP AR 1 New Reporting 

Requirements for Cash 

Aid and CalFresh 

AR 2 Reporting Changes For 

Cash Aid and CalFresh 

AR 3 Mid-Year Status Report 

For Cash Aid and 

CalFresh 

NA 1239 AR Notice of Action 

Continued (With Budget) 

DFA 377.5 CalFresh Household 

Change Report. 

NA 200 Multi-Purpose Notice of 

Action 

Informs the customer about 

the AR change and rules. 

Informs the customer of 

his/her new IRT, and 

Reminds the customer 

of the AR reporting 

requirements. 

Allows the customer to 

report mid-year changes in 

writing. 

Notifies the customer of 

his/her monthly cash aid 

amount for the annual 

period. 

Customer change report 

form which must be 

provided to CalFresh CR 

households. 

Note: The DFA 377.5 will 

be provided to customers 

with combination 

CalWORKs AR/CO- 

CalFresh cases. 

Notifies the customer of no 

change to the CalWORKs 

benefits. 

NA 200A Discontinue – Over IRT Notifies the customer of the 

termination of CalWORKs 

benefits. 

Questions District Mangers (DMs) with questions regarding this IIN may contact Karen 

Akparanta, Program Specialist (PS) I, at (909) 383-9673 or 





SEPTEMBER 25, 2012 

SUBJECT: Access to the Paternity Opportunity Program (POP) Database 

DISTRIBUTION: CalWORKs and Medi-Cal FILE: CWPHB – In Front of Handbook 

MCPHB – In Front of Handbook 

REFERENCE: ACL 11-82, POP Letter 

11-02 

OBSOLETE: When Handbook is 

Updated 

Overview Current regulation states when legal paternity has been established in the 

case of an unmarried father and mother, referral to the Local Child Support 

Agency (LCSA) for paternity establishment is not required. A declaration 

signed by both the unmarried biological father and mother filed with the state 

Department of Child Support Services (DCSS) is considered verification that 

legal paternity has been established for the child. 

The Paternity Opportunity Program (POP), administered by DCSS, 

processes declarations of paternity and records information in the POP 

database. Information obtained from the POP database is considered 

verification that legal paternity has been established for that child. 

Objective DCSS has provided access to the POP database to authorized county 

personnel. The Transitional Assistance Department (TAD) will pilot the use 

of the POP database to verify the establishment of paternity for the 

CalWORKs and Medi-Cal programs. The object of the pilot is to: 

Promote customer service, 

Reduce the number of unnecessary referrals to LCSA, and 

Reduce workload impact for both TAD and DCSS. 

Pilot Period The POP database pilot period begins October 1, 2012 and will continue until 

December 31, 2012. An expansion of the pilot will be determined based on 

review of the results of the initial pilot. 

Pilot offices The POP database access will be piloted in the following TAD offices: 

03 – Yucca Valley, 

04 – Redlands, 

07 – Del Rosa, and 

79 – Twenty-Nine Palms. 




Access Access to the POP database will require a log-in ID and password that will be 

assigned by DCSS. Designated CalWORKs and Medi-Cal staff will receive: 

An initial e-mail from DCSS to confirm the request for access, 

A second e-mail from DCSS regarding instructions for obtaining system 

technical report from the vendor, SyTech, if needed, and 

A subsequent e-mail from SyTech which will: 

– Explain information provided by the POP database, 

– Provide log-in information and a link to the database, and 

– Provide instructions for viewing information in the POP database. 

Note: Attachments 1, 2, 3 and 4 provide a view of the POP Login and data 

screens. 

Procedure When the Unmarried Father (UMF) is in the home and the Eligibility 

Worker (EW) cannot determine if legal paternity has been established, 

authorized staff will access the POP database and follow the step/action 

chart below: 

POP Tracking 

Sheet 

Step Action 

1 Complete POP database search, and: 

If the search… Then… 

Confirms legal paternity has 

been established for the 

child, 

Does not confirm legal 

paternity has been 

established for the child, 

2 Journal findings and action taken. 

Image a copy of the online screen 

print into C-IV. 

Do not complete a referral to 

DCSS. 

Complete: 

Support Questionnaire in C-IV, 

and 

CW 2.1 NA for referral to DCSS. 

Form POP M Sheet - POP Tracking Sheet (See Attachment 5) has been 

developed to capture the: 

Volume of POP database searches performed, and 

Number of successful searches. 

Staff will complete the POP Tracking Sheet and e-mail to their supervisor 

every Monday. 

Monthly Tracking and Region POP Totals documents have been developed 

to capture POP database search information for the district and region 

respectively. Supervisors will update these documents weekly. 




Access 

changes 

To request access to the POP database for additional staff, or to remove 

access for staff, District Managers (DMs) must contact their Regional 

Secretary by e-mail and provide the following information: 

To request access for additional staff: 

– Staff Name/Title, 

– Office location, 

– Phone number, and 

– Supervisor Name/Title and phone number 

To remove access for staff: 

– Staff Name, and 

– Supervisor Name. 

Questions District Mangers (DMs) with questions regarding this Interim Instruction 

Notice (IIN) can contact Karen Akparanta, Program Specialist (PS) I at 

(909) 383-9673 or kakparanta@hss.sbcounty.gov. 


Login 

Authorized users that have been provided an email – password combination can login to the site 

at ca-pop.net to gain access to the database. 

Home Page 

ATTACHMENT 1 

Once you have logged in, you will be taken to your home page which will list the 15 most 

recently accessed declaration records. 


Find 

ATTACHMENT 2 

To find a declaration, click on the Find link on the main menu bar at the top of any page to be 

directed to the Declaration Search page. 



To perform a match search, type in any of the known values for a search. The database 

will return only those results that exactly match what you entered. The more values you 

enter, the narrower the search results will be. So a search for Father Last of SMITH will 

return a lot of records, while a search for Father Last of SMITH and a Father First of 

WILLIAM will significantly narrow the results as only those records with Fathers named 

WILLIAM SMITH will appear. 

Search Results 

ATTACHMENT 3 

To view the results returned by the database, click on the PCN for the record you wish to view 

and you will be redirected to the details page for that record. 


Declaration Details Page 

The Declaration Details Page will provide paternity information for the child. 

ATTACHMENT 4 


POP Tracking Sheet 

EW Name EW File # 

Total Searches 

Monday Tuesday Wednesday Thursday Friday 

Date Totals 

Successful Searches 

Comments: 

ATTACHMENT 5 




OCTOBER 11, 2012 

SUBJECT: Extended Benefits Beyond Age 19 

DISTRIBUTION: CalWORKs and 

Foster Care 

FILE: CWPHB – In Front of Handbook 

FCPHB – In Front of Chapter 16 

REFERENCE: ACL 12-43, 12-48, 12-12 

OBSOLETE: December 31, 2013 

Overview The purpose of this Interim Instruction Notice (IIN) is to provide Eligibility 

Workers (EWs) with information regarding the continuation of Aid to Families 

with Dependent Children (AFDC) – Foster Care (FC) benefits, known as 

Extended Foster Care (EFC), for eligible young adults who attain age 19 in 

2012. This includes youth who are/were receiving: 

Resuming 

AFDC-FC 

benefits 

Foster Care, 

Kinship Guardianship Assistance Payment (Kin-GAP), 

Adoption Assistance Program (AAP), and 

California Work Opportunity and Responsibility to Kids (CalWORKs). 

Senate Bill (SB) 1013 includes changes to law that affect the age of eligibility 

for extending AFDC-FC benefits. This law adds language which authorizes 

Young Adults who turn 19 years of age prior to January 1, 2013 and have 

been receiving AFDC-FC or CalWORKs benefits between January 1, 2012 

and December 31, 2013 to continue receiving these benefits up to age 21, 

provided they continue to meet all other applicable eligibility requirements 

including participation conditions. This includes Young Adults in Non-Related 

Legal Guardianship (NRLG) cases granted through Juvenile Court and the 

extension of benefits for youth receiving Kin-GAP and AAP. 

Note: This change does not apply to youth who turned 19 years of age in 

2011. 

Young Adults who have not continuously received AFDC-FC benefits or who 

exited Foster Care in 2012 due solely to attaining age 19 in 2012 may have 

benefits resumed if they agree to meet one of the participation conditions and 

have not been dismissed by juvenile court. 


IIN #12-053 (10/12) DM:BG:ts PAGE 1 OF 9


Re-entering 

EFC 

NRLG 

eligibility 

criteria 

NRLG 

re-entry 

A Young Adult who has exited Foster Care and was dismissed by Juvenile 

Court in 2012 but wishes to re-enter Foster Care: 

Must have had a court order for Foster Care placement on his/her 18 th 

birthday, 

Will need to complete the Voluntary Re-entry Agreement (SOC 163), and 

A petition must be filed with the court (within 180 days). 

To be eligible to EFC, a Young Adult in a Juvenile Court appointed 

Non-Related Legal Guardianship (NRLG) must meet the eligibility criteria 

specified below: 

Age 

Education and employment participation conditions 

NRLG case Plan including the Transitional Independent Living 

Plan (TILP) 

Authority for placement (completing the Mutual Agreement – SOC 162) 

Eligible facility 

Note: Rules pertaining to NRLG cases only apply to guardianships granted 

through Juvenile Court, not through Probate Court. 

A Young Adult who was in a Juvenile Court appointed NRLG placement and 

who wishes to return to the care of his/her former guardian and re-enter Foster 

Care, must meet the eligibility criteria below: 

The guardian must have been in receipt of the non-federal AFDC-FC 

benefit payment on the youth’s 18 th birthday 

Meet the education and employment participation conditions 

Needs to complete a SOC 163 

The Young Adult may live in a college dorm or other setting as required to 

access education/employment opportunities, as long as the former guardian 

maintains support for him/her. Benefits can only be made to the guardian. 




AAP and 

Kin-GAP 

EFC eligibility 

requirements 

Evaluating 

EFC 

AAP and Kin-GAP agreements for eligible youth approaching age 19 should 

include eligibility to age 21 and cases must not be terminated solely due 

to the youth attaining age 19. 

This applies to Young Adults who have met the following requirements: 

Program Requirement 

AAP The initial AD 4320 must have been signed when the 

youth was at least 16 years old and he/she will turn 18 on 

or after January 1, 2012 

Kin-GAP Federal - The youth must have attained the age of 16 

years old before the Kin-GAP negotiated agreement 

payments began. 

State – The youth must have attained 16 years old 

before the Kin-GAP aid payments began. 

To qualify for EFC, a Young Adult must be : 

18 years old on January 1, 2012 

Under authority for placement on his/her 18 th birthday 

Evidenced by court order of placement 

Signed appropriate Mutual Agreement dependent on type of case or 

Voluntary Placement Agreement 

Meeting one or more participation conditions with a completed SOC 161 

Placed in an eligible facility 

Within 60 days of assumption/resumption of jurisdiction of the Transitional 

Independent Living Case Plan (TILCP), including the Transitional 

Independent Living Plan (TILP). 

All cases where a young adult is attaining the age of 19 must be evaluated for 

EFC eligibility. Do not discontinue the FC case solely due to attaining 

age 19. 




Re-entry/ 

resumption 


list 

A list of cases was requested from the Legislation Research Unit (LRU) 

identifying those who may be eligible for re-entry into EFC, or resumption of 

benefits. The list includes Young Adults who: 

Turned 19 in 2012, 

Were in receipt of AFDC-FC after they turned 18, and 

Had been a dependent or ward of the court when they were 18. 

The following table describes the reinstatement type and the requirement for 

issuing EFC: 

EFC Reinstatement 

Requirement 

Type 

Re-entry Those who were discontinued and dismissed from 

juvenile court due to turning 19 years of age may 

be eligible for re-entry and must obtain a court 

order reestablishing dependency. 

Resumption Those who were discontinued solely due to being 

18 years old, but were not dismissed from juvenile 

court may be eligible to resume payments back to 

the date of discontinuance. 




EFC process The following process occurs when a Young Adult is identified as being eligible 

to EFC: 


1 The Probation Officer (PO)/Social Worker (SW)/Children and 

Family Services (CFS) staff: 

Contacts the Young Adult and verifies that he/she chooses to 

continue in the EFC, 

Ensures the following forms are on file: 

SOC 161, 

SOC 162 (for new and resumed EFC cases), and 

SOC 163 (for re-entries), 

Reviews Child Welfare Services/Case Management System 

(CWS/CMS) placement history to verify dates and 

accuracy of placements (for resumed cases), 

Determines that all other EFC eligibility criteria are met, and 

Forwards the forms to the CFS Office Assistant (OA). 

2 The CFS/PO OA: 

Updates the Special Project Code in CWS/CMS, 

Prints out a current Placement History from CWS/CMS, and 

Forwards all documents to the Foster Care OA. 

3 The Foster Care OA: 

Stamp dates the received forms: 

SOC 161, 

SOC 162 (for new and resumed EFC cases), and 

SOC 163 (for re-entries), 

Placement History from CWS/CMS, 

Repends the Foster Care case, if applicable, 

Forwards the packet to the appropriate Foster Care EW. 

4 The Foster Care EW: 

Confirms if the case is considered a re-entry to EFC or a 

resumption of benefits, 

Reviews the following forms for completion and signs off as 

appropriate: 

SOC 161, 

SOC 162, and/or, 

SOC 163 (if applicable), 

Determines through the Placement History Detail page in 

C-IV that the Young Adult is listed in an eligible placement, 

Updates all necessary fields in C-IV, 

Issues all benefits and notices, as appropriate, and 

Journals all case actions. 




Required 

forms 

Resumed cases will already have some of the necessary forms on file, except 

as noted. Re-entry cases will need to ensure the forms indicated are 

received/completed and on file. The chart below lists the forms that must be 

on file for re-entering EFC cases or where payment will be resumed. 

Forms Re-entry Resumption 

SAWS 1 X on file 

FC 2 NM X N/A 

EA 1 if applicable on file 

SOC 163 X N/A 

SOC 158A X on file 

FC3/3A & all other eligibility forms X on file 

Copy of the termination of jurisdiction court 

order 

X N/A 

Copy of court order with reestablishing 

jurisdiction 

X N/A 

SOC 161 X X 

TILP & Case plan X 

(within 60 

days) 

X 

Approval of Family Caregiver Home 

(SOC 815) and SILP approvals 

if applicable if applicable 

SOC 162 not required X 

Approve Non-Minor Dependent 

as 

as 

(NA 1269) 

appropriate appropriate 

Discontinue Non-Minor Dependent 

as 

as 

(NA 1270) 

appropriate appropriate 

Note: The SOC 163 is the Voluntary Placement Agreement and the EW must 

set a task to follow up and verify that a court order has been obtained within 

180 days/six months of the signing of the voluntary placement order or EFC 

must terminate. 




EDBC 

instructions 

for aid code 

40 and 42 

cases 

EDBC for 

Kin-GAP cases 

A manual Eligibility Determination Benefit Calculation (EDBC) must be 

completed in C-IV to issue EFC benefits for the Young Adult. Overriding the 

Foster Care EDBC will not allow benefits to be issued ongoing. 

The following are C-IV case processing instructions for a Young Adult who 

has turned 18 and opts to remain in the EFC program: 

Step Action 

1 Add a permanency plan record, if needed. 

Note: Leave the current Placement Authority record as is. 

2 Process any outstanding placement changes. 

3 Determine monthly benefits by completing a Foster Care Budget 

Worksheet (FC 30). 

4 Run a Manual EDBC for the month following the youth’s 18 th birthday. 

Select New Policy as the Manual EDBC Reason. 

Note: For further information see the C-IV User Guide: Completing a 

Manual EDBC - Foster Care, AAP and Kin-GAP. 

5 Select the Foster Care Aid Code on the Manual EDBC that was being 

used prior to the youth turning 18. 

6 Complete and send the Approve Non-Minor Dependent (NA 1269) Notice 

of Action (NOA) located in the TAD Forms Catalog. 

7 Set a Task for the receipt of the SOC 161. 

8 Set a case flag for the correct aid code. 

9 Journal all case actions. 

Follow the steps below for Kin-GAP cases that include a youth who has 

turned 18 years of age and opts to continue receiving Kin-GAP as a Young 

Adult: 

Step Action 

1 Run EDBC and process an EDBC override for the month following the 

youth’s 18 th birthday. 

Note: For further information see the C-IV User Guide: EDBC-Overriding, 

2 Complete the following on the Program Configuration Override List 

page: 

Select New Policy from the EDBC Override Reason 

drop-down box. 

Select Active from the Program Status drop-down box 

Select the Kin-GAP aid code applied to the youth prior to turning 18 

from the Aid Code drop-down box. 

3 Complete and send the NA 1269 located in the TAD Forms Catalog. 


5 Set a case flag for the correct aid code for the case. 





EDBC for AAP 

NMD cases 

EDBC for 


EFC 

Follow the steps below for AAP cases that include a youth who has turned 

18 years of age and opts to continue receiving AAP as a Young Adult: 

Step Action 

1 Run a manual EDBC for the month following the youth’s 18 th birthday. 

2 Determine monthly benefits by completing a Foster Care Budget 

Worksheet (FC 30). 

3 Select the AAP aid code which applied to the youth prior to turning 18 on 

the Manual EDBC from the Aid Code drop-down box. 

Note: For further information see the C-IV User Guide: Completing a 

Manual EDBC- Foster Care, AAP and Kin-GAP. 





Follow the steps below for cases that include a CalWORKs youth who has 

turned 18 years of age and opts to continue receiving CalWORKs as a 

Young Adult: 

Step Action 

1 Establish a new case with a CalWORKs program for the Young Adult. 

Note: Link the existing CalWORKs case as a companion case to the new 

CalWORKs case. 

2 Determine monthly benefits by completing a manual CalWORKs Budget 

from the Budgets link found on the TAD website. 

3 Run a Manual EDBC in C-IV for each month, by selecting the following: 

New Policy as the Manual EDBC Reason. 

CalWORKs Aid Code which applied to the youth prior to turning 18 

years of age. 

Rush from the Immediacy Indicator drop-down box. 

Note: EDBC must be run on the first or second business day of the 

following month. For example, for the benefit month of February, run a 

Manual EDBC on the first or second business day of March. For further 

information see the C-IV User Guide: Completing a Manual EDBC, 

CalWORKs or ‘Reapplications and Rescissions’ job aid for information 

regarding how to rescind a discontinuance. 


5 Set a the following Tasks: 

Monthly: To run Manual EDBC, and 

Every six months: Receipt of the SOC 161. 






QR 7 

processing 

QR 7 


Young Adult’s receiving Extended Benefits are not required to complete 

Eligibility/Status Reports (QR 7s) to maintain eligibility. Due to current C-IV 

functionality, QR 7s will be automatically sent to these Young Adults, 

therefore, EWs must complete the following: 

Scan the report as Received. 

Edit the Customer Reporting Detail page in C-IV and select N/A for all 

questions applicable to the CalWORKs program. 

In order to prevent the discontinuance of a CalWORKs-EFC case, a Manual 

EDBC must be completed prior to the QR 7 discontinuance batch job, which 

runs on the second business day of the month. 

In the event a case is discontinued in error for no QR 7, the CalWORKs 

program must be rescinded (as the Young Adult receiving EFC is not 

required to complete a QR 7 to maintain eligibility). 

Questions Managers with questions regarding the information contained in this IIN can 

contact: 

Bridget Garcia, Program Specialist (PS) I, at (909) 383-9779 or 

bgarcia@hss.sbcounty.gov, 

Shannon Bailey, PS I, at (909) 383-9717 or 

shannon.bailey@hss.sbcounty.gov. 




JUNE 1, 2012 

SUBJECT: CalWORKs, CalFresh and Medi-Cal Processing Timeframes 

DISTRIBUTION: CalWORKs, CalFresh 

and Medi-Cal 

FILE: In front of the CalWORKs, 

CalFresh and Medi-Cal Policy 

Handbooks 

Overview This Interim Instruction Notice (IIN) provides information on processing 

timeframes for: 

County Policy 

for rescinding 

QR 7, MSR, and 

Medi-Cal RE 

discontinuances 

CalWORKs – Re-Evaluations (REs) and Quarterly Reports (QR 7s) 

CalFresh – Recertifications (RCs) and Quarterly Reports (QR 7s) 

Medi-Cal – REs and Mid-Year Status Reports (MSRs) 

The following policy is effective upon receipt of this IIN: 

CalWORKs, CalFresh and Medi-Cal case discontinuances due to 

non-receipt of the QR 7, MSR, Medi-Cal RE, or verification/information 

requested to determine eligibility will be rescinded when the customer: 

Provides the information and/or verification that constitutes a complete 

QR 7, MSR or Medi-Cal RE within 30 days of the effective date of the 

discontinuance, and 

Continues to be otherwise eligible for benefits. 

Action to rescind the discontinuance must be completed no later than 

two (2) business days from the receipt of the missing information/ 

verification. 

Example: CalWORKs/CalFresh QR 7 Submit Month is April; the last day to 

submit the QR 7 is May 1 st . The customer provides the QR 7 on May 8 th . 

Action to rescind the discontinued case must be completed by May 10 th , 

which is two business days after the day of receipt of the QR 7. 


IIN #12-036 (06/12) DM:MC:kc PAGE 1 OF 5



QR 7s 

timeframes 


and 

CalWORKs/ 

CalFresh QR 7 

rescind policy 

The processing timeframes for the CalWORKs QR 7 are as follows: 

The QR 7 is due by the extended filing date, which is the first day of the 

month following the Submit Month. 

The C-IV Batch auto discontinues the entire case the night of the second 

business day following the Submit Month. The discontinuance creates 

the following cases: 

– Transitional CalFresh (if applicable), and 

– Post Medi-Cal. 

The following chart contains the CalWORKs and CalWORKs/CalFresh QR 7 

rescind policy for the late receipt of a QR 7: 

If the customer provides the 

missing QR 7 and/or 

verifications… 

During the first five working days of 

the month, 

On or after the sixth working day 

through the last day of the month, 

For more information about good cause see the: 

Then the EW will complete the 

following within two business 

days of receipt of the missing 

information… 

Accept and process the 

completed QR 7, 

Automatically grant good cause 

and rescind the discontinuance, 

and 

Journal “Good Cause exists” 

along with all other case actions 

completed. 

Note: Benefits are not pro-rated. 

Determine whether good cause 

exists according to established good 

cause policy, and if good cause: 

Exists, the discontinuance will be 

rescinded. 

Does not exist, the 

discontinuance will not be 

rescinded. 

CalWORKs Policy Handbook (CWPHB), Chapter 10 - Reporting, and 

CalFresh Policy Handbook (CFPHB), Chapter 9 – Reporting. 




Non- 

Assistance 

CalFresh 

QR 7 

The processing timeframes for the Non-Assistance (NA) CalFresh QR 7 are 

as follows: 

The QR 7 is due by the extended filing date, which is the first day of the 

month following the Submit Month. 

The C-IV Batch auto discontinues the entire case the night of the second 

business day following the Submit Month. 

If good cause is determined and the case is rescinded, the continuing EW 

must determine on-going eligibility and process the case within two business 

days of receiving the late QR 7. Benefits are determined from the first day of 

the month; they are not pro-rated. 

Per regulations, if a customer comes back into the office within 30 days from 

his/her discontinuance to reapply for benefits, the customer has the option of: 

Completing a new application for CalFresh, or 

Restarting his/her case using the Restoration of Aid waiver. 

The following chart shows the processing time frames for NA CalFresh QR 7s: 

If the customer chooses ... Then the EW will ... 

To start a new CalFresh case, Follow all existing intake processing 

Restarting his/her case using the 

Restoration of Aid waiver, 

timeframes. 

Process the case within two 

business days of the receipt of the 

QR 7 and/or verifications following 

the Restoration of Aid instructions in 

the CFPHB, Chapter 1 – 

Applications. 

Medi-Cal MSR The processing timeframes for the Medi-Cal MSR are as follows: 

The MSR is due by the last day of the Submit Month. 

C-IV completes a Batch auto run that discontinues the parents the day 

before 10-day Notice of Action (NOA) of the Submit Month. 

If a discontinuance is rescinded, the rescind action must be completed within 

30 days after the discontinuance BUT once all the requested/missing 

verifications are received from the customer, the EW must complete the 

rescind action within two business days. The continuing EW completes the 

action using the MC 176S reason. 

After 30 days, an Add Person application must be completed to add the 

parents back to the case. 

For more information about the processing of the MSR, see the Medi-Cal 

Policy Handbook (MCPHB), Chapter F – Reporting/Budgeting. 





Reevaluations 

(REs) 

CalFresh 


(RCs) 

The processing timeframes for the CalWORKs RE are as follows: 

The RE is due by the last day of the RE month. 

If the customer does not complete the RE process, the EW manually 

takes a negative action in C-IV by the 10-day NOA date in the RE month 

in order to generate the discontinuance NOA. 

Customers have 10 days to provide requested verifications; this includes 

days that go into the following month. 

Example: The household’s RE is due in April; the household completes a 

telephone interview on April 26 th and has 10 days to provide any 

requested verification by May 6 th . The customer provides the verification 

on May 4th. The RE is considered timely and the case is rescinded to 

the first day of the month. 

Once the customer provides the requested verifications, the EW has two 

business days to process the RE. 

There is no good cause for not completing the RE by the last day of 

the RE month. 

Customers that do not complete the RE prior to the last day of the RE 

month must reapply for CalWORKs benefits through the intake process. 

Benefits are prorated from the date the customer reapplies for benefits 

and are based on the date of application. 

The processing timeframes for the CalFresh RC are as follows: 

The RC is due by the last day of the certification period, 

If the RC is not completed, C-IV Batch automatically discontinues cases 

on the last day of the RC month 

Customers have 10 days to provide requested verifications; this includes 

days that go into the following month. 

Example: The household’s RC is due in April; the household completes a 

telephone interview on April 26 th and has 10 days to provide any 

requested verification by May 6 th . The customer provides the verification 

on May 4th. The RC is considered timely and the case is rescinded to 

the first day of the month. 

Once the customer provides the requested verifications, the EW has two 

business days to process the RE. 

There is no good cause for not completing the RC by the last day of 

the RC month. 

Customers that do not complete the RC prior to the last day of the RC 

month must reapply for CalFresh benefits through the intake process. 

Benefits are prorated from the date the customer reapplies for benefits 

based on the date of the application. 




Medi-Cal Re- 

Evaluations 

(REs) 

The processing timeframes for the Medi-Cal RE are as follows: 

The RE is due by the last day of the RE month. 

If the customer does not complete the RE process, the EW must 

manually discontinue the case by the 15 th of the RE month in order to 

generate the 10-day NOA. 

If a discontinuance is rescinded, the rescind action must be completed within 

30 days after the discontinuance BUT once all the requested/missing 

verifications are received from the customer, the EW must complete the 

rescind action within two business days. 

After 30 days, if the customer does not provide the requested/missing 

verifications, he/she must reapply for Medi-Cal benefits through the Intake 

process. 

Note: If there is a deemed eligible child on the case, the case will not be 

discontinued, therefore, the case will be processed by the continuing EW. If 

the discontinued member(s) request Medi-Cal after 30 days, the application 

is considered an Add Person application and it will be processed by the 

continuing EW. 

For more information regarding Medi-Cal recertification timeframes, see the 

Medi-Cal Policy Handbook, Chapter A, Section A8 – Re-Evaluation. 

Questions District Managers with questions related to this IIN may contact: 

Maria Contreras, PS II at the Program Development Division (PDD), at 

(909) 383-9704 or at contrerasm@hss.sbcounty.gov . 




MARCH 21, 2012 

SUBJECT: Implementation of the 4H Aid Code 

DISTRIBUTION: CalWORKs; Foster Care FILE: CWPHB - In Front of Handbook 

FCPHB - In Front of Handbook 


OBSOLETE: December 31, 2012 

Overview The California Department of Social Services (CDSS) issued All County 

Letter (ACL) 11-59, regarding the implementation of Aid Code 4H. Aid code 

4H was created in order to identify children who: 

Are dependents/wards of the court, 

Are not eligible to receive Foster Care (FC) payments, and 

Have been placed with relatives who are receiving CalWORKs on their 

behalf. 

Children who are dependents/wards of the court have the right to choose 

between Fee for Service (FFS) Medi-Cal or a Medi-Cal managed care health 

plan. They may also be eligible for other FC - linked benefits, such as: 

Eligibility to the Former Foster Care Children program after they reach 

age 18, or 

Extended benefits, if appropriate. 

The 4H aid code will allow these children to be easily identified so that these 

services can be administered. 

4H aid code At this time, the CalWORKs program allows only one aid code for the entire 

Assistance Unit (AU). With the implementation of the 4H aid code, only the 

FC dependent child will be identified as a 4H member with the remaining AU 

being aided under the original CalWORKs aid code. System Change 

Request (SCR) 41625 has been developed to add the 4H aid code 

functionality to C-IV. Until C-IV is updated with the 4H aid code, Eligibility 

Workers (EWs) must follow the instructions found in this Interim Instruction 

Notice (IIN). 


IIN #12-021 (03/12) DM:KA:kc PAGE 1 OF 3


Transfer of 4H 

cases 

All cases indentified as having a 4H member within the AU must be 

Inter-District Transferred (IDT’d) to the designated 4H/4N CalWORKs EW. 

The 4H/4N EW will maintain the CalWORKs case as long as the 4H 

dependent child is aided within the AU. 

The case will be transferred according to the established IDT policy from the 

4H/4N EW to the applicable Transitional Assistance Department (TAD) office 

when the 4H dependent child: 

Is no longer a dependent, 

Ages out of the CalWORKs/FC program, or 

Leaves the AU. 

MEDS The 4H aid code shall be reported as a secondary Medi-Cal aid code for the 

dependent child. The Medi-Cal Eligibility Data System (MEDS) will store 

both the CalWORKs and Medi-Cal eligibility information. 

Case flags The case flag “4H FC dependent – CalWORKs” has been created to identify 

those CalWORKs cases with a FC dependent child in the AU. 




Identifying 4H 

cases 

Potential 

eligibility to 

Extended 


A list titled “4H Cases” will be posted to the C-IV Resource Center on a 

quarterly basis. This list contains CalWORKs cases that have a FC 

dependent child in the AU. These cases must be transferred to the 

designated 4H/4N EW in the TAD District 07 office. 

EWs must review the cases on the current list and complete the following 

process by 4/30/2012: 

Step Action 

1 Contact the FC EW III to verify the aided child currently has court 

dependency, and: 

If the child… Then… 

Has court dependency, Set the “4H FC dependent - 

CalWORKs” Person Flag 

in C-IV, and 

Does not have court 

dependency, 

Go to Step 2. 

Complete a Journal entry 

indicating that case does 

not have a 4H child in the 

AU, and 

Stop here. 

2 Complete a Journal entry stating: 

A 4H foster child has been identified in the AU, 

The name of the 4H member, and 

The case has been transferred to the designated 4H/4N EW. 

3 Follow IDT procedures to send the case to the designated 4H/4N 

EW. 

Once the cases are transferred, the 4H/4N EW will: 

Utilize the list titled “4H Cases” to identify which cases contain FC 

dependent children turning 18 in 2012, and 

Evaluate the child’s eligibility to Extended CalWORKs (see the “Extended 

CalWORKs for Young Adults” section in Chapter 1 – Applications, of the 

CalWORKs Policy Handbook). 

Questions District Managers (DMs) may contact Karen Akparanta in the Program 

Development Division (PDD) at (909) 383-9673 with questions regarding this 

IIN. 


Table of Contents 

CalWORKs POLICY HANDBOOK 

CHAPTER 1 

Applications 

Overview ........................................................................................................................ 1-1 

Application Basic Information: Overview ........................................................................ 1-2 

Application Overview ...................................................................................................... 1-3 

Advance Eligibility Determination Process ..................................................................... 1-9 

C4Yourself e-Application .............................................................................................. 1-14 

Obtaining and Evaluating Evidence ............................................................................. 1-17 

Application Processing Time Frames ........................................................................... 1-18 

CalWORKs Denial – Med-Cal Application Referral Process ........................................ 1-20 

Rescind of Denial ......................................................................................................... 1-23 

Social Security Number (SSN) ..................................................................................... 1-24 

Beginning Date of Aid (BDA) for New Applications ...................................................... 1-27 

Immediate Need (IN) .................................................................................................... 1-29 

Restoration of Eligibility and Benefits: QR 7 Discontinuance ................................... 1-34.1 

Foster Care (FC) – Miller vs. Youakim: Overview ........................................................ 1-35 

Foster Care (FC) – Miller vs. Youakim ......................................................................... 1-36 

Dependents/Wards of the Court ................................................................................ 1-38.1 

Extended CalWORKs for Young Adults .................................................................... 1-38.4 

Re-Evaluations (REs): Overview .................................................................................. 1-39 

Re-Evaluations (REs): Basic Information ..................................................................... 1-40 

Re-Evaluation (RE) Procedure ..................................................................................... 1-41 

Setting Re-Evaluation (RE) Dates ................................................................................ 1-44 


CWPHB #4642 (08/12) TABLE OF CONTENTS PAGE 1 OF 3

Table of Contents, Continued 

Add Persons: Overview................................................................................................1-47 

Add Person ..................................................................................................................1-48 

Beginning Date of Aid (BDA) for Add Persons.............................................................1-50 

Beginning Date of Aid (BDA) Examples.......................................................................1-52 

Beginning Date of Aid (BDA) Chart..............................................................................1-55 

Adding a Person to the Assistance Unit (AU) ..............................................................1-56 

Add Person Results in Ineligibility ................................................................................1-57 

Rules for Newborns......................................................................................................1-62 

Unborn/Pregnancy Special Needs (PSN) ....................................................................1-64 

Change of Payee: Overview ........................................................................................1-66 

Change of Payee .........................................................................................................1-67 

Domestic Abuse: Overview ..........................................................................................1-69 

Domestic Abuse: Basic Information .............................................................................1-70 

Domestic Abuse: Program Information ........................................................................1-71 

Safe At Home Program ................................................................................................1-75 

Service Providers .........................................................................................................1-77 

Diversion: Overview .....................................................................................................1-78 

Basic Diversion Information .........................................................................................1-79 

Identifying Potential Diversion Candidates...................................................................1-82 

The Diversion Process .................................................................................................1-83 

Making the Diversion Decision: A Collaborative Approach ..........................................1-84 

Issuing Diversion: Basic Rules.....................................................................................1-86 

Issuing Diversion: The Process....................................................................................1-87 




Diversion Issued via Vendor Payments .......................................................................1-88 

Diversion Issued via Warrant/EBT ..............................................................................1-89 

Establishing the Diversion Period ................................................................................1-90 

Secondary Diversion ....................................................................................................1-91 

The Impact of Diversion on Time Limits.......................................................................1-93 

When a Diversion Recipient Reapplies for CalWORKs ...............................................1-95 

Example of a Reapplication After Diversion.................................................................1-96 

Statewide Finger Imaging System (SFIS): Overview ...................................................1-97 

Statewide Finger Imaging System (SFIS): Basic Information ......................................1-98 

Statewide Finger Imaging System (SFIS) Process ......................................................1-99 

Statewide Finger Imaging System (SFIS) Requirements ..........................................1-101 

Statewide Finger Imaging System (SFIS) Processing Priority ...................................1-103 

Statewide Finger Imaging System (SFIS) Compliance ..............................................1-104 

Statewide Finger Imaging System (SFIS) Searches..................................................1-105 

Statewide Finger Imaging System (SFIS) Resolution ................................................1-107 




MAY 9, 2013 

SUBJECT: Alignment of CalWORKs and CalFresh Programs 

DISTRIBUTION: CalFresh and CalWORKs FILE: CalFresh - In Front of Chapter 1 

CalWORKs - In Front of Chapter 1 


OBSOLETE: September 30, 2013 

Overview In October 2013, the State of California is changing the CalWORKs and 

CalFresh reporting system from Quarterly Reporting (QR) to Semi-Annual 

Reporting (SAR). Cases will be converted from QR to SAR based on the 

Submit Month cycles and Re-Evaluation/Recertification (RE/RC) dates. 

Under SAR, a report will be due every six months. If a Submit Month cycle is 

not aligned with the RE/RC cycle, there is a possibility there will be a period 

of more than six months between the last quarterly report and the first semiannual 

report. 

As of September 2012, staff has been reconciling lists of cases that require 

aligning of the RE/RC and Submit Month cycles. This Interim Instruction 

Notice (IIN) contains revised instructions for aligning the cycles. 

Obsolete The instructions in this IIN obsolete information provided in: 

Shortening 

CalFresh 

certification 

periods 

IIN #12-049 ERRATA 

IIN #12-062 

Due to an approved waiver from Food and Nutrition (FNS), counties are 

allowed to shorten CalFresh certification periods in order to align with other 

programs, i.e., CalWORKs and Medi-Cal, during the conversion period from 

QR to SAR. 

RE Date Report In C-IV Release 13.01, the RE Date Report became available in C-IV in order 

to provide lists of cases whose RE and RC are not aligned. Staff will 

discontinue use of the RE Date Report at this time because the report 

includes several cases that do not require reconciliation, i.e., Transitional 

CalFresh cases. 

A revised list containing cases whose RE and RC are not aligned will be 

posted on the C-IV Resource Center and will be reconciled in lieu of the RE 

Date Report. See the “C-IV lists” block in this IIN for more information 

regarding this list. 


IIN #13-025 (05/13) DM:KE:ts PAGE 1 OF 4


C-IV lists C-IV lists requiring reconciliation will be posted on the C-IV Resource Center 

on a monthly basis, effective with the issuance of this IIN. As cases are 

reconciled, they will drop off the lists. The lists are titled: 

Change 

Reporting 

cases 

Annual 

Reporting/ 

Child Only 

(AR/CO) cases 

Reconciliation 

of “RE/RC 

Months Not 

Aligned” list 

RE/RC Months Not Aligned 

RE/RC Not Aligned with Submit Months 

The C-IV lists may contain CalFresh cases with a reporting type of Change 

Reporting (CR). While CR cases do not use Submit Months, staff must still 

reconcile CR cases that appear on the “RE/RC Not Aligned with Submit 

Months” list in the event the case becomes QR prior to SAR implementation. 

The C-IV lists may include AR/CO cases that require action because: 

The RE and RC need to be aligned, or 

The RC is not due in a Submit Month, as CR cases must also be 

reconciled (see the “Change Reporting cases” block of this IIN). 

Note: AR/CO CalFresh cases will change from CR to SAR when SAR is 

implemented. 

Cases with an RE and RC due in different months will appear on the “RE/RC 

Months Not Aligned” list and must be aligned. The Eligibility Worker (EW) 

will complete the RE or RC whose due date arrives first and follow these 

guidelines: 

If the program 

Then align the two programs by… 

due first is… 

CalFresh (RC) Completing the CalWORKs RE at the same time as 

the RC. 

CalWORKs (RE) Shortening the CalFresh RC period, taking the 

following steps: 

Click View Details in the CalFresh program block. 

Click Edit on the CalFresh Detail page. 

Change the RE Due Month to match the 

CalWORKs RE. 

Click Save and Return. 

Send a manual Notice of Action (NOA) according 

to the guidelines in the “NOA for shortened RCs” 

block of this IIN. 







Months Not 

Aligned with 

Submit 

Months” list 

Submit 

Months and 

Quarterly 

Reporting 

Changing QR 

cycle – 

skipped 

issuances 

Cases with an RE and/or RC that are not set for a Submit Month will appear 

on the “RE/RC Not Aligned with Submit Months” list. The following table 

provides instructions for the reconciliation of this list. 

If the... Then... 

RE and RC are not aligned (causing 

one of these dates to be outside of a 

Submit Month), 

Follow the steps in the “Reconciliation 

of ‘RE/RC Months Not Aligned’ list” 

block to align the RE/RC and the 

Submit Months. 

Submit Months are incorrect, Correct the Begin Month and 

Submit Months, and 


Note: The CalWORKs Begin Month 

is always the application month, but 

the CalFresh Begin Month is the first 

month in which the household is 

eligible. 

RE or RC month is incorrect, Change the Submit Months to 

match the RE/RC month. The 

customer must still be seen within 

the same certification period on 

the Notice of Action (NOA). 


Note: While the CalWORKs RE and/or CalFresh RC should be aligned with 

the Medi-Cal RE, Medi-Cal does not use Begin or Submit Months; therefore, 

the CalWORKs/CalFresh EW can change these months, if necessary, 

following the guidelines above. 

Changing Submit Months will also change the QR cycle. EWs will need to 

evaluate whether a Quarterly Report (QR 7) is required. A QR 7 is required 

for QR cases if the Submit Month is being changed to a: 

Current month, 

Upcoming month and it is after 10-day NOA in the current month, or 

Future month where it would cause a Skipped Issuance (See the 

“Changing QR cycle – Skipped Issuances” block for more information). 

Note: Changing Submit Months requires QR 7s in the months referenced 

above. EWs are not required to obtain QR 7s for past Submit Months. 

Changing the QR cycle may cause a skipped issuance reason of “QR 7 Does 

not Exist for the Previous 3 Months.” EWs will take the appropriate action(s) 

to clear skipped issuances using the “Skipped Issuance Report and 

Troubleshooting” instructions in Operations and Reference Handbook (ORHB) 

Chapter N – Management Reports. 




NOA for 

shortened RCs 

For CalFresh households who were given a new certification period during 

the reconciliation of the lists addressed in this IIN, EWs will send a manual 

NA 290 and include the following: 

If the benefit amount… Then the NOA must state… 

Changed, Effective _________your benefit amount for 

your new certification period will be $_____ 

from ________ through _________. 

Rules: 63-503.2, 63-503.3, 63.509(a), 63- 

504.1, 63-504., ACL 13-08. 

Did not change, Effective _________your certification period 

has been changed to _________ through 

__________. 

Rules: 63-504.1, 63-504.2, ACL 13-08. 

Questions District Managers (DMs) with questions regarding this IIN should contact the 

following staff at the Program Development Division (PDD): 

Karem Evans, Program Specialist (PS) I, 

(909) 383-9631 

kevans@hss.sbcounty.gov 

Erika Kleespies, PS I, 

(909) 383-9709 

ekleespies@hss.sbcounty.gov 





SUBJECT: Monthly Lists for Alignment of CalWORKs and CalFresh Programs 

DISTRIBUTION: CalWORKs and CalFresh FILE: CalWORKs – In Front of Chapter 1 

CalFresh – In Front of Chapter 1 

OBSOLETE: October 31, 2013 



Reporting (SAR). Current cases will be converted from QR to SAR based on 

the Submit Month cycles and Re-Evaluation (RE)/ Recertification (RC) dates. 

If a Submit Month cycle is not aligned with the RE/RC cycle, there is a 

possibility there will be a period of more than six months between the case’s 

last quarterly report and the first semi-annual report. 

Interim Instruction Notice (IIN) #12-049 ERRATA was issued on 9/17/12 

regarding lists of cases posted to the C-IV Resource Center that required 

reconciliation. Since that time, C-IV has begun generating similar lists that 

will be posted to the C-IV Resource Center on a monthly basis and also 

require reconciliation; these lists involve the alignment of CalWORKs REs, 

CalFresh RCs and Submit Months. 

C-IV lists Two lists requiring reconciliation will be posted to the C-IV Resource Center 

on a monthly basis, effective with the issuance of this IIN. As cases are 

reconciled, they will drop off of the lists. The lists are titled: 

Annual 

Reporting/ 

Child Only 

(AR/CO) cases 


RE/RC Months Not Aligned with Submit Months 

C-IV is in the process of implementing a System Change Request (SCR) for 

1/13 that will allow staff to generate reports with these cases through the 

C-IV system. When this SCR is implemented, the lists will no longer be 

posted to the C-IV Resource Center. 

Because AR/CO cases may have different RE/RC periods and no longer use 

Submit Months, the lists identified in this IIN will not contain some AR/CO 

cases, as follows: 

RE/RC Months Not Aligned – will not contain AR/CO cases with CalFresh 

and earned income. 

RE/RC Months Not Aligned with Submit Months – will not contain any 

AR/CO cases. 


IIN #12-062 (10/12) DM:EK:deg PAGE 1 OF 3




Months Not 




Months Not 

Aligned with 

Submit 


Cases with an RE and RC not due in the same month will appear on the 

“RE/RC Months Not Aligned” list and must be aligned. While an RE can be 

completed sooner than the month it is due, RC periods cannot be shortened 

or lengthened once they are set. The Eligibility Worker (EW) will complete 

the RE or RC whose due date arrives first and follow these guidelines: 

If the program due is ... Then align the two programs by… 

CalFresh (RC), Completing the CalWORKs RE at the same 

time. 

CalWORKs (RE), Completing the RE, 

Setting the next RE period for the same 

month as the RC, and 

Completing the RC and RE at the same 

time. 

Note: Many cases have CalWORKs and CalFresh that are erroneously 

assigned to two different EWs or Master Assignment Queues (MAQs), such as 

Cont CWCF and Cont NACF. Both programs must be reassigned to the 

appropriate EW or MAQ when aligning the RE and RC. 

Cases with an RE and/or RC that are not set for a Submit Month will appear 

on the “RE/RC Not Aligned with Submit Months” list. The following table 

provides instructions for the reconciliation of this list. 

If the... Then ... 

RE and RC are not aligned (causing 

one of these dates to be outside of a 

Submit Month), 

Follow the steps in the “Reconciliation 

of ‘RE/RC Months Not Aligned’ list” 

block to align the RE/RC and the 

Submit Months. 








eligible. 


match the RE/RC month. The 



the Notice of Action (NOA). 



the Medi-cal RE, Medi-Cal does not use Begin or Submit Months; therefore, 






Submit 

Months and 

Quarterly 

Reporting 

Changing QR 

cycle – 

skipped 

issuances 

Changing Submit Months will also change QR cycle. EWs will need to 

evaluate if a Quarterly Report (QR 7) is required. A QR 7 is required if the 

Submit Month is being changed to a: 


Upcoming month, and it is after 10-day NOA in the current month, or 


“Changing QR cycle – Skipped Issuances” block for more information.) 




not Exist for the Previous 3 Months.” 

EWs will take the appropriate action(s) to clear skipped issuances using the 

“Skipped Issuance Report and Troubleshooting” instructions in Operations and 

Reference Handbook (ORHB) Chapter N – Management Reports. 

Questions District Managers (DMs) with questions related to this IIN may contact 

Erika Kleespies, Program Specialist I (PS I), at ekleespies@hss.sbcounty.gov 

or (909) 383-9709. 



INTERIM INSTRUCTION NOTICE #12-049 ERRATA 


SUBJECT: Alignment of CalWORKs and CalFresh Programs 

DISTRIBUTION: CalWORKs and CalFresh FILE: CalWORKs - In Front of Chapter 1 

CalFresh - In Front of Chapter 1 

OBSOLETE: October 31, 2013 



Reporting (SAR). In preparation for this change, San Bernardino County is 

reviewing case files for accuracy. This Interim Instruction Notice (IIN) 

contains information and instructions regarding CalWORKs and CalFresh 

cases that may require corrections. 

Aligning 

RE/RCs and 

assignment of 

cases 

The following issues have been identified: 

CalWORKs Re-Evaluation (RE) and CalFresh Re-Certification (RC) are 

not due in the same month. 

RE and RC dates are not aligned and programs are assigned to two 

different Eligibility Workers (EWs) or Master Assignment Queues 

(MAQs). 

CalWORKs or CalFresh cases have an RE/RC month not set in a 

QR 7 Submit Month. 

Lists The following lists have been posted to the C-IV Resource Center: 


RE/RC Not Aligned with Submit Months 


IIN #12-049 ERRATA (09/12) DM:EK:ts PAGE 1 OF 4

INTERIM INSTRUCTION NOTICE #12-049 ERRATA, Continued 

RE/RC and 

Submit Month 

alignment 

lists 



Months Not 


The following table explains what information is contained in the lists. 

Name of List List Contains 

RE/RC Months Not Aligned Tab 1 - Cases with RE/RC months 

not aligned and assigned to the 

same EW or MAQ. 

Tab 2 - Cases with RE/RC months 

not aligned and assigned to two 

RE/RC Not Aligned with Submit 

Months 

different EWs or MAQs. 

Tab 1 - CalWORKs cases with the 

RE month not set for a QR 7 Submit 

Month. 

Tab 2 - CalFresh cases with the RC 

month not set for a QR 7 Submit 

Month. 

The following table provides instructions for the reconciliation of the “RE/RC 

Months Not Aligned” list. 

Step Action 

1 Check Tabs 1 and 2 on the list to identify cases. 

2 Request the program be reassigned to the appropriate EW or MAQ 

if CalWORKs and CalFresh are assigned to different EWs/MAQs. 

Example: CalWORKs is assigned to Cont CWCF and CalFresh is 

assigned to Cont NACF. Both programs will be assigned to Cont 

CWCF. 

3 Complete the RC or RE when the first due date arrives and: 

If the program due 

is… 

Then align the two programs by... 

CalFresh (RC), Completing the CalWORKs RE at 

the same time. 

CalWORKs (RE), Completing the RE, 

Setting the next RE period for 

the same month as the RC, and 

Completing the RC and RE at 

the same time. 

Note: While an RE can be 

completed sooner than the month it 

is due, RC periods cannot be 

shortened or lengthened once they 

are set. 




Example - 

Aligning 

RE/RC months 


of “RE/RC Not 

Aligned with 

Submit 


Submit 

Months and 

Quarterly 

Reporting 

The following is an example of how to align an RE and RC when the RE 

comes first (Refer to Note in Step/Action table, Step 3, in the “Reconciliation 

of ‘RE/RC Months Not Aligned’ list” block): 

A customer has an open CalWORKs case with an RE due 10/31/12 and an 

open CalFresh with an RC due 12/31/12. The EW will complete the RE in 

10/12 and set a two-month certification period to align with the RC in 12/12. 

Then, in 12/12, the EW will complete both the RE and RC, and the RE/RC 

periods for both programs will be 1/31/13-12/31/13. 

The following table provides instructions for the reconciliation of the “RE/RC 

Not Aligned with Submit Months” list. 

If the… Then... 

CalWORKS and CalFresh RE and 

RC are not aligned, 

Follow steps 2 and 3 in the 

“Reconciliation of ‘RE/RC Months Not 

Aligned’ list” block to align the RE/RC 

and the Submit Months. 



Journal all actions. 





eligible. 


match the RE/RC month. (The 



the NOA.) 

Journal all actions. 


the Medi-cal RE, Medi-Cal does not use Begin or Submit Months; therefore, 



Changing Submit Months will also change the Quarterly Reporting (QR) cycle. 

EWs will need to evaluate if a QR 7 is required. A QR 7 is required if the 

Submit Month is being changed to a: 


Upcoming month, and it is after 10-day NOA in the current month, or 


“Changing QR cycle – Skipped Issuances” block for more information.) 



IIN #12-049 ERRATA (09/12) DM:EK:ts 


PAGE 3 OF 4


Changing QR 

cycle – 

Skipped 

Issuances 


not Exist for the Previous 3 Months.” 

EWs will take the appropriate action(s) to clear skipped issuances using the 

“Skipped Issuance Report and Troubleshooting” instructions in Operations and 

Reference Handbook (ORHB) Chapter N – Management Reports. 

Questions District Managers (DMs) with questions related to this IIN may contact the 

following staff at the Program Development Division (PDD): 

Erika Kleespies, Program Specialist (PS) I 

(909) 383-9709 

ekleespies@hss.sbcounty.gov 

Patty Carson, PS I 

(909) 383-9606 

pcarson@hss.sbcounty.gov 

Maria Contreras, PS II 

(909) 383-9704 

contrerasm@hss.sbcounty.gov 


Overview 

Application/Re-Evaluation/Additional Persons 

Introduction Customers wishing to receive assistance under a CalWORKs cash aid 

program must fulfill certain application requirements. The requirements for 

various cash aid programs, including requirements for Re-Evaluation (RE) 

and additional persons are included in this chapter. 

Reference The following references are applicable to the information in this chapter: 

• EAS 40-105.2, 40-105.3, 40-107.7, 40-107.9, 40-128, 40-129, 40-131, 

40-157, and 40-181 

• EAS 42-715 

• EAS 44-206.1 

• EAS 44-314, 44-317, and 44-318 

• EAS 45-202 

• EAS 81-215 

• EAS 82-832.3 

Contents This chapter contains the following topics: 


Application: Basic Information 1-2 

Foster Care (FC) – Miller vs. Youakim 1-35 

Re-Evaluation (RE) 1-39 

Add Persons 1-47 

Change of Payee 1-66 

Domestic Abuse 1-69 

Diversion 1-78 

Statewide Finger Imaging System (SFIS) 1-97 

CWPHB #4605 (04/11) APPLICATIONS 1-1

Overview 

Application: Basic Information 

Introduction This section includes basic information about filing an application for 

CalWORKs cash aid. 

Reference The following references are applicable to the information in this section: 

All County Letter (ACL) #12-35 

Eligibility and Assistance Standards (EAS): 40-105.2, 40-107.7, 40-128, 

40-129, 40-131, 40-157, 44-206.1 (b) and 44-317 

Contents This section contains the following topics: 


Application Overview 1-3 

Advance Eligibility Determination Process 1-9 

C4Yourself e-Application 1-14 

Obtaining and Evaluating Evidence 1-17 

Application Processing Time Frames 1-18 

CalWORKs Denial – Medi-Cal Application Referral Process 1-20 

Rescind of Denial 1-23 

Social Security Number (SSN) 1-24 

Beginning Date of Aid (BDA) for New Applications 1-27 

Immediate Need (IN) 1-29 

Restoration of Eligibility and Benefits: QR 7 Discontinuance 1-34.1 


Application Overview 

Introduction This section covers various aspects of the application process, provides 

definitions, and discusses application types, processing procedures, the 

Statement of Facts and retrieval of case records. 

Definitions The following terms and definitions apply to the application process: 

Application 

types 

Applicant customer: The individual, family or child making (or on whose 

behalf is made) a new application or a request for restoration or reapplication 

of aid. 

Application: A request for aid on the SAWS 1 made in person at the 

Transitional Assistance Department (TAD) or on C4Yourself by an applicant 

or individual acting on behalf of the applicant. 

C4Yourself: The online application which the customer accesses via the 

internet to apply for CalWORKs, CalFresh and Medi-Cal. 

Customer: A generic term referring to an applicant or recipient customer. 

Electronic Application (e-App): An application the customer completes 

through the internet and submits to a District office. This application contains 

the SAWS 1 and SAWS 2 questions and is called C4Yourself. 

Inquiry: A general request for information regarding Temporary Assistance for 

Needy Families (TANF) made without the individual indicating a need for 

assistance or made with the individual declining to apply. 

Recipient customer: An individual who is receiving aid. 

Different application types are defined in the chart below: 

Application Type Definition 

Intercounty 

Transfer (ICT) 

Transfer of responsibility for determination of eligibility 

from one county to another. A SAWS 1 is not needed 

unless the sending county failed to include it in the ICT 

packet. 

New application A request for aid when the customer has not previously 

applied for CalWORKs in the same county. A SAWS 1 

or application made in C4Yourself is needed. 

Restoration A request for aid when that customer and program 

were known to C-IV. A Restoration may be due to an 

Appeals action, erroneous QR 7 discontinuance, 

erroneous discontinuance or denial, a reapplication, or 

a new application. A SAWS 1 or application made in 

C4Yourself is needed. 



Application Overview, Continued 

Restoration 

types 

Application 

processing 

procedures 

When an applicant customer applies for aid and that customer and program 

were know to C-IV, then that customer and program must be Restored. 

When Restoring a program or person, staff must determine the correct 

Restoration Reason to User. The table below lists the reasons for restoration 

and the Restoration Reason to use. 

If the person/program is being Restored Then use Restoration 

because … 

Reason … 

An Appeals action requires it, Appeals. 

A complete QR 7 was received by extended QR 7 Discontinuance. 

filing date or Good Cause is determined and 

the program was discontinued for no QR 7, 

The person/program was 

Erroneous Disc/Deny. 

discontinued/denied in error, 

A new application is received and the Restoration. 

person/program was discontinued/denied 

less than 12 months ago, 

There is a new application and the 

New Application. 

person/program was discontinued/denied 

more than 12 months ago, 

Once a customer requests aid (including a request for additional persons, 

reapplication or restoration) the Eligibility Worker (EW) must do all of the 

following: 

• Obtain the appropriate Statement of Facts when in C-IV or C4Yourself. 

• Conduct a face-to-face interview, 

• Retrieve available information from closed files and C-IV, 

• Request and evaluate pertinent evidence, 

• Grant or deny the application within prescribed time frames, and 

• Send the appropriate Notice of Action. 

This process is referred to as an Intake action and is time studied as an 

Intake function, even if done by a Continuing EW. 




Statement of 

Facts 

Process for 

obtaining the 


Facts (SAWS 2) 

The Statement of Facts (SAWS 2) is the document used to gather 

information to determine CalWORKs eligibility. The Statement of Facts is the 

financial and non-financial root questions in C-IV and questions on the 

C4Yourself e-Application. The Statements of Facts is required for all: 

• All CalWORKs, 

• Refugee Cash Assistance (RCA), and 

• Joint CalWORKs/CalFresh applications. 

The process for obtaining the SAWS 2 is as follows. The SAWS 2 is: 

• Completed by the EW and the customer in C-IV (Non-financial and 

Financial Root Questions). 

• Completed by the customer or representative unless the customer is not 

physically or mentally able to complete the SAWS 2. In this case, the 

EW will assist the customer. 

• Completed by the customer in C4Yourself. 

• Reviewed with the customer by the EW. When an error or incorrect 

answer is discovered, the EW will make the corrections in C-IV, reprint 

the SAWS 2, and have the customer sign the corrected SAWS 2 

certification/signature page. The customer is given the SAWS 2 and a 

copy of the certification/signature page. The original 

certification/signature page is imaged into C-IV. 

• Must be signed by the caretaker relative or both parents (including 

stepparent) in the presence of the EW. If either parent is unable to sign the 

SAWS 2 in person due to a physical or mental incapacity, the SAWS 2 will 

be accepted with one signature and the reason documented in the journal. 

• If the customer does not return the appropriate Statement of Facts 

(SAWS 2, QR 22, QR 23, CW 8A), or fails or refuses to include 

mandatory filing unit members on the form, the EW will deny the 

application (or discontinue the open CalWORKs). 

Note: The SAWS 2 will not be imaged into C-IV. 




Mandatory 

Journal entries 

Supplemental 

forms 

Who must be 

included on the 


Facts 

After the interview is completed with the customer, the EW is required to 

make the following mandatory Journal entry: 

If the SAWS 2 or 

C4Yourself 

e-Application 

had… 

Then the Journal entry is… 

No changes, “The customer answered all root questions in C-IV (or 

answered all questions in C4Yourself). The SAWS 2 was 

printed for the customer to review. The customer did not have 

any changes. The customer signed the SAWS 2 

certification/signature page. The SAWS 2 and a copy of the 

certification page were given to the customer. The original 

certification/signature page forwarded to imaging.” 

Changes, “The customer answered the root questions in C-IV (or 

answered all questions in C4Yourself). The SAWS 2 was 

printed for the customer to review. The customer had changes 

to Q #. The changes were made in C-IV and re-reviewed with 

the customer, and no further changes. The customer signed 

the SAWS 2 certification/signature page. The revised SAWS 2 

and a copy of the certification page were given to the 

customer. The original certification/signature page forwarded to 

imaging.” 

Forms that must be obtained in addition to, or instead of, the SAWS 2 

include: 

Form Explanation 

QR 22 – Statement of Facts Obtained in addition to the SAWS 2 

for a sponsored non-citizen. 

QR 23 – Statement of Facts Obtained in addition to the SAWS 2 

when a senior parent is in the home. 

CW 8A Can be used in lieu of the SAWS 2 

for adding children under age 16. 

The following individuals must be included on the appropriate Statement of 

Facts: 

Parents of applicant child(ren) 

Siblings and half-siblings of applicant child(ren) 

The spouse of a person required to be in the Assistance Unit (AU) 

The pregnant woman in an AU of one case 

The caretaker, stepparent, and/or second parent of an SSI or Welfare-to- 

Work (WTW) sanctioned child 

Optional persons when aid is requested for them 

Senior parents 

Sponsors of noncitizens 




The face-toface 

interview 

Who must 

attend the faceto-face 

interview 

A face-to-face interview with the customer is required prior to the granting of 

aid. Using the SAWS 2A QR, the EW will review and discuss the following with 

the customer: 

• Rights and Responsibilities, including: 

− The customer’s responsibility to report all facts, furnish a SSN, apply 

for unconditionally available income, assign support rights and 

provide any evidence necessary to make eligibility determinations. 

− The customer’s right to be informed of other programs to which 

entitled. 

• Work Registration 

• Standard Utility Allowance (SUA) if a joint CalWORKs/CalFresh 

application 

• WIC/CHDP programs 

• IEVS information 

• Availability of Child Care 

The following persons must attend the face-to-face interview, unless the 

individual has physical or mental barriers that limit his/her ability to attend the 

interview: 

• Applicant/Recipient customer 

• Both parents in a two-parent household 

• Stepparent, if included as an optional person 

Note: When an intercounty transfer (ICT) application is for a customer who 

is a nonneedy caretaker relative receiving CalWORKs benefits on behalf of a 

child who is a dependent of the court and not eligible to federal Foster Care, 

the customer is exempt from the face-to-face interview requirement. See the 

“Inter-County Transfer (ICT)” section of the ORHB for information on 

processing these ICT applications. 




Case 

restorations 

All documents in C-IV must be reviewed on all case restorations. The 

customer will not be required to provide documentation/verification that is 

already in C-IV. If the necessary verification/documentation is not in C-IV, 

the customer will need to obtain it. 

If a CalWORKs only 

case is restored… 

Within the calendar 

month after 

discontinuance/denial, 

More than one calendar 

month after but within 

one year from 

discontinuance/denial, 

Then… 

• A new SAWS 2 (root questions or C4Yourself 

e-Application) is not needed when the old 

SAWS 2 (root questions or C4Yourself e- 

Application) is in C-IV. However, the old RE 

date must be used. 

• A new SAWS 2 (root questions or C4Yourself 

e-Application) must be obtained if the old RE 

date is due within three calendar months from 

date of this application. If the old RE is not due 

within three calendar months, the old SAWS 2 

and RE date are used. 

Note: A SAWS 2 is always required when the customer reapplies for 



Advance Eligibility Determination Process 

Overview Effective December 1, 2008 the Transitional Assistance Department (TAD) 

implemented the Advance Eligibility Determination (AED) process. This 

process involves reviewing the customer’s SAWS 1 application, TAD 278 ID, 

completing the AED 100, and using the Reference Tool (AED 99) to guide 

the AED worker with determining: 

Homeless 

applicants 

Combination 

Medi-Cal/Non 

Assistance 

(NA) CalFresh 

applications 

Appointment 

requirement 

Advance 

Eligibility 

Determination 

procedure 

• The need for an expedited appointment for applicants with Immediate 

Need (IN) or Expedited Services (ES) eligibility, and 

• Potential eligibility for programs. 

Applicants who are homeless will: 

• Complete the AED process, and 

• Receive a same day appointment with an Intake Eligibility Worker (EW). 

Applications for Non Assistance (NA) CalFresh are taken and processed by 

the Medi-Cal (MC)/NA CalFresh intake combo workers in addition to 

CalWORKs/CalFresh intake workers. MC applications are taken and 

processed by MC intake workers. The AED interviewer will be utilized to 

determine potential eligibility for the combination MC/NA CalFresh 

applications. 

All applicants have a right to file an application. Applicants who request an 

appointment, including “obviously ineligible” applicants will receive a return 

appointment with an EW for the eligibility determination process. 

Selected Intake EWs will be assigned to the duty of AED Interviewer. The 

following table outlines the AED procedure: 


1 Customer applies for assistance. 

2 Reception Office Assistant (OA) gives the customer a packet 

containing the following documents: 

• TAD 278 ID 

• SAWS 1 

− Reviews the CalFresh Expedited Service Script (FS 31) 

with the applicant and write “ES explained” and initials in 

the County Use Only section under the Primary language 

area of the SAWS 1. 

• TAD/WTW Program Checklist 101 

3 Customer returns the completed paperwork to Reception OA. 



Advance Eligibility Determination Process, Continued 

Advance Eligibility Determination procedure (continued) 


4 The Reception OA: 

• Reviews the TAD 278 ID and SAWS 1 for completeness. 

• Reviews the CalFresh Expedited Service Script (FS 31) with the applicant 

and write “ES explained” and initials in the County Use Only section under 

the Primary language area of the SAWS 1, if not completed in Stage 2. 

• Researches the C-IV System to: 

− Ensure the customer does not currently have an open case (see C-IV 

System research block of this handbook). 

− Verify whether the customer was denied for missing the initial interview 

and received a Notice of Missed Interview (NOMI). 

Note: If application/case was denied/discontinued for the missed interview and 

the new application is within thirty (30) days of the first application date, the new 

application is assigned to the previous EW. 

• Date stamps each document received. 

• Places all the paperwork in the designated AED interviewer tray. 

5 AED Interviewer: 

• Obtains completed paperwork from AED tray. 

• Reviews program eligibility information on the TAD 278 ID and the 

SAWS 1 (see Program eligibility information block). 

• Informs the CalFresh applicant of the potential to receive ES (See 

AED 99, Reference Tool). 

• Informs the applicant about: 

− C4Yourself.com and creating an account (internet access is required) 

− Interactive Voice Response system (IVR) 

If applicant would like more information on C4Yourself or IVR, refer 

applicant to see the district office’s designated person one half-hour 

before the scheduled interview appointment. 

• Reviews C-IV and MEDS to determine if: 

− Applicant is potentially eligible, and 

− Previous denial/discontinuance was appropriate. 

• Interviews the applicant customer and completes the AED 100 (see 

Eligibility determination block). 

• Completes the County Use section on SAWS 1. 

• Schedules a return appointment and notates the appointment date and time 

on the TAD 127. 

• Attaches a copy of the AED 100, TAD 127, to the SAWS 1, TAD 278 ID, 

TAD WTW/ Program Checklist 101 and forwards to the Intake/Pending OA. 

Note: If the customer is applying for both MC and NA CalFresh, the AED 

interview is for NA CalFresh purposes only. The customer has the option of 

completing the MC application by mail or at the same time as the NA CalFresh 

application. 




Advance Eligibility Determination procedure (continued) 

C-IV System 

research 


6 Intake/Pending OA: 

• Completes MEDS research. 

• Pends the application and enters the customer’s appointment 

into the Customer Schedule Detail page in C-IV. 

• Forwards the TAD 127, TAD 278 ID, SAWS 1, TAD/WTW 

Program Checklist 101, AED 100 and MEDS print-outs to the 

assigned Intake EW. 

Note: Joint MC and NA CalFresh applications must be assigned 

to a MC/NA CalFresh worker for best customer service. 

The reception OA will research C-IV to verify applicant customer does not 

currently have an open case. 

If the applicant 

customer… 

Then… 

Has an open CalWORKs, • Refer the customer to the assigned Eligibility Worker (EW), even if 

the case is to be discontinued at a future date. 

• Give the customer a “How Can We Help” card (TAD 20 E/S) and 

write in the spaces provided on the card the customer’s: 

− Case number 

− EW name and number 

− Employment Services Specialist (ESS) name and number. 

Does not have an open 

CalWORKs case, 

• 

• 

Place the paperwork in the AED tray. 

Ask customer to wait to be seen by AED interviewer. 

Has an open Transitional 

CalFresh case and is 

applying for CalFresh 

and/or CW, 

• Give the customer the required forms and when completed and 

returned to reception, place all the paperwork in the designated AED 

interviewer tray. 

Does not have an open 

CalFresh case, 

• 

• 

Expand the CalFresh on the Case Summary page. 

Review the denial/discontinuance date and denial/discontinuance 

reason. 

If the denial/discontinuance date 

is… 

Less than thirty days from the 

application date and denied or 

discontinued for a missed interview, 

Less than thirty days from the 

application date and 

denied/discontinued for reason other 

than missed interview, 

More than thirty days from the 

application date, 

Then… 

Refer customer to the 

previously assigned EW and 

complete journal entry. 

Have customer complete new 

application. 

Have customer complete new 

application. 

• Place the paperwork in the AED tray. 

• Ask customer to wait to be seen by AED interviewer. 

CWPHB #4605 (04/11) APPLICATIONS 


1-11


Program 

eligibility 

information 

Eligibility 

determination 

If potential 

eligibility… 

Exists for 


CalFresh 

Does not 

exist, 

The AED interviewer will utilize the AED 99 – Advance Eligibility 

Determination Reference Tool - and review the following forms and specific 

questions to determine potential program eligibility. 

Form Question(s) Program Eligibility Information 

TAD 278 ID N/A Single individuals without children applying for 

CalWORKs only. 

SAWS 1 14, 15 Reported resources/income do not exceed limits for 

the family size. 

AED 100 Income and Resource information. 

After interviewing the applicant customer, the AED interviewer will determine 

if potential program eligibility exists. 

Then the AED interviewer will… 

• Schedule the customer for a return appointment with a Intake EW. 

• Complete the TAD 127 and give it to the customer. 

• Initial the TAD 278 ID (to identify who interviewed the customer). 

• Forward the completed TAD 278 ID, SAWS 1, TAD/WTW 

Program Checklist 101, AED 100 and a copy of the TAD 127 to 

the Intake/Pending OA to pend application and enter the 

customer’s appointment into the Customer Schedule Detail 

page in C-IV. 

Note: If customer is eligible to IN/ES, the customer will be scheduled 

for a return appointment no later than the next work day. 

• Verbally inform the customer he/she is not eligible. 

• Forward application to the Intake/Pending OA for research and 

pending prior to completing the denial process. 

• Process denial within appropriate timeframes, entering 

appropriate information in C-IV to ensure the correct denial NOA 

is generated. 

• Journal case action/information in C-IV. 

• Image supporting documents. 

Note: If denial action is for: 

• CalWORKs or CalWORKs/CalFresh application – C-IV completes 

an auto-test and opens a pending MC program; the MC 

application is then assigned to a MC Intake EW. 

• Non Assistance (NA) CalFresh application – No MC action to be 

taken and no further action is required. 

• MC/NA CalFresh application with NA CalFresh denial – MC 

application is handled separately. 

Important: If potential eligibility does not exist and customer requests an 

appointment or employment hours/income is questionable the customer will 

be scheduled for a return appointment. 




Intake EW 

responsibilities 

Monitoring of 

procedure 

If eligibility exists, the Intake EW will do the following: 

Step Action 

1 Review SAWS 1, MEDS and C-IV research and AED 100 received 

from the Intake/Pending OA. 

2 Conduct face-to-face interview with customer. 

3 Complete root questions and Detail pages in C-IV and process 

application according to established guidelines. 

4 Image the TAD 127, TAD 278 ID, SAWS 1, MEDS print out, and 

other supporting documents. 

Note: The AED 100 will not be imaged into C-IV. 

The Eligibility Worker Supervisor I (EWSI) will monitor the AED process by: 

• Randomly checking wait times for AED interviews. 

• Reviewing workload inventories on a weekly basis to ensure denials are 

completed correctly. 

EWSI and District Managers (DMs) will monitor the Intake board to ensure 

appointments are being kept within the mandated timeframes. 


C4Yourself e-Application 

Introduction Customers may submit an application for CalWORKs through C4Yourself. 

C4Yourself is an online application which customers access through the 

internet. The application is submitted electronically to the Transitional 

Assistance Department (TAD). This application is also referred to as an 

e-Application. The questions listed on the e-Application are from the 

SAWS 1 and SAWS 2. 

Generic date of 

birth 

Homeless 

e-Applications 

To pend an application in C-IV the applicant’s name and date of birth (DOB) 

is required. In some instances an e-Application may not have the applicant’s 

date of birth. If the Office Assistant (OA) is unable to determine the 

applicant’s date of birth through customer contact or research in Medi-Cal 

Eligibility Data System (MEDS), a generic date of birth of 01/01/1970 will be 

used. The OA will journal the following: 

• Short Description: Generic DOB 

• Long Description: DOB not listed on the e-Application 

− Unable to obtain DOB from customer or MEDS. Generic DOB 

1/1/1970 assigned to (customer’s name). 

Important Note: If a generic DOB is used, the EW may need to: 

• Correct a MEDS alert, 

• Correct the Client Index Number (CIN), and 

• Request Income Eligibility Verification System (IEVS). 

The OA will enter the Transitional Assistance Department (TAD) district office 

address if the customer states he/she is homeless on the e-Application. 



C4Yourself e-Application, Continued 

C4Yourself 

e-App 

processing 

When the C4Yourself application is received in the office, the Office Assistant 

(OA) will schedule an appointment with the next Eligibility Worker (EW) on 

the Intake Board (See “Scheduling the Interview” section in the e-Tools 

chapter of the Operations and Reference Handbook (ORHB)). Once the 

e-Application has been assigned to the EW, the EW will take the following 

action to process the application: 

Step Action 

1 Review the application for Immediate Need (IN) requests (see 

“Reviewing the e-Application” section in the e-Tools chapter of the 

Operations and Reference Handbook). 

If the customer... Then the EW will… 

Requests IN, Conduct an IN interview and issue or 

deny IN payment no later than the next 

working day following the date: 

• Of request for IN, or 

• The date the OA receives the e-App. 

Does not request IN, • Review the application prior to the 

face-to-face interview appointment 

(see ORHB e-tools Chapter and C-IV 

User Guide, “C4Yourself” for specific 

procedure). 

• Conduct the face-to-face interview 

(see the ”Face-to-face interview” 

section in this chapter) and request 

any needed verification and/or forms 

(see ”Required Forms” section in the 

e-Tools chapter of the ORHB). 

Note: The EW will only address those 

root questions which are unanswered or 

need more information or clarification 

during the interview. 

2 Refer to the C-IV User Guide, “C4Yourself” for instructions on 

processing the e-Application. 


Note: Customers cannot apply for Homeless Assistance (HA) through 

C4Yourself and must complete the HA 42. 



C4Yourself e-Application, Continued 

Re-Evaluations 

(REs) 

EWs will continue to mail re-evaluation (RE) packets and appointments to 

customers. Customers with C4Yourself accounts may be notified by 

C4Yourself the RE is due in the month of the RE (refer to ORHB “Processing 

a Re-Evaluation/Recertification from C4Yourself” section). Customers may 

choose to submit an e-Application for the RE. When the customer 

completes an RE through C4Yourself, the EW will do the following: 

Step Action 

1 Schedule the customer for an interview. 

If the customer… Then schedule the 

customer for a… 

Has a telephone number, Telephone interview. 

Does not have a telephone Face-to-face interview. 

number, 

2 Review the e-Application prior to the appointment. 

3 Conduct the interview. 

4 Process the RE e-Application the same as a new e-Application. 


Note: Any requests for IN on the RE e-Application must be denied and a 

Notice of Action (NOA) sent to the customer. 


Obtaining and Evaluating Evidence 

Introduction Certain evidence must be gathered and evaluated at the time of application 

for cash aid. This section provides information about obtaining and gathering 

evidence. 

Process When determining eligibility to CalWORKs, the Eligibility Worker (EW) follows 

the steps below: 

County’s 

obligation to 

assist 

customer 

Step Action 

1 Reviews the SAWS 2 or e-Application, and any journal entries, 

Tasks, and Reminders set on all cases for the customer. 

2 Requests verification to substantiate all eligibility factors. 

3 Reviews all documents. 

4 Evaluates eligibility for CalWORKs by evaluating the following 

eligibility factors: 

• Deprivation - Child(ren) only 

• Age - Child(ren) only 

• Residence 

• Citizen/Noncitizen/Refugee status 

• Social Security Numbers 

• Work Registration/Exemptions 

• Student eligibility 

• Income 

• Financial Eligibility 

• Resources 

• Federal Financial Participation 

• Special Needs 

The gathering of evidence necessary to make an eligibility determination is a 

joint responsibility of the customer and the County. 

• The County will inform the customer what evidence is required, why it is 

required and how it will be used. 

• The customer will cooperate with the County in the evidence gathering 

process to the fullest extent possible. 

• When it is not possible for the customer to obtain necessary evidence, 

the County will obtain it for him/her. 

When needed in the evidence gathering process, a signed release of 

information or consent form must be obtained from the customer. The 

signed release of information will state the purpose of the contact and the 

individual or agency to be consulted. The TAD 228 form meets these 

criteria. 


Application Processing Time Frames 

Introduction Regulations provide time frames for processing applications for CalWORKs. 

This section provides information about the time frames for processing 

applications, and approving or denying cash aid. 

Approval time 

frames 

Denial time 

frames 

Denial of 

Immediate 

Need (IN) 

When the customer meets all eligibility requirements, the Eligibility Worker 

(EW) will approve CalWORKs (run EDBC) within the appropriate time frame. 

The beginning date of aid regulations will be followed carefully and equitably. 

The application must be processed when eligibility is established. The 

following rules apply to both the Intake and additional person processes: 

• All applications must be processed within 30 days from the date of 

application/request. 

• EWs should take action to process cases as soon as eligibility is 

established but no later than 15 calendar days after required verification 

is provided. 

• If a case is partially eligible (i.e., one undocumented noncitizen, caretaker 

and other children meet criteria) aid will be granted for the eligible 

person(s). 

Note: Immediate Need (IN) requests must be processed by the working day 

following the date of request or the date the Office Assistant (OA) receives 

the e-Application. 

When the customer does not meet eligibility requirements within set time 

frames, the EW will deny the application and send an appropriate Notice of 

Action (NOA). 

An application will be denied: 

• At the time of application if the ineligibility is obvious (i.e. no eligible child 

in the home), or 

• When ineligibility occurs prior to authorization, even if the Assistance Unit 

(AU) was eligible for aid in the month of application, or 

• When there has been no contact with the customer, the later of: 

− Four calendar days after customer failed to keep an appointment, or 

− Fourteen (14) calendar days after the application date. 

Exception: If the AU is not income eligible for the month of application only, 

aid will be effective the first of the following month. 

The Immediate Need request will be denied, and NOA sent, within one day of 

IN request or the date the OA receives the e-Application if IN: 

• Was deferred or met through means other than payment issuance. 

• Eligibility criteria were not met. 



Application Processing Time Frames, Continued 

Written 

withdrawal of 

application 

When the customer provides a written request for withdrawal of application, 

the Eligibility Worker (EW) will complete the CW 10 – Notice of Withdrawn 

Application and give to the customer. A denial NOA is not required when the 

customer requests application withdrawal in writing. 


CalWORKs Denial – Medi-Cal Application Referral Process 

Introduction County Welfare Departments must ensure Medi-Cal and CalFresh benefits 

continue to families that remain eligible for these programs. All people 

denied or discontinued CalWORKs benefits must be referred for a 

determination of continued eligibility for Medi-Cal and CalFresh. This 

includes those families denied CalWORKs cash aid after Diversion is 

approved. 

Referral 

process - 

general 

Referral 

requirements 

Referral 

requirements 

exceptions – 

full program 

application 

Referral 

requirements 

exceptions – 

add person 

application 

District offices must standardize their processes in order to ensure all 

CalWORKs denials are referred to a Medi-Cal unit, reviewed for Medi-Cal 

eligibility, and have appropriate action taken. 

All denied CalWORKs applications, whether for the full program or a person, 

must be referred immediately to the Medi-Cal unit for an eligibility 

determination when the CalWORKs application is denied. 

The only exceptions for referral of full CalWORKs application denials to 

Medi-Cal are: 

• The customer withdrew the CalWORKs application by specifically stating 

in writing that he/she is withdrawing his/her request for Medi-Cal also; 

• All applicant customers are deceased; 

• All applicant customers are Foster Care or Kin-GAP children; 

• All applicant customers are in jail or other ineligible institutions; 

• All applicant customers are out of state, and 

• All applicant customers are receiving SSI. 

The only exceptions for referral of add person CalWORKs application denials 

to Medi-Cal are: 

• The customer withdrew the CalWORKs application by specifically stating 

in writing that he/she is withdrawing his/her request for Medi-Cal also; 

• The add person is deceased; 

• The add person is a Foster Care or Kin-GAP child; 

• The add person is in jail or other ineligible institutions; 

• The add person is out of state, and 

• The add person is receiving SSI. 



CalWORKs Denial – Medi-Cal Application Referral Process, 

Continued 

ICTs in not 

accepted 

When a CalWORKs Intercounty Transfer (ICT) in is not accepted, prior to 

running the EDBC to deny/discontinue the CalWORKs, send the CW 215A, 

CalWORKs Intercounty Transfer Continuation Request for Additional 

Documents form to the sending county: 

• Informing the sending county the CalWORKs ICT was not accepted, and 

• Requesting documents for the Medi-Cal referral. 

C-IV entries Prior to completing the processes to deny the CalWORKs program or a 

pending CalWORKs add person, CalWORKs EWs must complete all known 

data entry elements in the Non-Financial and Financial pages in C-IV. 

Beginning 07/31/2006, most CalWORKs denials (full program and add 

person) should result in C-IV adding all denied CalWORKs applicants as 

pending persons to: 

• Existing Active Medi-Cal programs, or 

• Newly pended Medi-Cal programs. 

Note: If C-IV fails to add all denied CalWORKs applicants as pending 

persons to an existing Active Medi-Cal program or to a newly pended Medi- 

Cal program and the denial does not meet one of the exceptions for referral 

listed in the Referral requirements exception blocks, then follow the 

instructions in the following block. 



CalWORKs Denial – Medi-Cal Application Referral Process, 

Continued 

Instructions – 

C-IV does not 

set up Medi-Cal 

pending 

program or 

person 

The following chart has the actions for the CalWORKs EW when C-IV does 

not set up a pending Medi-Cal program or person and the following 

conditions exist: 

• The CalWORKs program or a CalWORKs add person is being denied, 

AND 

• The program/person was not denied for one of the exceptions. 

When the CalWORKs 

application is denied 

and there is … 

Not a Medi-Cal program 

for any applicant on the 

pending CalWORKs case 

number, 

A Medi-Cal program for a 

least one applicant on the 

pending CalWORKs case 

number, but it is not 

active, 

An active Medi-Cal 

program for any applicant 

on the pending 

CalWORKs case number, 

Then the CalWORKs EW will … 

• Add the Medi-Cal program and add all the 

CalWORKs Program Persons (applicants) 

as Medi-Cal Program Persons. Medi-Cal 

application and effective date = 

CalWORKs application date. 

• Assign pending Medi-Cal program to self. 

• Run EDBC to fail/deny the CalWORKs 

program. 

• Complete a journal entry. 

• Transfer pending Medi-Cal program to a 

Medi-Cal EW following REAC procedures. 

• Restore the Medi-Cal program and 

restore/add all CalWORKs Program 

Persons (applicants) as Medi-Cal Program 

Persons. Medi-Cal application and 

effective date = CalWORKs application 

date. 

• Assign pending Medi-Cal program to self. 

• Run EDBC to fail/deny the CalWORKs 

program. 

• Complete a journal entry. 

• Transfer pending Medi-Cal program to a 

Medi-Cal EW following REAC procedures. 

• Run EDBC to deny/fail CalWORKs. C-IV 

will not create a Medi-Cal EDBC. Any 

applicants not already on the active 

Medi-Cal program will be added to the 

Medi-Cal program in pending status. 

• Notify owning Medi-Cal EW of the change 

in Medi-Cal program persons by setting a 

Task and sending an email. 

• Complete a journal entry 


Rescind of Denial 

Introduction There are situations when a denial action requires a rescind action. This 

section provides information about when to rescind a denial, allowing 

additional days, second denial actions, and when not to rescind a denial. 

When to 

rescind denial 

Allowing 

additional days 

The Eligibility Worker (EW) will rescind a denial and process the application 

based on the original application date if the customer is otherwise eligible 

when: 

• The denial is based solely on the customer's failure to cooperate in 

providing evidence of eligibility, and 

• The EW receives the needed evidence within 30 calendar days of the date 

of the denial. If the 30th calendar day falls on a weekend or holiday, the 

date is advanced to the next working day (e.g. 30th day is Sunday, 

Monday is considered the 30th day). 

A new SAWS 2 is not required for CalWORKs. 

Note: This also includes situations in which some family members are 

denied, while others are approved. 

If the customer supplies the missing evidence within 30 calendar days, but 

additional information is needed to process the case, the EW will notify the 

customer verbally or by letter and allow him/her 10 calendar days to supply 

the information/verification. 

Note: If tenth day is a weekend or holiday, allow the customer until the next 

working day to supply the information/verification. 

Second denial If the denial is rescinded, and again denied, a second denial NOA will be 

sent based on the new reason for ineligibility. 

When not to 

rescind a denial 

The EW will not rescind a denial when the customer: 

• Did not complete a SAWS 2 or QR 7. 

• Did not have an application interview. 

• Refused to cooperate (the customer actively refused verbally or in 

writing). 


Social Security Number (SSN) 

Introduction Social Security Numbers (SSNs) are required verification for all CalWORKs 

applicant/recipient customers. This section includes information about SSN eligibility 

requirements, confirming SSNs and what to do when the SSN cannot be confirmed, 

and Enumeration at Birth (EAB). 

Eligibility 

requirements 

Confirming 

Social Security 

Numbers 

As a condition of eligibility, each individual in the Assistance Unit (AU) must: 

• Furnish his/her SSN within 30 days following the date of application, or 

• Provide proof of a “completed” SSN application within 30 days following the date 

of application (including SSA-2853-OP3 for newborns enumerated at birth), and 

• Provide his/her SSN to the county when received. 

Note 1: Eligibility for individuals cannot be established without one of the above 

verifications. 

Note 2: A “completed” SSN application is an application that was accepted and is 

being processed by the Social Security Administration (SSA). 

The MC 194 can no longer state “pending further information”. 

SSNs will be confirmed by viewing SSN cards or SSA’s form, series OA-702. If the 

SSN card or OA-702 form is not available, the following are acceptable evidence: 

• Award letter, Medicare card or check from Social Security Administration (SSA) 

with the customer’s name, SSN, and the letters A, HA, J, T, or M following the 

SSN. 

• SSN verification from a previous application, providing there is no Medi-Cal 

Eligibility Data System (MEDS) alert on that SSN. 

• TAD 194 A signed and stamped by SSA. 

• MEDS printout or Income and Eligibility Verification System (IEVS) abstract with 

the following: 

SSN-VER 

code 

Status Description 

J Old • Replaced with “W” as of 9/25/09, and 

• Still used in MEDS; however, the code has been 

redefined as follows: 

− SSN verified via Title XVI data match - failed SSA 

data match. 

Note: Any MEDS record/screen print dated prior to 

9/25/09 that has the SSN-VER code of “J” continues to be 

acceptable verification for the customer. 

W Temporary • Replaced the “J” as of 9/25/09 as acceptable 

verification for a customer’s SSN, and 

• Will be replaced with SSN-VER code “A”. Change 

will occur on a flow basis throughout 2010 with the 

MEDS validation process. 

A Permanent • Replaced the “J” and the “W” codes, and 

• As of 9/25/09, any MEDS record coded with “A” is 

acceptable verification. 

Note: Military ID cannot be used to verify/confirm a Social Security Number for 

CalWORKs. 



Social Security Number (SSN), Continued 

When the 


Number cannot 

be confirmed 

Enumeration at 

Birth (EAB) 

When a customer’s SSN cannot be confirmed, the Eligibility Worker (EW) will 

refer the customer to Social Security Administration (SSA) to apply for one, 

except for newborns enumerated at birth (see Enumeration at Birth). The 

EW will: 

• Give the customer a TAD 193 and MC 194 to take to the SSA office. The 

customer must provide verification showing a “completed” SSN 

application within thirty (30) days of the SAWS 1. 

• Set a Task to follow up on SSN in 45 days (SSN cards are sent out 

approximately 14 days after the application is submitted to SSA). 

• If Social Security card is not submitted within 45 days, send a follow-up 

letter. 

• If there is no response, send an NOA to discontinue the individual 

needing the Social Security card at the end of the current QR Payment 

Quarter. 

• Document all actions/contacts in the case journal. 

Note: Sometimes a customer moves without giving a forwarding address to 

the Post Office. The customer should check with the SSA office, as returned 

cards are held there for 60 days after returning from the Post Office. 

The Social Security Administration, in cooperation with local hospitals, will 

assign Social Security Numbers to newborns. This is called Enumeration at 

Birth (EAB). 

• EAB is optional, at the parent's discretion. If EAB is not done, a referral for 

SSN will be done following SSN application procedures. 

• EAB is done with the registration of birth at the hospital. 

• If EAB is done, the parent receives a receipt (SSA-2853-OP2). This is 

acceptable verification for application of SSN. The EW will: 

− Set a Task to follow up on SSN card in 45 days (SSN cards are mailed 

to parents in approximately six weeks after the birth is registered). 

− If the Social Security card is not submitted within 45 days, send a 

follow-up letter. 

− If there is no response, send an NOA to discontinue the newborn at the 

end of the current QR Payment Quarter. 

− Narrate all actions/contact in the case journal. 

Note: If the parent loses or misplaces the SSA-2853-OP2 before providing it 

to TAD, do not refer the parent to SSA for further documentation, as SSA has 

no record. SSA will not accept a new application for 90 days pending the 

processing of the SSN through EAB. 



Social Security Number (SSN), Continued 

SSNs and 

beginning date 

of aid chart 

The following chart demonstrates SSN situations that may occur during the 

application process and the resulting beginning date of aid (BDA). 

If the situation at CalWORKs 

Application is the … 

Individual has SSN and number is 

confirmed, 

Individual has SSN, but cannot 

confirm number, 

Individual has no SSN and proof of 

“completed” SSN application is 

returned within 30 days following 

date of CalWORKs application, and 

CalWORKs application has not 

been processed. 



returned within 30 days following 

date of CalWORKs application, and 

CalWORKs application has been 

approved, 



returned after 30 days following 

date of application, 


“completed” SSN application is not 

on file, 

Then the Beginning Date of Aid 

(BDA) is the … 

Date of CalWORKs application, if 

otherwise eligible. 



Note: The SSN must be confirmed 

within 30 days from the date 

following the date of application. 



Notes: 

1. If proof of “completed” SSN 

application is not on file when 

the case is processed, aid will 

be denied for the individual with 

no SSN. 

2. If the individual is the only 

eligible child, the entire AU is 

ineligible and ineligible for IN. 

Date of CalWORKs application. 

Original request for aid for the 

individual is denied. A new 

CalWORKs application is required. 

BDA is the date of new CalWORKs 

application (date of request) if 


Note: If the individual is the only 


ineligible. 

Aid will be denied for the individual. 

Note: If the individual is the only 


ineligible. 


Beginning Date of Aid (BDA) for New Applications 

Introduction Information regarding the Beginning Date of Aid (BDA) for new applications 

is provided in this section. This includes definitions and terms, and BDA 

rules and examples. 

Reference The following references are applicable to the information under this topic: 

• EAS 44-317 

Definitions and 

terms 

Following is a list of definitions and terms associated with BDA. 

Application Date 

• Intake – The date the completed SAWS 1 or e-Application is received by 

the Transitional Assistance Department (TAD). 

• Continuing – The date the request for aid is received by phone, in 

person, or in writing (i.e. QR 7). 

BDA – The date the aid payment begins. 

Eligibility Conditions – Conditions that do affect BDA and must be met by 

the applicant customer prior to authorization of CalWORKs. These 

conditions include: 

• Deprivation, 

• Residency, 

• Citizenship status, 

• Age, 

• Income, 

• Resources, and 

• Work registration requirements. 

Technical Conditions of Eligibility – Conditions that do not affect BDA, but 

must be met by the applicant customer prior to authorization of CalWORKs. 

The four conditions are: 

• Furnishing a Social Security number (SSN) or verification of an 

application for an SSN. 

Note: This condition is met if TAD has a previous copy of the SSN on file 

or the SSN is verified on an Income and Eligibility Verification System 

(IEVS) or Medi-Cal Eligibility Data System (MEDS) print out with the 

appropriate SSN-VER code. 

• Application of unconditionally available income, such as Unemployment 

Insurance Benefits (UIB), Social Security benefits, and State Disability 

Insurance (SDI). 

• Application for UIB by the Principal Earner (PE) in an Unemployment 

deprivation case. 

• Agreement to cooperate with the Department of Child Support Services 

(DCSS), this County’s Local Child Support Agency (LCSA), through 

completion of the Notice and Agreement for Child, Spousal and Medical 

Support. 



Beginning Date of Aid (BDA) for New Applications, Continued 

BDA rules – 

new 

applications 

BDA rule – add 

person 

application 

while full case 

application 

pending 

Additional 

examples 

The BDA shall not precede the date of application. Aid will begin on the date 

of application or the date on which the applicant customer meets all eligibility 

conditions, whichever is later. 

• If all eligibility conditions exist for each mandatory member of the 

Assistance Unit (AU), the BDA is the application date, provided the 

technical conditions are met for each mandatory AU member prior to 

authorization 

• 

Example: A pregnant woman only (PWO) applies for cash aid on 

December 5 and meets technical conditions December 7. She provides 

other verification including pregnancy verification to establish eligibility on 

December 9. BDA is December 5. 

• If eligibility conditions do not exist on the application date, the BDA is the 

date eligibility conditions are met. 

Example: An AU applies for cash aid and meets technical conditions on 

12/13. The Eligibility Worker interviews the customer on December 19 

and determines on December 13 the customer was over resource limits, 

but was below resource limits on December 17. BDA is December 17, as 

the customer met CalWORKs eligibility conditions on that date. 

Note: If ineligibility occurs prior to granting aid, the case will be denied, even 

if the AU was eligible for aid in the month of application. 

If an add person application is made while a full case application is still 

pending (has not yet been approved or denied), the BDA for an add person is 

the latter of: 

• The add persons date of application, or 

• The date the add person meets all eligibility conditions. 

The following chart outlines additional examples of the BDA rules listed 

above: 

Application Date Technical Date Eligibility Authorization BDA 

Date Conditions Met Conditions Met Date 

02/03/YY 02/04/YY 02/03/YY 02/13/YY 02/03/YY 

03/27/YY 04/03/YY 03/27/YY 04/07/YY 03/27/YY 

10/10/YY 10/10/YY 10/13/YY 10/17/YY 10/13/YY 

07/17/YY 07/17/YY 08/01/YY 08/04/YY 08/01/YY 


Immediate Need (IN) 

Introduction Immediate Need (IN) payments may be requested at time of application, or 

any time prior to approval when the customer has need for immediate cash 

assistance. This section provides information about IN, including terms and 

definitions, criteria, methods of request and payment, procedures and 

timeframes. 

Reference The following reference is applicable to the information in this section: 

• EAS 40-129 

Terms and 

definitions 

The following terms and definitions apply to IN: 

Apparent Eligibility: The information provided on the Statement of Facts or 

information otherwise available to the County, indicating that the customer 

would be eligible for CalWORKs if this information were verified. 

Expedited Determination of Eligibility (EDE): Determination of regular cash 

grant within three (3) calendar days if the IN emergency is due to a pending 

eviction. 

Immediate Need: A need that exists when the customer is eligible or 

apparently eligible to CalWORKs and has insufficient income and/or liquid 

resources to meet expenses for shelter, utilities, lack of essential clothing, 

essential transportation or other emergencies relating to health and safety. 

Immediate Need Time Frame: When all IN criteria are met, the customer is 

eligible to an IN payment within one (1) work day of IN request or the date the 

Office Assistant (OA) receives the e-Application. 

Liquid Resources: Resources immediately available and readily converted to 

cash. This does not include Cash Surrender Value (CSV) of insurance policies, 

personal effects, motor vehicles, real property, or uncashed checks received in 

the current month (Uncashed checks received in the current month are 

considered income). 



Immediate Need (IN), Continued 

Criteria Eligibility for IN exists when the customer meets all of the following criteria: 

• Is apparently eligible for CalWORKs: 

− A pregnant woman with no other children must provide pregnancy 

verification. 

− An eligible non-citizen must provide verification of legal status. 

• Has an emergency situation (without regard to whether it could have 

been anticipated) that cannot be addressed by the issuance of CalFresh 

or Homeless Assistance. An emergency situation exists when the 

customer: 

− Is homeless or has an eviction notice (includes a 3-day pay or quit). 

− Has a utility shut off notice (regardless of the shut off date) or 

verification of terminated services. 

− Does not have enough food for three (3) calendar days. The 

Eligibility Worker (EW) may issue CalFresh to meet this need as long 

as ES criteria are met and the benefits are available within one day of 

IN request and can be used to meet the need. 

− Is unable to meet essential transportation needs relating to food, 

medical care, or job. (If CalWORKs eligibility is established within the 

IN time frame and establishing Medi-Cal eligibility takes care of the 

medical emergency, Medi-Cal can be issued in lieu of the IN 

payment.) 

− Lacks essential clothing such as diapers or clothing needed for 

inclement weather. 

− Has any other emergency relating to health or safety. 

• Has resources that do not exceed resource limits. The limits differ 

according to the emergency. 

− Pending eviction: liquid resources together with income must be less 

than the rent owing. The income must be available to meet the 

emergency and be received from the first of the month through the 

end of the IN time frame. 

− Essential transportation: liquid resources must be less than the cost 

of the emergency. (Do not include current month’s income as a 

resource.) 

− All other emergency situations: liquid resources must be less than 

$100. 

• Complies with all technical conditions for CalWORKs: 

− SSN enumeration requirement 

− Applies for unconditionally available income (including UIB) 

− Agrees to cooperate with Child Support 

Criteria Notes Immediate Need criteria notes are as follows: 

• Persons included in an existing AU are not eligible to IN. This includes 

customers who were part of an AU in another state. 

• AU members who do not meet the SSN requirements are not eligible for 

IN. If the AU member is the only eligible child, IN will be denied. 




IN payment 

requests 

The customer may request an IN payment any time during the application 

process. The request can be made: 

• By completing the IN section of the SAWS 1 at application, 

• By completing the IN questions on the C4Yourself e-App, or 

• Verbally or in writing any time after the application was submitted. The 

Eligibility Worker (EW) will provide the customer with the CW 4, Request for 

Immediate Need Payment. 

Note: The EW cannot complete the IN section of the SAWS 1 or the CW 4 for 

the customer, except at the customer’s request. This request must be 

documented in the case journal. 

IN payments The EW must conduct an IN interview and issue or deny a payment to IN 

customers no later than the next working day following the date the IN request 

was received, or the date the OA received the e-Application. For emergency 

situations other than a pending eviction, the EW will issue: 

• $200 or the prorated amount of cash aid, whichever is less, if the customer 

meets all technical conditions of eligibility. 

• The full cash grant only if the customer submitted all verification to 

process regular CalWORKs within the IN time frames. 

Second IN 

request 

Note: IN payment amounts are based on and approved for the AU members 

who have met all technical conditions. An EW cannot deny an IN request 

because one (or more) AU members have not yet met technical conditions 

(i.e., the EW will approve IN for the children in the AU who have met 

technical conditions even if their parent still needs to apply for UIB). 

In the case where a customer received less than $200 IN, due to the issuance 

of a prorated grant, a second IN payment may be made in the following month 

as long as: 

• A second request is made on the CW 4, 

• The customer remains apparently eligible, 

• The ongoing CalWORKs payment has not yet been issued, and 

• The customer’s emergency continues or a new emergency has arisen. 

The combined amount of IN payments cannot exceed $200 (even if the 

customer applies for aid more than once in a calendar month). 

The EW will send the customer an NOA for each approval. 




Expedited 

determination 

of eligibility 

(EDE) 

Choice of IN or 

EDE 

If the emergency is a pending eviction, the customer may choose an Expedited 

Determination of Eligibility (EDE). This is a determination for regular cash aid. 

The EW must complete the EDE by the end of the third workday following the 

date of the IN request. 

A customer who is IN eligible can only choose to have EDE when all of the 

following conditions are met. The customer: 

• Has an eviction notice (including a 3-day pay or quit) 

• Has insufficient funds to pay the rent owing, and 

• Is currently residing in the home. 

The customer may choose to receive IN ($200) in one (1) work day and only 

meet technical conditions, or request EDE and provide all verification 

necessary to process the case and get a full grant in three (3) days. When the 

customer has this choice, the EW will: 

• Inform the customer in writing of the information and verification 

necessary to determine CalWORKs eligibility, 

• Have the customer complete the CW 43, Customer Choice Form, 

• Issue payment according to the customer’s choice, and 

• Send an approval NOA. 

Note: If the customer fails to meet all CalWORKs requirements by the third 

workday but has met all technical requirements, the EW will issue IN on the 

third workday. 

Issuance IN is issued via the EBT system. The EW arranges for the over-the-counter 

(OTC) issuance of the EBT card and PIN. 




IN timeframes 

and action 

Completion of 

the application 

process 

The following chart shows timeframes and actions concerning Immediate 

Need. 

Day 0 = The date the IN request is received, or the date the OA receives the 

e-Application. 

Day 1 = The date the IN payment must be issued. 

Example: A customer submits an e-Application on Friday at 7:00 pm. The 

OA receives the e-Application on Monday at 8:00 am. Day 0 is Monday, the 

date the OA received the e-Application. 

Day Action 

0 IN Request (SAWS 1, CW 4 or e-Application), 

0 or 1 • IN interview (SAWS 2) 

• EW requests verifications 

• If eviction emergency, give customer choice of IN or EDE 

1 • If IN eligible, issue $200 or prorated amount of CalWORKs, 

whichever is less 

• Arrange for over-the-counter (OTC) issuance of the EBT card 

and PIN 

3 • For EDE determinations, issue full grant via EBT 

When IN, ES, or Homeless Assistance (HA) have been issued to meet a 

customer's emergency situation, the EW will process the regular CalWORKs 

case within 15 workdays. 

• BDA rules will be followed. 

• The amount of aid payment will be the grant amount less any IN payment 

issued for that month. 

• The EW will issue payment as soon as administratively possible, but no 

later than 15 calendar days from the date all verification is received. 




Denials If the customer fails to meet IN eligibility conditions within the IN time frame, the 

EW will deny the IN request by sending a denial NOA. 

• If the NOA is hand-delivered, it must include a CW 4, Request for 

Immediate Need, so the customer can apply again if an emergency 

arises. 

• The denial of the IN request does not preclude the customer from 

reapplying anytime during the application period. 

• IN requests may be denied in the following situations: 

− Technical Conditions are not met. 

− The need for food or housing was met by the issuance of CalFresh 

Expedited Service (ES) or Homeless Assistance (HA). 

− The customer is not apparently eligible to CalWORKs. 

− Based upon available information, the customer does not have an 

emergency situation. 

− The customer currently receives aid, is being added to an existing 

CalWORKs case, or received aid from another state in the month of 

application. 

− The request was made on behalf of a child placed in Foster Care. 

− The entire AU is currently under sanction. 

− The County is unable to establish the eligibility because the customer 

failed or refused to cooperate, or failed to show for the IN interview. 

Discontinuance 

procedures 

after IN 

issuance 

If a customer becomes ineligible after an IN payment was issued, the EW will: 

• Send the appropriate IN denial NOA. 

• Deny CalWORKs and send denial NOA. 

• Refer to Medi-Cal. See CalWORKs Denial – Medi-Cal Application 

Referral Process in this Chapter. 

• Determine any overpayments. If the AU received IN but was not eligible 

to CalWORKs, the IN payment is an overpayment. 


Restoration of Eligibility and Benefits: QR 7 Discontinuance 

Introduction This section contains information regarding the restoration of CalWORKs 

eligibility and benefits for QR 7 discontinuances. 

Overview Effective 7/1/12, customers submitting a completed QR 7 within the month 

following discontinuance for an incomplete QR 7 or non-submission of a 

QR 7 will be given the option of having their CalWORKs/CalFresh benefits 

restored without completing a new application or intake interview, provided 

all other eligibility criteria are met. Eligibility and benefits for the Assistance 

Unit (AU) will be determined based on the submitted complete QR 7 and 

prorated from the date the QR 7 (and necessary verification) is provided. 

References The following regulation is applicable to the information in this section: 

All County Letter (ACL) #12-35 

General rules General rules regarding the restoration of eligibility and benefits for QR 7 

discontinuance, provided the AU chooses to resolve the discontinuance and 

provides all necessary verification in the month following the discontinuance: 


Transitional 

CalFresh (TCF) 

Eligibility will be restored and benefits pro-rated from the date the AU 

resolves the discontinuance (as specified above). 

Note: If the QR 7 is submitted on the second working day of the month 

(day following extended filing date), benefits are not prorated; case has 

not yet been discontinued and the AU is eligible to a full month’s benefits. 

AUs with a new county of residence who meet the criteria of restoration 

will have their cases restored and Inter-County Transferred (ICT’d). 

Restored AUs are considered recipient cases. Therefore: 

A new application or application interview is not required, 

Applicant eligibility criteria, such as applicant earned income 

disregard and the 100-hour work rule, do not apply, 

The AU is not entitled to Immediate Need (IN), 

Another Statewide Fingerprint Imaging System (SFIS) image is not 

required, 

The Quarterly Reporting (QR) cycle remains the same, 

The original Re-Evaluation (RE) period remains the same, and 

Benefits are based on information reported on the QR 7. 

Note: Restoring benefits at a decreased level (based on applicable 

changes, pro-ration, etc.) is appropriate because the case is going 

from a discontinued status to an active status after a break in aid. 

This is not considered a mid-quarter decrease. 

AUs receiving CalFresh benefits will have their CalFresh benefits terminated 

when a complete QR 7 is not submitted timely; however, Transitional 

CalFresh (TCF) benefits will be received. When a complete QR 7 is 

submitted in the month following discontinuance, regular CalFresh benefits 

will be restored effective the first of the following month, provided a timely 

Notice of Action (NOA) is issued for the termination of TCF benefits. 



1-34.1

Restoration of Eligibility and Benefits: QR 7 Discontinuance, 

Continued 

Options for the 

CalWORKs AU 

The CalWORKs AU may select the most beneficial process for its 

circumstance. The AU may: 

Provide a completed QR 7 and have the case processed as a restoration 

of eligibility and benefits, or 

Submit a new application and request IN. 

Exceptions The AU’s eligibility and benefits will not be restored when the AU has been: 

Good cause 

and erroneous 


Notice 

requirements 

Forms and 

NOAs 

Discontinued for failure to complete the RE, or 

Disqualified from the program. 

The restoration of eligibility and benefits does not change the need to 

determine good cause for submitting a late QR 7. The Eligibility Worker (EW) 

will still need to determine if the AU had good cause for not submitting a 

complete and timely QR 7. 

If, during the restoration process, it is determined the case was erroneously 

discontinued, the discontinuance will be rescinded and benefits restored. 

See Chapter 10, Section 5 for more information about good cause. 

Notice of Action (NOA) requirements for the restoration of eligibility and 

benefits are as follows: 

An adequate NOA is required when approving or denying an AU’s 

restoration. 

Note: An adequate NOA is sufficient when the AU’s eligibility is restored 

and issued a decreased benefit amount, since restoring discontinued 

benefits is considered to be a positive action (10-day NOA is not 

required). 

Combination CalWORKs/CalFresh cases require a timely discontinuance 

NOA for TCF cases. 

The following forms and NOAs are used when approving or denying the 

restoration of eligibility and benefits for a QR 7 discontinuance: 

Form Number/Title Use 

NA 40-125A – Restore After QR 7 Informs the AU of the approval of the 

Discontinuance, Approve 

restoration 

Appropriate Denial NOA (notify Informs the AU of the denial of the 

customer of the reason for denial) restoration 

CF 250 – Advance Eligibility Informs the continuing EW of a 

Determination (AED) Restoration of 

Aid Routing Slip 

restoration 


CWPHB #4642 (08/12) APPLICATIONS 1-34.2


Continued 

Quarterly 

Reporting 

information 

When restoring eligibility and benefits due to a missing or incomplete QR 7, 

consider the following information: 

Eligibility and benefit amount will be determined based on information 

pertaining to the QR Data Month. 

Report or provision of updated information from what has been provided 

on the QR 7 during the restoration process is considered a voluntary 

mid-quarter report and action is taken according to existing policy. 

The original discontinuance date will remain in effect when an AU 

provides a complete QR 7 to resolve the reason for discontinuance and 

is subsequently determined ineligible for assistance for another reason. 

Examples The following are examples of restoration of eligibility and benefits for QR 7 

discontinuances: 

Example 1: The AU fails to submit the July QR 7, and the CalWORKs and 

CalFresh programs are discontinued August 31. The AU begins receiving 

TCF effective September 1. The AU submits a complete QR 7 on 

September 15. Mom anticipates receiving monthly gross earnings of $1000, 

and attaches appropriate verifications. CalWORKs is restored effective 

September 15 establishing the QR cycle as Sept/Oct/Nov. The new earnings 

are used to determine eligibility and benefit amounts for the month of 

September and the remainder of the payment quarter. CalWORKs benefits 

will be prorated for September. 

Because the AU received TCF in September, the EW must: 

Send a timely NOA to terminate TCF effective September 30, and 

Restore regular CalFresh benefits effective October 1. 

The RE and RC periods remain the same as previously established. 

Example 2: The AU submits the November QR 7 timely, but fails to provide 

income verification. The case is discontinued December 31. On January 21, 

the AU provides the missing income verification and informs the EW that a 

new AU member, with income, moved into the home on January 19. Since 

the addition of the new AU member is a voluntary report and his/her income 

would decrease benefits, the new AU member will not be added when 

restoring benefits. Eligibility and benefits will be restored based on the 

November QR 7. The new AU member and his/her income will be used 

beginning the next eligible payment quarter. 

Example 3: The AU fails to submit the November QR 7, and the case is 

discontinued December 31. On January 10, the AU submits the QR 7 and 

reports full-time employment started in November, which makes the AU 

ineligible. A denial NOA is sent to the customer and benefits are not 

restored. 




Continued 

Restoration 

process – 

Customer in 

office 

The chart below gives an overview of the restoration process when the 

customer comes into the office the month following a QR 7 discontinuance 

to reapply for CalWORKs/CalFresh: 


1 The Office Assistant (OA) gives the customer the TAD 278 ID and SAWS 1. Once completed and 

returned, the OA forwards the paperwork to the Advance Eligibility Determination (AED) Interviewer. 

2 The AED Interviewer determines if there is good cause, and if: 

Yes, initiates action based on good cause information in Chapter 10, Section 5. 

No, researches C-IV, and: 

If the case was discontinued 

for… 

Incomplete or missing QR 7, or 

Missing verification, 

Failure to complete the 

RE/Recertification (RC), or 

Disqualified from the program, 

Goes to Stage 3. 

Then the AED Interviewer… 

Reviews the application and schedules the customer for a 

return appointment with an intake worker. 

3 The AED Interviewer informs the customer he/she has the option to provide a complete QR 7 or 

complete a new application, and: 

If the customer chooses to… Then the AED Interviewer… 

Provide a complete QR 7, Gives the customer a CW 89 to complete a written 

withdrawal of application, 

Completes a CW 10 and gives a copy to the customer, 

Images the CW 89 and CW 10 into C-IV, 

Prints the QR 7 for the customer to complete, 

Completes a Journal entry including the options given 

and the choice made by the customer, 

Completes a CF 250 - AED Restoration of Aid Routing 

Slip and attaches it to the QR 7, and 

Forwards the CF 250 to the supervisor of the previous 

assigned EW/Master Assignment Queue (MAQ). 

Provide the missing verification, Gives the customer a CW 89 to complete a written 

withdrawal of application, 

Completes a CW 10 and gives a copy to the customer, 

Images the CW 89 and CW 10 into C-IV, 

Informs the customer to bring in or mail the missing 

verification to the previous EW/MAQ, 

Informs the customer benefits will be prorated from the 

date the missing verification is provided, stressing the 

benefit of returning the verification as soon as possible 

(before the end of the month), and 


and the choice made by the customer. 

Complete the new application, Reviews the application, 

Reviews for IN/Expedited Services (ES) entitlement, 

Schedules the customer for a return appointment with 

an intake worker, and 


and the choice made by the customer. 



1-34.4


Continued 

Restoration process – Customer in office (continued) 


4 The previous assigned EW/MAQ unit takes the following action when the 

complete QR 7 or missing verification is received timely for the restoration of 

eligibility and benefits: 

Rescind the CalWORKs/CalFresh program. (See the C-IV User Guide 

instructions, “Rescind, Restoration of Eligibility and Benefits for CalFresh” 

when restoring the CalFresh program.) 

Approves or denies the restoration. 

If the restoration is 

approved and the case is… 

Then… 

CalWORKs/CalFresh, CalWORKs benefits are prorated from the 

date the missing verification is provided, 

TCF will continue through the end of the 

month and will then be discontinued with 

timely notice, and 

Regular CalFresh benefits are effective the 

first of the month following the TCF 

discontinuance. 

CalFresh only, Benefits will be prorated from the date the 

QR 7/missing verification is provided. 

Sends the appropriate CalWORKs/CalFresh approval/denial NOA. 

Journals all actions taken. 

Note: If the customer does not provide the completed QR 7/missing verification 

within the month of the discontinuance, no action is required by the EW and the 

case remains discontinued. 




Continued 

Restoration 

process – 

Customer 

calls 

The EW will follow the steps listed below when the customer calls inquiring 

about the discontinuance of his/her CalWORKs/CalFresh benefits: 

Step Action 

1 Determine if there is good cause, and if: 

Yes, initiate action based on good cause information in Chapter 10, Section 5. 

No, research C-IV, and: 

If the case was discontinued for… Then… 

Incomplete or missing QR 7, or Go to Step 2. 


Failure to complete the RE/RC, or Inform the customer he/she must reapply for 

Disqualified from the program, CalWORKs/CalFresh by completing an application at: 

C4Yourself.com, 

The nearest TAD office, or 

The following internet site: 

http://www.dss.cahwnet.gov/cdssweb/entres/forms/ 

English/DFA285A1.pdf 

The application is printed and mailed to the 

nearest TAD office. 

Stop here. 

2 Inform the customer he/she has the option to provide a complete QR 7, the missing verification or 

complete a new application, and: 

If the customer chooses to… Then… 

Provide a complete QR 7, Print the missing QR 7 and mails it to the customer, or 

schedules an appointment for the customer come in and 

complete. 

Explain to the customer the benefits of returning the 

QR 7 as soon as possible. 

Complete a Journal entry including the options given and 

the choice made by the customer. 

Provide the missing verification, Inform the customer to bring in or mail the missing 

verification to the previous EW/MAQ. 

Explain to the customer the benefits of returning the 

verification as soon as possible (before the end of the 

month). 



Reapply, Inform the customer he/she must reapply for 

CalWORKs/CalFresh by completing an application at: 

C4Yourself.com, 

The nearest TAD office, or 

The following internet site: 

http://www.dss.cahwnet.gov/cdssweb/entres/forms/ 

English/DFA285A1.pdf 

The application is printed and mailed to the 

nearest TAD office. 





1-34.6


Continued 

Step Action 

3 Take the following action when the QR 7 or missing verification is received timely for 

restoration of eligibility and benefits: 

Rescind the CalWORKs/CalFresh program. (See the C-IV User Guide 

instructions, “Rescind, Restoration of Eligibility and Benefits for CalFresh” when 

restoring the CalFresh program.) 

Approve or deny the restoration. 


approved and the case 

is… 

Then… 









CalFresh only, Benefits will be prorated from the date the QR 7 or 

missing verification is provided. 

Send the appropriate CalWORKs/CalFresh approval/denial NOA. 


Note: If the customer does not provide the completed QR 7/missing verification 

within the month of the discontinuance, no action is required by the EW and the 

case remains discontinued. 




Continued 

Restoration 

process – 

Customer 

reapplies via 

C4Yourself 

The chart below gives an overview of the restoration process when the customer 

reapplies for CalWORKs/CalFresh benefits via C4Yourself in the month following 

the discontinuance: 


1 The OA completes a file clearance and assigns the application to an Intake EW. 

2 The EW determines if there is good cause, and if: 

Yes, initiates action based on good cause information in Chapter 10, Section 5. 

No, then researches C-IV, and: 

If discontinued… Then the EW… 

Incomplete or missing QR 7, or Goes to Stage 3. 


Failure to complete the RE/RC, 

or 

Disqualified from the program, 

Processes the application as the customer 

is not eligible to restoration of benefits. 

Stops here. 

3 The EW informs the customer he/she has the option to provide the complete QR 7, 

missing verification or complete a new application, and: 

If the customer chooses to… Then the EW… 

Provide the complete QR 7, Prints the missing QR 7 and mails, or 

schedules an appointment for the customer to 

come in and complete, 

Explains to the customer the benefits of 

returning the complete QR 7 or verification as 

soon as possible, 

Denies the application for “Verbal Withdrawal” 

and sends the NOA, and 

Completes a Journal entry including the 

options given and the choice made by the 

customer. 

Provide the missing verification, Informs the customer to bring in or mail the 

missing verification, 

Explains to the customer the benefits of 

returning the complete QR 7 or verification as 

soon as possible (before the end of the 

month), 

Denies the application for “Verbal Withdrawal” 

and sends the NOA, and 



customer. 

Complete the new application, Reviews the application for IN/ES entitlement, 

Documents IN/ES reviewed, 

Processes the application, and 



customer. 



1-34.8


Continued 


4 The previously assigned EW/MAQ unit takes the following action when the missing 

verification is received timely for restoration of eligibility purposes: 

Rescinds the CalWORKs/CalFresh program. (See the C-IV User Guide 

instructions, “Rescind, Restoration of Eligibility and Benefits for CalFresh” when 

restoring the CalFresh program.) 

Approves or denies the restoration. 


approved and the case is… 

Then… 









CalFresh only, Benefits will be prorated from the date the 

QR 7/missing verification is provided. 

Sends the appropriate CalWORKs/CalFresh approval/denial NOA. 


Note: If the customer does not provide the completed QR 7/missing 

verification within the month of the discontinuance, no action is required by the 

EW and the case remains discontinued. 


Overview 

Foster Care (FC) – Miller vs. Youakim 

Introduction This section provides information about the Miller vs. Youakim court order, 

which provides a benefit option for a caretaker relative of a child placed in the 

home by certain court orders or a voluntary placement agreement. 

References The following reference is applicable to the information is this section: 

• EAS 45-202 

Contents This section contains the following topic: 


Foster Care (FC) – Miller vs. Youakim 1-36 


Foster Care (FC) – Miller vs. Youakim 

Introduction The Miller vs. Youakim court order requires a child placed with a relative who 

is not legally responsible for the child be considered for eligibility to either 

CalWORKs or Federal Foster Care (FC) – Miller vs. Youakim benefits. 

Definition of 

“Relative” 

Relative legal 

guardian 

FC eligibility – 

Miller vs. 

Youakim 

“Relative” means a person related to the child by birth or adoption who is 

within the fifth degree of kinship to the child by being one of the following: 

• The father, mother, brother, sister, half-brother, half-sister, uncle, aunt, 

first cousin, first cousin once removed, nephew, niece, or any such 

person of a preceding generation denoted by the prefixes grand-, great-, 

great-great, or great-great-great. 

• The stepfather, stepmother, stepbrother, or stepsister. 

• The spouse of any person named in the first bullet above, even after the 

marriage has been terminated by death or dissolution. 

Relatives that have legal guardianship of a child are not eligible to Federal 

Foster Care, but may be eligible to other Foster Care benefits. The 

CalWORKs EWS I should contact the Foster Care EWS I to discuss the 

situation. 

In order to be eligible to Miller vs. Youakim Foster Care, the child must meet 

the following requirements: 

• All general CalWORKs eligibility requirements: 

− Age 

− Property 

− Residence 

− Citizenship/Noncitizenship 

− Social Security number 

− Income 

− Deprivation 

• Be placed in the relative’s home by a juvenile court order, Indian Tribal 

court order, or a voluntary placement agreement 

• Be linked to the Federal Aid to Families with Dependent Children – 

Family Group/Unemployment (AFDC FG/U) Program, as it existed on 

July 16, 1996 (See Federal AFDC-FC linkage requirements block in this 

Handbook section). 



Foster Care (FC) – Miller vs. Youakim, Continued 

Federal AFDC- 

FC linkage 

requirements 

Relative 

Approval – 

SOC 815 

Program 

Choice 

Indicator – FC 4 

The linkage requirement is met if one of the following conditions exists during 

the month in which the petition was filed or the voluntary placement 

agreement was signed: 

• The child was living in the home of the parent or relative from whom 

removed and would have been eligible for Federal AFDC-FG/U had an 

application been made, or 

• The child was no longer living in the home of the parent or relative from 

whom removed, but had been living in the home within any of the six 

months prior to the month in which the petition was filed, and would had 

been eligible for Federal AFDC-FG/U had an application been made. 

In order for a relative to receive Federal Foster Care, the relative and their 

home must be assessed and approved by a Social Worker from the Relative 

Approval Unit (RAU). If the home is approved, the Social Worker will 

complete the SOC 815 – Approval of Family Caregiver Home form. This form 

must be included in the case file before the child is approved for Federal 

Foster Care. 

Relatives that are not approved or are in the process of being assessed by 

the RAU Social Worker are not eligible to Foster Care benefits and must be 

evaluated for CalWORKs. 

If federally eligible, the Eligibility Worker (EW) will use the FC 4 – Program 

Choice Indicator to offer the relative the choice of receiving: 

• Foster Care benefits for the child only, or 

• Foster Care for the child and CalWORKs for the relative, if needy, or 

• CalWORKs for the child and the needy caretaker relative. 



Foster Care (FC) – Miller vs. Youakim, Continued 

Relative’s 

choice 

Use the following chart to determine the actions required when a relative 

completes the FC 4: 

Relative’s choice Who Action required 

CalWORKs only Intake EW Narrates the relative’s choice in the case 

journal and processes the application 

according to CalWORKs procedures. 

Foster Care EWS I Notifies the FC EWS I of the pending 

application. Forwards the SAWS 1 and 

any other information obtained (SAWS 2, 

FC 4, verifications, etc.) to the FC EWS I. 

FC for the child EWS I • Notifies the FC EWS I of the pending 

and CalWORKs 

FC application. 

for the relative 

• Sends a photocopy of the SAWS 1 

and any other information obtained to 

the FC EWS I. 

• Coordinates with the FC EWS I for 

the approval/denial of the child’s FC 

application. The relative’s 

CalWORKs application cannot be 

processed until the status of the FC 

application is known. 

• If the FC benefits are approved, 

ensures the relative’s CalWORKs 

application is processed. Arranges to 

have the CalWORKs case assigned 

to the FC Unit; the Foster Care will 

be carried by the FC companion case 

EW. 

• If notified the FC benefits for the child 

have been denied, the child will be 

included in the relative’s CalWORKs 

AU. 


Dependents/Wards of the Court 

Introduction Children who are dependents/wards of the court, not eligible to Foster Care 

(FC) payments, and placed with relatives who are receiving CalWORKs on 

the dependent’s behalf have the option of Fee-For-Service (FFS) Medi-Cal 

or Medi-Cal managed care health care coverage. These children are eligible 

to other FC-linked benefits such as extended CalWORKs or Medi-Cal for 

youth aging out of the FC system. 


ACL 11-59 

Aid code 4H The Department of Health Care Services (DHCS) created aid code 4H to 

identify dependents/wards of the court, not eligible to Foster Care (FC) 

payments, and placed with relatives who are receiving CalWORKs on the 

dependent’s behalf. 


referral from 

Foster Care 

When FC is denied for the dependent/ward of the court child, the FC 

Eligibility Worker (EW) will refer the application to CalWORKs. The FC EW 

will attach form FC 4HL, Dependent referral, to the SAWS 1 to notify the 

CalWORKs EW the child is a dependent/ward of the court. Because the 4H 

aid code is not yet an option for CalWORKs recipients in C-IV, EWs will do 

the following to identify these children on the CalWORKs case: 

Step Action 

1 Process CalWORKs application 

2 Set person case flag titled “4H FC dependent – CalWORKs” for 

the child. 

3 Image form FC 4HL and any supporting documentation into C-IV. 

4 Set Tasks to review: 

Court dependency at Re-Evaluation (RE). 

Potential transfer to extended CalWORKs (see the “Extended 

CalWORKs for Young Adults” section in this chapter of the 

handbook) at age: 

– 17½ - “Receipt of SOC 161”, and 

– 18 - “Receipt of SOC 162”. 

5 Complete and submit a TAD 110P to the Medi-Cal Eligibility Data 

System (MEDS) Office Assistant (OA) to code 4H aid code in 

MEDS. 

6 E-mail Office Assistant (OA) to assign the case to the designated 

4H/4N EW in Transitional Assistance Department (TAD) District 

07. 




Dependents/Wards of the Court, Continued 

Re-Evaluation At the annual Re-Evaluation (RE), continued court dependency status for the 

dependent/ward of the court child must be verified. The EW will contact the 

FC EW III in the TAD 07 office via e-mail to verify dependency status, and: 

If the child is… Then the EW will… 

A court dependent, Journal that court dependency 

for the child has been verified, 

and, 

Process the RE. 

No longer a court dependent, End date the case flag, 

Journal the child is no longer a 

dependent of the court, 

Evaluate for on-going CalWORKs 

eligibility, and 

Transfer the case to the 

appropriate office. 

Discontinuance Dependents/wards of the court discontinued from CalWORKs for reasons 

other than no longer being a court dependent may be transferred to Medi-Cal 

aid code 4L or aid code 4M to ensure the child has the option of continued 

receipt of FFS or Medi-Cal managed care health care coverage. 

If the child is discontinued due 

to … 

CalWORKs program age 

requirements, 

Any other reason except no longer 

a court dependent, 

Then transfer to Medi-Cal aid code… 

CWPHB #4630 (03/12) APPLICATIONS 1-38.2 

4M. 

Note: If the dependent chooses to 

receive extended CalWORKs, evaluate 

eligibility to extended CalWORKs. 

4L. 

Note: The child will not be transferred to aid code 4L or 4M Medi-Cal when 

court dependency is lost. He/she will be transferred to the appropriate 

Medi-Cal aid code (see the Medi-Cal chapter in this handbook). 

Continued on next page

Dependents/Wards of the Court, Continued 

Transfer to aid 

code 4L or 4M 

The 4H/4N EW will take the following action when transferring the 

dependent/ward child to the aid code 4L or 4M, if appropriate. 

If dependency is… And C-IV transfers 

the child to… 

Then The 4H/4L EW will… 

Verified for the child, 3N Medi-Cal, Override the 3N Medi-Cal 

to 4L Medi-Cal for the 

dependent child prior to 

accepting the Medi-Cal 

Eligibility Determination 

and Benefit Calculation 

(EDBC). 

Forward case to the 4L/4M 

EW. 

Journal action taken. 

Verified for the child 38 Medi-Cal, Forward the case to the 

4L/4M EW to evaluate for 

on-going Medi-Cal 

eligibility. 

Journal action taken 

Not verified for the 3N or 38 Medi-Cal, Forward case to the 

child, 

applicable TAD office 

according to established 

Inter-District Transfer (IDT) 

policy . 

Denials A dependent/ward child on whose behalf a CalWORKs application is made 

will be denied CalWORKs when CalWORKs eligibility requirements are not 

met. The case will be forwarded to the 4L/4M EW for the Medi-Cal eligibility 

determination. 


Extended CalWORKs for Young Adults 

Introduction This section of the handbook includes information regarding CalWORKs 

eligibility for Young Adults. 


All County Letters (ACLs): 11-78 and 13-10 

Definition A Young Adult is a current dependent child or ward of the juvenile court who 

is: 

18, but less than 21 years of age, 

In foster care under the responsibility of Children and Family 

Services (CFS) or the Probation Department, and 

Participating in a Transitional Independent Living Plan (TILP). 

Eligibility Prior to January 1, 2012, dependent children placed with relatives who are 

not eligible to receive federal or state foster care payments but are still 

eligible to foster care services may qualify for CalWORKs benefits until age 

18, or until the child graduates from high school or a vocational or technical 

training program if enrolled full time and will graduate before reaching age 

19. These children may be eligible to extended CalWORKs benefits as a 

Young Adult when living with an approved caretaker relative (including an 

approved relative living in another state) who is not eligible to federal or state 

foster care payments. 

Eligible Young 

Adults 

The maximum age for eligibility to extended CalWORKs benefits is effective 

as follows: 

January 1, 2012 – Up to age 19, and 

January 1, 2013 – Up to age 21. 

Effective January 1, 2013, the phase-in approach was eliminated. Young 

Adults turning 19 years of age prior to January 1, 2013 will continue to 

receive benefits beyond age 19 and up to age 21, provided all other 

applicable eligibility requirements have been met. 

Note: Eligibility Workers (EWs) should encourage caretaker relatives to 

contact the Social Worker (SW) regarding applying for the Kinship Guardian 

Assistance Payment (Kin-GAP) program. 

Eligible Young Adults include those who: 

Turn 18 in 2011 and are in foster care dependency on January 1, 2012. 

Turn 18 in 2012 or later and are in foster care dependency on January 1, 

2012. 

Are ineligible for either federal or state only foster care. 



Extended CalWORKs for Young Adults, Continued 

Young Adults 

not eligible 

Program 

requirements 

Mutual 

Agreement 

Six-month 

certification 

Young Adults not eligible to extended CalWORKs benefits in 2012 are those 

who: 

Have terminated court dependency prior to January 1, 2012, 

Turned age 19 in 2011, 

Are married, 

Are in the military, 

Are incarcerated, or 

Are in a non-related legal guardianship through the probate court. 

Young Adults are not subject to CalWORKs rules or reporting requirements. 

However, in addition to the criteria listed in the “EligibleYoung Adults” block 

in this handbook section, the Young Adult must meet one of the following 

program requirements: 

Enrolled in and working towards completing high school or an 

equivalency program, 

Enrolled at least half-time in post-secondary or vocational school, or 

enrolling for the next available term, 

Participating in a program or activity that promotes or removes barriers to 

employment, 

Employed at least 80 hours per month, or 

Is incapable of enrollment or participation in school or employment due to 

a documented medical condition. 

The Young Adult must sign a Mutual Agreement form, SOC 162, on or after 

age 18 (but before age 18½) to voluntarily consent to remain in foster care 

as a court dependent in order to receive extended CalWORKs benefits. The 

Social Worker will obtain the SOC 162 and forward a copy of the signed form 

to the EW. 

A six-month certification of participation of eligibility is required in order for 

the Young Adult to receive extended benefits for the following six-month 

period. The Social Worker will complete a Six Month Certification of 

Extended Foster Care Participation form, SOC 161, to certify that the Young 

Adult intends to meet one of the five participation activities and forward the 

form to the EW. The initial SOC 161 will be completed at the six-month TILP 

prior to the young adult’s 18 th birthday. Subsequent SOC 161s are required 

every six months and must be provided no later than the first month of the 

following six-month period. 




Extended 


Assistance Unit 

(AU) 

Pregnant/ 

parenting teens 

Extended 


termination 

Informing 

notice 


Action 

The Young Adult will be aided in his/her own Assistance Unit (AU) of one. 

(Aid Code 4N has been designated for extended CalWORKs cases; 

however, this aid code is not yet available in C-IV. The young adult will be 

aided on Aid Code 30 until aid Code 4N is functional in C-IV.) He/she will 

receive the non-exempt CalWORKs grant amount for one person. Payment 

will be made directly to the Young Adult. Any changes in grant amounts will 

require 10-day noticing. 

Note: Needy caretaker relatives receiving CalWORKs will not be eligible to 

cash assistance if the Young Adult is the only eligible child in the CalWORKs 

case. 

Pregnant/parenting teens who are 18 or approaching their 18th birthday will 

have the option to: 

Continue benefits as a young adult and receive the same grant amount 

as an AU of one, or 

Establish their own AU on a regular CalWORKs case in order to aid their 

child. Teens choosing this option are subject to CalWORKs program 

rules and reporting requirements. 

Note: EWs must continue to inform pregnant/parenting teens of their 

options. 

The Young Adult will continue to receive extended CalWORKs until he/she 

reaches the maximum age for eligibility (see the “Eligibility” block in this 

section of the handbook). 

In accordance with CalWORKs regulations, EWs will send the 

QR 2103 form, Reminder For Teens Turning 18 Years Old, regarding options 

to the caretaker relatives 60 days prior to the child turning 18. Caretakers 

will be instructed to provide the QR 2103 form to the Young Adult. 

Note: Teens inquiring about the extended CalWORKs/Foster Care program 

will be referred to their Social Worker. 

The following Notices of Action (NOAs) have been developed for Young 

Adults: 

NA 1269 – Approve Non-Minor Dependent (Young Adult) – Used to 

approve extended CalWORKs for the Young Adult. 

NA 1270 – Discontinue Non-Minor Dependent (Young Adult) – Used to 

notify the Young Adult that extended CalWORKs cash aid will be 

discontinued and the reason for the discontinuance. 




Procedure for 

SOC 162 

Procedure for 

SOC 161 

When the Young Adult chooses to receive extended CalWORKs, the 

following will occur: 


1 Young Adult completes the SOC 162. 

2 Social Worker forwards a copy of the SOC 162 to the EW. 

3 EW: 

Reviews and signs the SOC 162. 

Completes a change of payee (discontinues payee’s case and opens 

the Young Adult’s case with new case number). 

Sets a person level case flag “4N – Extended CalWORKs” on the 

Young Adult’s case. 

Completes and submits a TAD 110P to the Medi-Cal Eligibility Data 

System (MEDS) Office Assistant (OA) to complete an EW 20 

transaction and enter ESAC 4 code for tracking in MEDS. 

Sends a NA 1269 to advise approval to extended CalWORKs 

benefits to the Young Adult. 

Images the SOC 162 into C-IV. 

Journals action taken. 

The Social Worker will: 

Complete the initial SOC 161 at the Young Adult’s six month TILP. 

Complete subsequent SOC 161s at the end of each six-month 

certification period. 

Forward a copy of the SOC 161 to the EW. 

The EW will complete the following when the SOC 161 is received: 

Step Action 

1 Review and sign the SOC 161 to verify participation requirements are 

met. 

2 Set a Task six months from the TILP date to expect the next 

SOC 161, and: 

If the SOC 161 is… Then… 

Received by the end of 

the first month of the 

next six month period, 

Continue CalWORKs benefits. 

Not received by the 

end of the first month 

of the next six month 

period, 

 

 

Suspend CalWORKs benefits until the 

SOC 161 is received, and 

Send a NA 100 C-IV to notify the Young 

Adult of the CalWORKs suspension. 

3 Image the SOC 161 into C-IV. 


Note: Override the aid payment to $0 in 

the CalWORKs EDBC in C-IV to suspend 

payment. 

Note: The EW will contact the FC EW III to obtain the TILP date. 


CWPHB #4632 (05/12) APPLICATION 1-38.7


C-IV 

workarounds 

Inter-County 

Transfers 

(ICTs) 

Aid code 4N has been designated for the payment of extended CalWORKs 

benefits. Because the aid code is not yet available in C-IV, the following 

workaround is required to aid the Young Adult: 

Step Action 

1 Complete a Manual Eligibility Determination and Benefit 

Calculation (EDBC) and, select: 

The CalWORKs aid code the Young Adult was aided under 

prior to turning 18. 

“Rush” from the Immediacy Indicator drop-down. 

Note: The Manual EDBC must be run on the first or second 

business day of each month to avoid skip issuances for no QR 7. 

2 Complete and send the appropriate NOA. 

3 Update the “RE Due Month” on the Case Summary page to 

the six-month certification period. 

4 Set a Task to run Manual EDBC each month. 


Note: Because C-IV will require a QR 7 for the quarter, staff must edit the 

Customer Reporting page and select N/A for all questions applicable to 

CalWORKs when the QR 7 is sent. 

An Inter-County Transfer (ICT) will be completed for the extended 

CalWORKs case when: 

The Young Adult: 

– Has resided continuously in another county for one year or more, 

– Intends to remain in that county, and 

Jurisdiction has been transferred via court order to the other county, 


1 Social Worker contacts the EW and requests an ICT of the 

extended CalWORKs case. 

2 EW: 

Initiates the case transfer to the other county, and 

Sends only the following documents: 

– SOC 162, 

– Most current SOC 161, and 

– Identification for the Young Adult. 

Discontinues the case at the end of the transfer period. 


Overview 

Re-Evaluations (REs) 

Introduction This section provides information about Re-Evaluation (RE) of eligibility, and 

includes information about RE policy, RE procedure, and setting and aligning 

RE dates. 


• ACL #03-18 

• ACIN # I-54-03, I-84-03, I-09-04, I-10-04, I-29-04, and I-44-04 

• EAS 40-181 



Re-Evaluations (REs): Basic Information 1-40 

Re-Evaluation (RE) Procedure 1-41 

Setting Re-Evaluation (RE) Dates 1-44 


Re-Evaluations (REs): Basic Information 

Introduction This section describes Re-Evaluations (REs), which are the yearly 

redeterminations of eligibility for CalWORKs customers. 

Re-Evaluation 

(RE) 

The Re-Evaluation (RE) is the redetermination of CalWORKs eligibility 

required by regulation. The RE process requires the CalWORKs customer to 

complete the SAWS 2 Statement of Facts (Non-financial and Financial root 

questions) and attend an in-person face-to-face interview in the TAD office. 

Customers with C4 Yourself accounts may choose a phone interview if they 

submit an e-Application for the RE. The same basic concept applies when a 

household receives CalFresh. 

Rules for REs Regulations 40-181.2 and 63-504.1 governing REs for CalWORKs and 

Recertification (RC) for CalFresh are as follows: 

For CalWORKs, the RE must be completed at least once every twelve 

months. 

For CalFresh, the certification period depends on the status of the 

household members. CalFresh certification periods cannot be shortened 

once they are established, however initially set periods can be set for 

less than 12 months to align with the CalWORKs RE date. 

CalWORKs REs and CalFresh RCs must be set in the same month as a 

Quarterly Report (QR) Submit Month. 

Policy When the customer has CalWORKs and CalFresh, the RE/RC dates will be 

set for the same month. At Intake, the dates are set 12 months from the 

earliest program application date. The application date must be used 

regardless of authorization or approval in a subsequent month. 

Aligning the RE 

periods 

The RE/RC dates for Inter-County Transfers (ICTs) in are based on the pickup 

date and not the application date. So the first month of the RE/RC period 

for an ICT in, is the first month of aid in this County. 

The end of the CalWORKs RE period determines the time for 

redetermination, or RE. It is necessary for households receiving benefits 

from more than one program to have the same RE/RC dates so both can be 

completed at the same time. The practice of setting the RE/RC dates for the 

same month is called aligning the RE periods. The RE period for CalWORKs 

will be set for a maximum of 12 months in most cases. 

The 12-month period starts the first day of the month following the end of 

the current RE period. 

The actual interview date, in a QR Submit Month, does not have a 

bearing on the new RE period as long as it is completed prior to the end 

of the RE. 

Remember to align the companion Medi-Cal program RE date with the 

CalWORKs RE date. 


Re-Evaluation (RE) Procedure 

Introduction This section provides the Re-Evaluation (RE) procedure for the Eligibility 

Worker (EW) and information about conducting the interview. 

RE procedure The chart below outlines the general RE procedure. Review the “Application 

Overview” section of this chapter for more information about forms 

completion and the interview. 

Step Action 

1 Review the case to determine what verification, information, and forms the customer 

needs to provide. 

2 Send the customer an appointment letter indicating the appointment date and time, 

and the forms, verification, and information that is needed. This is sent by either the 

EW or designated clerical staff. 

Note 1: The appointment needs to be set in the first week of the RE month, which is 

a Quarterly Reporting (QR) Submit Month. Do not set the RE appointment in a 

month prior to the RE month. 

Note 2: If the household also receives CalFresh benefits, the Notice of Expiration of 

Certification (QR 377.2) is sent automatically by C-IV in the month prior to the 

Recertification (RC) month. The EW must send the QR 377.2 with the appointment 

letter if it was not sent by C-IV. 

3 Conduct a face-to-face interview. Customers with C4 Yourself accounts may choose 

a phone interview if they submit an e-Application for the RE/RC. 

If the RE/RC interview is missed (in 

person or unable to contact 

customer by telephone at the 

appointed time) and customer… 

Then send a … 

Receives CalWORKs only, Notice of Action (NOA) for CalWORKs 

discontinuance prior to the 10-day NOA 

deadline in the RE month. 

Receives CalWORKs and CalFresh, NOA for CalWORKs discontinuance 

prior to the 10-day NOA deadline in 

the RE month, and 

DFA 386 Notice of Missed Interview 

(NOMI) informing the customer that 

he/she must contact the EW to 

reschedule the RC interview. 

4 Review the case for continuing eligibility using the Statement of Facts (SAWS 2) 

and other information reported by the customer. 

5 Give the customer 10 days to provide any additional verification needed. 

6 Approve or discontinue/deny the RC application for CalFresh prior to the end of the 

RC Month. See the CalFresh Policy Handbook (CFPHB) Chapter 1 – Applications 

for additional information. 

Note 1: The above CalWORKs negative actions must be completed prior to the 10-day 

NOA deadline in the RE month to prevent the release of benefits in the event the benefits 

are held due to non-receipt of the QR 7. If the customer then turns in the QR 7 prior to the 

10-day NOA deadline, benefits are issued erroneously. 

Note 2: When there is a companion Medi-Cal program, the EW will also complete the RE 

for Medi-Cal. 



Re-Evaluation (RE) Procedure, Continued 

REs 

rescheduled 

after 10-day 

NOA 

Conducting the 

RE interview 

RE for 

sanctioned 

customer – EW 

responsibility 

If the customer reschedules his/her RE appointment for a date within the RE 

month but after 10-day NOA, the EW will: 

Reschedule the appointment for the next available date. 

Inform the customer that he/she may have an overpayment if the RE is 

not completed. 

Discontinue the case if the customer fails to show for the RE or the case 

is determined to be ineligible. 

Create and activate a recovery account for any overpayment(s). 

Using the Statement of Facts Non-financial and Financial root questions (and 

the Application For Cash Aid, Food Stamps, and/or Medi-Cal (SAWS 1) if the 

customer also has CalFresh benefits), the RE interview will include the 

following: 

An explanation of Rights and Responsibilities, 

A review of all documents needed to verify eligibility, including signatures 

on required forms, and 

The distribution of appropriate forms and pamphlets. 

Note: The Application for Food Stamp Benefits (DFA 285 A1) can be 

accepted in lieu of the SAWS 1 if completed by the customer for CalFresh. 

For telephone interviews, the EW will mail: 

Appropriate forms and pamphlets to the customer (see ORHB Chapter T 

for list of required forms), and 

A VER 100 to request verification and signatures on required forms. 

EWs will notify the Employment Services Specialist (ESS) by setting a Task 

and sending an e-mail when scheduling a Welfare-to-Work (WTW) 

sanctioned customer for a RE appointment. The EW will review the Status, 

and Status Reason on the Case Summary page to make this 

determination. The ESS will meet with the customer to try to engage him/her 

in WTW activities. The EW must: 

Notify the ESS by going into the Customer Appointment Detail page to 

ensure the ESS’s name is listed as one of the workers. 

Check the box for the ESS to be notified via e-mail. 

Call the ESS after the RE appointment so the ESS can meet with the 

customer. 

If the assigned ESS is… Then the EW will… 

Listed on the Customer 

Appointment Detail page, 

Add the ESS’s name to the page. 

Not listed on the Customer Use the generic ESS number for the 

Appointment Detail page, review 

the Case Summary page, 

district office. 



Re-Evaluation (RE) Procedure, Continued 

RE for 

sanctioned 

customer – 

ESS 


ESSs will be notified by the EW when a WTW sanctioned customer is 

scheduled for his/her RE, so the customer can cure his/her sanction. The EW 

will include the ESS on the Customer Appointment Detail page. The ESS 

will then be automatically e-mailed from C-IV with the following message: 

“A customer appointment has been created for you within C-IV.” 

The following information will be included in the e-mail: 

Case Number 

Customer’s name 

Type of appointment (i.e., RE appointment) 

Location 

Date 

Time Duration 

Comments 

The ESS will meet with the work-eligible customer after the EW’s scheduled 

appointment with the customer. 


Setting Re-Evaluation (RE) Dates 

Introduction This section provides information about setting Re-Evaluation (RE) dates at 

new application and to align with C-IV, and includes information about adding 

persons and companion Medi-Cal cases. 

Setting RE 

dates for 

applications 

When approving a new case, Intake will use the following chart as a 

guideline to align the CalFresh certification period with the CalWORKs RE 

date in preparation for aligning QR cycles. The application date is used to 

establish the RE dates, even if benefits are approved and/or authorized in a 

month subsequent to the month in which the application is received. 

Application CalWORKs CalFresh CalWORKs CalFresh 

Situation Date App Date RE Date RE Date 

Joint application 09/15/2004 09/15/2004 08/2005 08/2005 

Joint application 

ICT 

09/15/2004 09/15/2005 09/2005 09/2005 

Note: 

Note: 

Assuming Assuming 

10/01/2004 

pick-up date 

10/01/2004 

pick-up date 

Joint application 09/15/2004 09/15/2004 08/2005 08/2006 

and HH is NQR 

(Change 

Reporting) with all 

adult members 

Note: 2 year 

cert. period for 

NQR and all 

adult members 

elderly or disabled 

elderly or 

disabled 

Ongoing 


applies for 

CalFresh (align 

CalFresh with 

CalWORKs) 

02/11/2004 09/15/2004 01/2005 01/2005 

Ongoing CalFresh 

HH applies for 

CalWORKs (align 

CalWORKs with 

CalFresh: See 

note below) 

09/15/2004 02/11/2004 01/2005 01/2002 

Note: When an ongoing CalFresh household applies for and is authorized 

CalWORKs, all necessary information from the previous CalFresh case must 

be copied and filed in the new case to support the CalFresh portion of the 

case and RE. This includes but is not limited to: 

• SAWS 1 

• Last QR 7 

• Shelter/Utility Verifications 



Setting Re-Evaluation (RE) Dates, Continued 

Setting RE 

dates under 

QRPB to align 

Continuing 

cases: 


aligning RE 

dates 

Add person: RE 

dates 

To align CalWORKs and CalFresh RE dates, at each RE, align CalWORKs 

and CalFresh RE dates for the same month, 12 months from the application 

date (Application month is considered month one of this 12-month period). 

The month the RE is set will also be a QR Submit Month, to avoid any 

potential mid-quarter changes. 

The following examples illustrate the instructions for aligning RE dates for 

continuing cases: 

• Example #1: Same application dates. Date of application for 

CalWORKs and CalFresh is 07/08/2005. The RE will be 06/2006. QR 

cycles are based on the date of application, 07/08/2005. 

• Example #2: Adding CalFresh to CalWORKs. Date of application for 

CalWORKs is 06/09/2005. The RE will be 05/2006. Date of application 

for CalFresh is 08/15/2005. The worker can establish the Certification 

period for 10 months to align the CalFresh RE with the CalWORKs RE in 

05/2006 (Certification period cannot be shortened once it has been 

established, but it may be set for less than 12 months in order to align 

with CalWORKs). QR cycles are based on the earliest date of 

application, 06/09/2005. Because the quarterly cycle has already been 

established with the CalWORKs application, CalFresh will continue on 

the same cycle when added. 

• Example #3: Adding CalWORKs to CalFresh. Date of application for 

CalFresh is 07/08/2005. The RE will be 06/2006. Date of application for 

CalWORKs is 10/13/2005. The CalWORKs RE must be set for 06/2006 

to align with the CalFresh RE. QR cycles are based on the earliest date 

of application, which is 07/08/2005. 

• Example #4: Adding CalFresh during CalWORKs RE. CalWORKs 

only case has a 04/2005 RE. At the RE taken 04/15/2005, the customer 

applies for CalFresh. Setting the CalWORKs and CalFresh REs at 

04/2006 would result in a 13 month CalFresh RE (04/2005 through 

04/2006) and the CalFresh RE cannot be set for longer than 12 months. 

To align the REs, set both for 01/2006, a QR Submit Month. This is a 

nine-month RE for CalWORKs and a 10-month RE for CalFresh. 

When adding a person to an existing case using a new SAWS 2 (Nonfinancial 

and Financial root questions), the existing RE dates must remain as 

previously established using the above rules. The RE dates are not updated 

when taking a new SAWS 2 in an add person situation. 



Setting Re-Evaluation (RE) Dates, Continued 

Add person: 

Example of 

aligning RE 

dates 

Companion 

Medi-Cal cases 

The following example illustrates the instructions for aligning RE dates when 

there is an add person: 

Example: Add person. Date of application for CalWORKs and CalFresh is 

07/09/2004. The REs for both are set for 06/2005. Absent dad rejoins the 

home on 09/20/2004 as an add person for CalWORKs and CalFresh. A new 

SAWS 2 is completed, and all eligibility criteria are met. The RE date will 

continue to be 06/2005 for both CalWORKs and CalFresh. 

When updating a CalWORKs and/or CalFresh RE, if there is a companion 

Medi-Cal case (such as CAT 3N), the RE date for the Aid Code 3N program 

must be updated at the same time. The CalWORKs RE establishes eligibility 

for companion Medi-Cal cases. 


Overview 

Add Persons 

Introduction This section contains information regarding add person applications including 

the determination of CalWORKs and cash-linked Medi-Cal Beginning Dates 

of Aid (BDAs) and what to do when adding the person results in financial or 

non-financial ineligibility for the Assistance Unit (AU). 


• ACL 03-18 

• ACIN I-54-03, I-84-03, I-09-04, I-10-04, I-29-04, and I-44-01 

• EAS 44-314 and 44-318 

• EAS 82-832.3 



Add Person 1-48 

Beginning Date of Aid (BDA) for Add Persons 1-50 

Beginning Date of Aid (BDA) Examples 1-52 

Beginning Date of Aid (BDA) Chart 1-55 

Adding a Person to the Assistance Unit (AU) 1-56 

Add Person Results in Ineligibility 1-57 

Rules for Newborns 1-62 

Unborn/Pregnancy Special Needs (PSN) 1-64 


Add Person 

Introduction This section contains information regarding add person applications, 

including the necessary forms and documentation, the eligibility 

determination process, general guidelines and add person reporting. 

Forms and 

documentation 

Eligibility 

determination 

process - 

application 

When adding persons to CalWORKs, use the following applications: 

If the add person is a/an… Then use the… 

Adult, SAWS 2 

Adult after Welfare-to- 

Most recent SAWS 2 if listed on it 

Work (WTW) program sanction and otherwise eligible. 

cured, 

New SAWS 2 if not listed on most 

recent SAWS 2. 

Child age 16 and older, SAWS 2 

Child age 15 and younger, CW 8A 

Newborn, CW 8A 

Below is the initial process the Eligibility Worker (EW) must take regarding 

scheduling the application appointment when a CalWORKs family reports a 

new person in the home: 

Step Action 

1 Determine whether or not the new person is a mandatory 

Assistance Unit (AU) member. 

2 Immediately schedule an appointment within the next 10 days to 

complete the application paperwork. 

3 Send the customer an appointment letter with the application 

paperwork. The application letter must list all verification(s) 

required. 

If the customer does not show for the appointment and does not contact the 

EW to reschedule, the EW will deny the add person request. If the 

customer reports the person in the home on the next QR 7, or reports the 

additional person again, this subsequent request will be treated as a new 

add person request. 

If the additional person is mandatorily included and the customer fails to add 

this person to the case, the EW must discontinue the entire CalWORKs 

program at the end of the QR Payment Quarter for the QR 7 that required 

report (add person) is due. 



Add Person, Continued 

Add person – 

general 

guidelines 

Add person 

reporting 

Customers may report or request CalWORKs for an additional CalWORKs 

family member any time during the quarter. The County can only take action 

mid-quarter on additional persons, which increase benefits. 

If the reported additional person results in a decrease or discontinuance of 

benefits, the County must not act on the information mid-quarter. The EW 

must send a No Change Notice of Action (NOA) informing the customer the 

additional person did not increase benefits and reminding the customer to 

report the information on the next QR 7. 

Mid-quarter changes in the CalWORKs family composition are considered 

Voluntary Reports and are not required to be reported within 10 days. 

However, this type of change must be reported on the QR 7 following the 

change. The EW must document the report and the change. 

In order for the report of a new person to be considered reported timely, the 

customer must report the new person no later than on the QR 7 submitted 

following the change or by the extended filing date for that QR 7. Reports 

received after the QR 7 following the change are considered untimely. 

The timeliness of the report is important in determining when benefits may be 

increased, as well as determining eligibility for cash-linked Medi-Cal for the 

new AU member. 

More information regarding the reporting requirements for add persons is 

located in the Reporting Chapter of this Handbook. 


Beginning Date of Aid (BDA) for Add Persons 

Introduction This section contains information regarding the Beginning Date of Aid (BDA) 

for add persons, for both CalWORKs and cash-linked Medi-Cal. This 

includes mandatorily included persons, optional persons, and sanctioned and 

noncooperating persons. 

Beginning Date 

of Aid (BDA) – 

add person 

The Beginning Date of Aid (BDA) for an add person is based on whether the 

CalWORKs benefits will increase or decrease due to the additional person 

and will either be the: 

• First of the month following the month of report, or 

• First of the QR Payment Quarter based on when the information is 

required to be reported on the QR 7. 

Increase: The BDA of an add person that results in an increase in benefits 

is the first of the month following the date the change is reported, not when 

the change actually occurred. 

Decrease: The BDA of an add person that results in a decrease in benefits 

is based on when the information is required to be reported on the QR 7. 

If the report is 

received in the… 

First month of the 

QR Payment 

Quarter (Begin 

Month), 

Second month of 

the QR Payment 

Quarter (Data 

Month), 

Third month of the 

QR Payment 

Quarter (Submit 

And the 

change has 

occurred… 

Since the last 

QR 7 Data 

Month, 

Since the last 

QR 7 Data 

Month, 

Prior to the 

Submit Month, 

Month), In the Submit 

And the 

benefits 

will… 

Then the BDA is 

the first of the… 

Increase, Following month. 

Decrease, Next QR Payment 

Quarter. 

Increase, Following month. 

Decrease, Next QR Payment 

Quarter. 

Increase or 

Decease, 

Next QR Payment 

Quarter (next 

month). 

Increase, Following month, 

Month, Decrease, QR Payment 

Quarter following 

the next QR 

Payment Quarter 

(in three months). 

Note: Do not add a person to the Assistance Unit (AU) until the application 

has been completed and all required verification is received. 



Beginning Date of Aid (BDA) for Add Persons, Continued 

Mandatorily 

included 

person 

Optional 

person 

Sanctioned and 

noncooperating 

persons 

Penalized 

persons 



Medi-Cal 

The BDA for mandatorily included persons is: 

• The first of the month following the month of report, if adding the person 

causes an increase to the CalWORKs grant; or 

• The first of the QR Payment Quarter following the QR 7 on which the add 

person is required to be reported, if adding the person causes a decrease 

or no change to the CalWORKs grant. 

The BDA for an optional person is the same as it is for mandatorily included 

persons. 

The BDA for sanctioned and noncooperating persons is the latter of: 

• The first of the month following the date the person met the 

requirement(s) that caused that person to be excluded from the 

Assistance Unit (AU), or 

• The first of the month following the date the person met all eligibility 

conditions. 

The date a penalty is removed from a penalized person is the end of the 

month in which the penalty is cured. 

Although the CalWORKs BDA isn’t effective until the first of the month 

following the month in which the change is reported or the first of the QR 

Payment Quarter following the report on the QR 7, cash-linked Medi-Cal will 

be effective for the new AU member effective the first of the month in which 

the change occurred, provided the customer met all CalWORKs eligibility 

conditions (financial and non-financial) and the AU reported the change 

timely. If the report is not timely, the BDA is the first of the month of report, 

unless the report is for a newborn. 

Use the table below to assist in determining the cash-linked Medi-Cal BDA 

for an add person. 

If the add person is… And the change 

is… 

Then the cash-linked 

Medi-Cal BDA is the 

first of the month… 

Newborn (including MFG Reported timely, Of birth. 

child), Not reported timely, Following the month of 

birth. 

Dad in a pregnant Reported timely, Of birth of the newborn. 

woman only (PWO) case, Not reported timely, Of report. 

Any other person, Reported timely, Of change. 

Not reported timely, Of report. 


Beginning Date of Aid (BDA) Examples 

Introduction This section contains a series of examples to assist in the determination of 

the Beginning Date of Aid (BDA) for a new Assistance Unit (AU) member, 

and includes increase and decrease of benefits. 

Example – add 

person 

increase 


person 

increase 

Situation: An AU consisting of Mom and one child is in the May/June/July 

quarter (Cycle 2). In June, Mom voluntarily reports Dad moved into the 

home that month. Dad has no income or property. 

BDA: As the addition of Dad results in an increase in CalWORKs benefits, 

Dad’s BDA will be: 

• July 1 for CalWORKs, the first day of the month following the month of 

report. 

• June 1 for Medi-Cal, the first day of the month in which the change 

occurred. 

Month May 

QR Payment Quarter 

June July 

Actions • Dad moves in. Dad added to AU 

• Mom reports Dad 

moved in. 

and CalWORKs. 

• Dad added to 

Medi-Cal. 

Situation: Same situation as above, but Mom does not voluntarily report 

Dad moving into the home mid-quarter. Mom reports Dad in the home on the 

June QR 7 submitted in July. This is considered a timely report. 

BDA: As the addition of Dad results in an increase in CalWORKs benefits, 

Dad’s BDA will be: 

• August 1 for CalWORKs, the first day of the month following the month of 

report. 

• June 1 for Medi-Cal, the first day of the month in which the change 

occurred because Mom reported Dad in the home timely. 

QR Payment Quarter QR Payment Quarter 

Month May June July August September 

Actions • Dad • June QR 7 Dad added to 

moves in. received. AU and 

• Dad • Mom CalWORKs. 

added to reports 

Medi-Cal. Dad in the 

home. 



Beginning Date of Aid (BDA) Examples, Continued 


person 

decrease 


quarter (Cycle 2). In May, Mom voluntarily reports Dad moved into the home 

that month. Dad has income sufficient to decrease benefits, but not cause 

financial ineligibility. 

BDA: As the addition of Dad results in a decrease in CalWORKs benefits, 

but not ineligibility, Dad’s BDA will be: 

• August 1 for CalWORKs, the first day of the next QR Payment Quarter 

following the report on the QR 7. 

• May 1 for Medi-Cal, the first day of the month in which the change 

occurred. 

QR Payment Quarter QR Payment Quarter 

Month May June July August September 

• Ac • Dad moves 

June QR 7 Dad added to 

tions in. 

received. the AU and 

• Dad 

reported in 

the home. 


• Dad added 

to Medi- 

Cal. 


person 

newborn timely 

report 

Situation: An AU consisting of Mom and one child is in the 

August/September/October quarter (Cycle 2) and has been receiving 

CalWORKs benefits since February. Mom is pregnant and due in 

September. Mom reports in September her second child was born 

September 14. This child does not have income or resources. 

BDA: As the addition of the newborn will result in an increase in benefits 

(not MFG), the newborn’s BDA will be: 

• October 1 for CalWORKs, the first day of the month following the month 

of report. 

• September 1 for Medi-Cal, the first day of the month of birth. 

Month August 


September October 

Actions • EDC for unborn. Newborn added to AU 

• Mom reports birth of 

newborn. 

and CalWORKs. 

• Newborn added to 

Medi-Cal. 



Beginning Date of Aid (BDA) Examples, Continued 


person while 

full case 

application still 

pending 

Situation: A family consisting of a mother and one child applies for 

CalWORKs on June 15. On June 23, while the application is still pending, 

the mother reports the father of the child moved in on that date. 

Application Date: The applications dates are: 

• June 15 for the mother and child 

• June 23 for the father 

BDA: Assuming all persons met the eligibility conditions on their date of 

application, the BDAs are: 

• June 15 for the mother and child 

• June 23 for the father 

Note: While a full case application is still pending, the BDA for an add 

person is the latter of the date of application or the date eligibility conditions 

are met. 


Beginning Date of Aid (BDA) Chart 

BDA Chart – 

Add person 

Adding Reported 

Timely 

New 

member 

results in 

Increased 

benefits 

New 

member 

results in 

Decreased 

benefits 

New 

member 

results in 

financial or 

nonfinancial 

ineligibility 

for the AU 

Newborn 

resulting in 

an Increase 

Newborn 

resulting in 

a Decrease 

MFG 

Newborn 

The chart below gives the CalWORKs and cash-linked Medi-Cal Beginning 

Dates of Aid (BDAs) for add persons. 

Not 

Reported 

Timely 

X First of the month 

following the month of 

report. 

BDA CalWORKs BDA Cash-linked 

Medi-Cal 



report. 

X First of the QR Payment 

Quarter following report 

on the QR 7. 



on the QR 7. 

X No BDA. Not eligible to 


X No BDA. Not eligible to 




report. 



report. 



on the QR 7. 



report. 

X Add to AU (no increase) 

the first of the month 


report. 

X Add to AU (no increase) 

the first of the month 


report. 

First of the month 

the change 

occurred. 




the change 

occurred, if eligible. 



No BDA. Not 

eligible to 

CalWORKs. Refer 

to Medi-Cal. 

No BDA. Not 

eligible to 

CalWORKs. Refer 

to Medi-Cal. 


of birth. 


following the month 





following the month 







CWPHB #4632 (05/12) APPLICATION 1-55

Beginning Date of Aid (BDA) Chart, Continued 

BDA Chart – Add person (continued) 

Adding Reported 

Timely 

Newborn 

and Dad 

(PWO 

cases) 

resulting in 

an increase 

Newborn 

and Dad 

(PWO 

cases) 

resulting in 

a decrease 

Not 

Reported 

Timely 



report. 

BDA CalWORKs BDA Cash-linked 

Medi-Cal 



report. 

X Newborn – First of the 

month following the 

month of report. 

Dad – First of the QR 

Payment Quarter 

following report on the 

QR 7. 

X Newborn – First of the 

month following the 


Dad – First of the quarter 

following the required 

report on the QR 7. 


of birth of the 

newborn. 

Newborn – First of 

the month of birth. 

Dad – First of the 










CWPHB #4632 (05/12) APPLICATION 1-55.1

Adding a Person to the Assistance Unit (AU) 

Introduction This section contains information regarding the procedure to add an 

additional person to an existing Assistance Unit (AU)/case. 

Application 

process – add 

person 

Once an application for the add person has been completed and all 

verifications have been provided, the Eligibility Worker (EW) will follow the 

steps below to process the application: 

Step Action 

1 Determine if the new person meets all eligibility criteria including: 

Deprivation, 

Income, 

Resources, and 

Citizenship. 

2 Determine the new AU member’s Beginning Date of Aid (BDA). 

3 Determine if the additional person is a mandatory or an optional 

AU member, and: 

If the additional And adding the Then… 

person is… person results in … 

Mandatory, Eligibility, Go to Step 4. 

Ineligibility, Discontinue the 


program. 

Optional, Eligibility, Go to Step 4. 

Ineligibility, Deny CalWORKs 

for the additional 

person. 

4 Pend a Welfare-to-Work program. 

5 Request a Time Limit Review when the additional person is an 

adult. 

6 Approve CalWORKs for the new AU member. 


CWPHB #4632 (05/12) APPLICATION 1-56

Add Person Results in Ineligibility 

Introduction This section contains information about adding a new person action that 

results in ineligibility (financial or non-financial) for the CalWORKs Assistance 

Unit (AU), including examples of financial and non-financial ineligibility 

situations. 

Process when 

new person 

results in nonfinancial 

ineligibility 

If adding the new person would result in an increase or decrease in benefits, 

but the new person does not meet other eligibility factors (resources, 

deprivation, etc.), the Eligibility Worker (EW): 

• Will not take action to add the person, and 

• Will not take action to discontinue benefits for the existing AU members 

mid-quarter. 

The following rules apply when the addition of a new person results in 

ineligibility other than financial: 

• If the new person, once added, results in the AU being ineligible to 

CalWORKs, the EW will not take any action to discontinue the AU’s 

benefits mid-quarter. 

• Once the EW determines the add person results in the AU being 

ineligible, the EW will: 

− Send the customer a No Change Notice of Action (NOA) informing 

him/her the report of the new person did not increase benefits. This 

NOA also reminds the customer to report this information on his/her 

next QR 7, and 

− Document the action(s) taken and reason(s) for such. 

• Action to add the new person will not be taken until reported on the QR 7. 

If the information remains consistent with the original report of the new 

person, the EW must: 

− Discontinue CalWORKs for the AU at the end of the current QR 

Payment Quarter due to non-financial ineligibility, 

− Send a NOA for discontinuance, 

− Send a NOA denying cash aid and cash-linked Medi-Cal for the new 

person, and 

− Refer the add person application to Medi-Cal. 



Add Person Results in Ineligibility, Continued 

Add person 

results in 

financial 

ineligibility 

Once the EW has completed a test EDBC and determined the additional 

person causes the AU to be financially ineligible, the following rules apply: 

• The EW will: 

− Send the customer a No Change Notice of Action (NOA) informing 

him/her the report of the new person did not increase benefits. This 

NOA also reminds the customer to report this information on his/her 

next QR 7, and 

− Document the action(s) taken and reason(s) for such. 

• Action to add the new person will not be taken until reported on the QR 7. 

If the information remains consistent with the original report of the new 

person, the EW must: 

− Discontinue CalWORKs for the AU at the end of the current QR 

Payment Quarter due to financial ineligibility, 

− Send a NOA for discontinuance, 

− Send a NOA denying cash aid and cash-linked Medi-Cal for the new 

person, and 

− Refer the add person application to Medi-Cal. 

Note: The new person is not entitled to receive cash-linked Medi-Cal, as 

he/she is not eligible for CalWORKs. The new person must be evaluated for 

eligibility to other Medi-Cal programs. 




When add 

person causes 


ineligibility 

after initially 

eligible 

When: 

• An add person was initially determined CalWORKs eligible, but action to 

authorize CalWORKs was delayed until after the required report on the 

QR 7 (adding person would decrease benefits), 

and 

• A subsequently reported change would causing CalWORKs ineligibility 

occurs prior to authorization of add for the add person, 

use 

• The chart below to determine what actions to take and when. 

When the add person 

causes the grant to 

decrease AND prior to 

authorization of 

CalWORKs … 

New reported information 

occurring in the Data 

Month or prior causes 

CalWORKs ineligibility for 

the AU, 

New reported information 

occurring in the Submit 

Month causes 

CalWORKs ineligibility for 

the AU, 

Then … 

Discontinue CalWORKs for the AU at the end of 

the current QR Payment Quarter. 

• Deny CalWORKs application for the add 

person, 

• Deny/discontinue cash-linked Medi-Cal for 

the add person and evaluate for other 

Medi-Cal program eligibility, 

• Treat the add person as a Non-AU Member 

for the upcoming QR Payment Quarter and 

use his/her income and needs to determine 

benefits for the remaining AU, and 

• Discontinue CalWORKs for the AU at the 

end of the upcoming QR Payment Quarter if 

the information reported on the QR 7 

received in that quarter is consistent with the 

previously reported information (AU 

CalWORKs ineligible). 





person results 

in financial 

ineligibility 



in non-financial 

ineligibility 


quarter (Cycle 2). Mom voluntarily reports in June Dad moved into the home 

that month. Dad has income sufficient to cause financial ineligibility if he and 

his income are added. 

Action: The EW: 

• Will take no action concerning eligibility or benefits for the existing AU in 

the current quarter (May/June/July). Action to discontinue based on 

financial ineligibility must be “held over” until review of the information 

reported on the next QR 7. 

• Must review the June QR 7 to ensure the information reported is 

consistent with the information previously provided in Mom’s voluntary 

report. If it is, discontinue CalWORKs based on Dad’s income at the end 

of the current quarter or July 31. 

• Will not establish cash-linked Medi-Cal eligibility for Dad based on Mom’s 

June voluntary report of Dad moving in. 

• Will refer Dad’s add person application to Medi-Cal. Dad must be 

evaluated for eligibility to other Medi-Cal programs. 


quarter (Cycle 2). Deprivation is absence. In May, Mom voluntarily reports 

Dad moved into the home that month. Dad is full-time employed, resulting in 

a loss of deprivation. 

Action: The EW: 

• Will take no action concerning the loss of deprivation for the existing AU 

in the current quarter (May/June/July). Action to discontinue based on 

ineligibility due to loss of deprivation must be “held over” until review of 

the information reported on the next QR 7. 

• Must review the June QR 7 to ensure the information reported is 

consistent with the information previously provided in Mom’s voluntary 

report. If it is, discontinue CalWORKs based on loss of deprivation at the 

end of the current quarter or July 31. 

• Will not establish cash-linked Medi-Cal eligibility for Dad based on Mom’s 

June voluntary report of Dad moving in. 

• Will refer Dad’s add person application to Medi-Cal. Dad must be 

evaluated for eligibility to other Medi-Cal programs. 






in ineligibility, 

Submit Month 

Situation: An AU consisting of Mom and one child in the May/June/July 

quarter. In May, Mom voluntarily reports Dad moved into the home that 

month. Dad in working part-time. His earnings causes the grant to 

decrease, so the add person action is held over (potential CalWORKs BDA is 

August 1. The June QR 7 is received reporting income for Dad, which 

decreases the grant, but does not cause income ineligibility. In July (the 

Submit Month), prior to authorizing CalWORKs for Dad, Mom calls to report 

Dad just received a raise. His income now causes the AU to be income 

ineligible for CalWORKs. 

Action: The EW will: 

• Deny CalWORKs for Dad; 

• Discontinue cash-linked Medi-Cal for Dad and refer his application to 

Medi-Cal to be evaluated for other Medi-Cal programs. 

• Treat Dad as a Non-AU Member and use the income reported on the 

June QR 7 to calculate benefits for the remaining AU Members (Mom 

and one child) for the upcoming QR Payment Quarter 

(August/September/October). 

• Review the September QR 7 to ensure the information reported is 

consistent with the information previously reported in August regarding 

Dad’s income. If it is, discontinue CalWORKs based on income 

ineligibility at the end of the QR Payment Quarter, or October 31. 


Rules for Newborns 

Introduction This section contains some rules specific to adding newborns, including 

those who meet the Maximum Family Grant (MFG) rules. 

Rules for 

newborns 

The following rules apply when adding a newborn to the Assistance Unit 

(AU): 

• After the application (CW 8A or SAWS 2) is completed and all other 

eligibility criteria are met, the newborn must be added to the AU effective: 

− The first of the month after the birth was reported, if the addition 

results in an increase in benefits, or 

− The first of the QR Payment Quarter following the QR 7 on which the 

birth is required to be reported, if the addition results in a decrease or 

no change in benefits. 

• If the mother was receiving Pregnancy Special Need (PSN) payments, 

the Eligibility Worker (EW) will take action to discontinue the PSN the 

month prior to the month the newborn is added to the AU. 

• The newborn is entitled to receive cash-linked Medi-Cal effective the 

month of birth, upon notification of the date of birth, baby’s name and 

gender. 

• If the newborn has income that would cause the AU to be ineligible or 

would result in a decrease in benefits, the EW will not take action to 

change benefits mid-quarter. Benefits will not be reduced or terminated 

mid-quarter. 

• Upon notification of the newborn’s name, birth date, and gender, the 

County must take action to approve Medi-Cal and issue a Medi-Cal card 

for the newborn effective that child’s date of birth when the parent(s) 

have already been determined CalWORKs eligible and the newborn is a 

mandatorily included person. 

Note: When adding the newborn as a Case and Program Person in the C-IV 

case, if the newborn is already in MEDS, match that CIN and do not create a 

new one. 



Rules for Newborns, Continued 

Newborns and 

MFG 

PSN and 

newborns 

When the addition of a newborn does not result in an increase to CalWORKs 

due the application of Maximum Family Grant (MFG) rules, the EW will add 

the newborn to the AU as follows: 

If the mother … And benefits … Then add the MFG newborn … 

Did not receive 

PSN, 

Will not change, The first of the month following the 

report of birth provided all conditions 

of eligibility have been met. 

Received PSN Will decrease, The first day of the next QR 

Payment Quarter following the 

report of the birth after all 

verifications have been provided. 

If the birth of the newborn is reported timely, cash-linked Medi-Cal is effective 

the first of the month of birth. 

Information regarding when to stop date pregnancy special need (PSN) 

payments when adding a newborn is located in the Pregnancy Special 

Needs section of the Special Needs Chapter of this Handbook. 


Unborn/Pregnancy Special Needs (PSN) 

Introduction This section of the CalWORKs Handbook Applications Chapter provides 

information regarding unborn children and Pregnancy Special Needs (PSN). 

Intake 

instructions 

Specific information is located in the Special Needs Chapter of this 

Handbook regarding: 

• Eligibility to PSN, 

• PSN start and stop dates, and 

• How to determine the last trimester for adult pregnant woman only 

(PWO) cases. 

This table outlines family composition and special instructions to be followed 

by Intake workers when determining PSN. 

Note: Adult pregnant women only must be in their last trimester to be 

eligible to CalWORKs. Pregnant teens/minors only can receive CalWORKs 

in their first and second trimesters as long as they are Cal-Learn participants. 

See the Special Needs Chapter of this Handbook. 

Family Composition Special Instructions 

PWO case: 

• Mom and unborn 

• Mom, Dad, and unborn 

• Mom, other children, and unborn 

(Mom’s or minor child’s) 

• Mom, Dad, other children, and 

unborn (Mom’s or minor child’s) 

• PWO case – minor parent and 

minor parent’s unborn 

• Non-needy caretaker, minor 

parent, and minor’s unborn 

• Verify pregnancy. 

• Set a Task for the expected date 

of confinement (EDC) date. 

• Establish BDA. 

• Issue PSN according to the 

instructions in the Special Needs 

Chapter. 

• Refer to WIC. 

• Refer excluded father to Medi- 

Cal (father is excluded until 

newborn is added) 


• Set a Task for the EDC date. 

• Establish BDA 



Chapter. 

• Refer to WIC. 

NOTE: PSN can only be authorized if the pregnant woman/minor is in the 

Assistance Unit (AU). Except for an AU of one case (pregnant woman only), 

deprivation does not need to be established to issue PSN; this is done when 

the baby is born. 



Unborn/Pregnancy Special Needs (PSN), Continued 

Continuing 

instructions 

This table outlines family composition and special instructions to be followed 

by Continuing workers when determining PSN. 

Family Composition Special Instructions 

• Mom, other children, and unborn 

(Mom’s or minor child’s) 

• Mom, Dad, other children and 

unborn (Mom’s or minor child’s) 

• Non-needy caretaker, minor 

child, and minor’s unborn 


• Set a Task for EDC. 



Chapter. 

NOTE: PSN can only be authorized if the pregnant woman/minor is in the 

AU. Except for an AU of one case (pregnant woman only), deprivation does 

not need to be established to issue PSN; this is done when the baby is born. 


Overview 

Change of Payee 

Introduction This section provides information and guidelines for completing changes of 

payee. 






Introduction This section provides information regarding guidelines and examples for 

change of payee. 

Guidelines for 

changing the 

payee 

An aided caretaker may leave the home and/or voluntarily give up care and 

control of an aided child(ren) to another caretaker relative. The Eligibility 

Worker (EW) will use the following guidelines to change the payee: 

• A new SAWS 1 and SAWS 2 are required for the new payee. The new 

payee will be assigned a new case number or his/her previous case 

number, if on aid before. 

• The beginning date of aid (BDA) for the new payee is determined by the 

living arrangements that existed on the first of the month following the 

month in which the change occurred. 

• If the initial caretaker received aid erroneously and an overpayment is 

established, the new payee can receive aid the first of the month 

following the month that the new living conditions existed (as long as 

eligibility conditions are met). 

• It is possible to issue a payment to the new payee prior to establishing 

the new AU if the previous caretaker agrees. 

Example 1 Situation: A mother and two children were receiving aid on 07/01. On 07/12, 

the mother leaves the children with their aunt. The aunt applies for aid as a 

needy caretaker on 07/18 and meets all eligibility conditions on 07/18. 

Action: The EW sends a timely (10-day) notice to discontinue mother 

effective 07/31. A new case number is assigned and aid is approved effective 

08/01 for the new AU. Prorated aid cannot be paid to the aunt for July. Aid 

was already paid to the mother according to the situation existing on the first of 

the month. 

Example 2 Situation: The same circumstances as above, except the aunt does not apply 

for aid until 07/29. She meets all eligibility factors on 07/29. 

Action: The EW sends a timely (10-day) NOA to discontinue the mother 

effective 08/31. A separate NOA is sent to the mother for the 08/01 

overpayment. A new case number is assigned for the new AU. Aid is 

approved effective 08/01 with no break in aid for the children. The aunt’s BDA 

is 08/01 (she has met all the conditions of eligibility). Follow BDA rules for an 

additional person. 



Change of Payee, Continued 

Example 3 Situation: Mother and two children receiving aid. On 11/05, mother leaves 

the two children with the Grandmother. Grandmother applies for aid as a 

non-needy caretaker for the two children on 11/10. 

Action: EW sends a timely (10-day) notice to discontinue mother effective 

11/30. Grandmother is payee for the grandchildren effective 12/01. Aid 

cannot be paid to the grandmother for November, as aid was already paid to 

the mother according to the situation that existed on the first of the month. 

Example 4 Situation: Mother and two children receiving aid. On 11/05, mother leaves 

the two children with Grandmother while she is in drug rehab. Grandmother 

applies for aid as a non-needy caretaker for the two children on 11/10. 

Action: If the mother intends to return to the home when she is released 

from drug rehab, this is a temporary absence situation and she remains 

eligible to receive CalWORKs. Grandmother is added to the CalWORKs as 

the payee effective 12/01 and as an AU Member using Beginning Date of Aid 

rules for add persons. If the mother does not intend to return to the home, 

see Example 3 above. 


Overview 

Domestic Abuse 

Introduction This section provides information regarding the County’s policies and 

procedures for victims of domestic abuse. 


• EAS 40-107.9 

• EAS 42-715 



Domestic Abuse: Basic Information 1-70 

Domestic Abuse: Program Information 1-71 

Safe At Home Program 1-75 

Service Providers 1-77 


Domestic Abuse: Basic Information 

Introduction This section provides basic information about the CalWORKs Domestic 

Abuse program, including background information and terms and definitions. 

Background Regulations require Counties to develop protocols to identify and assist 

CalWORKs customers who are or were victims of domestic abuse to obtain 

employment and become self-sufficient. 

Terms and 

definitions 

The following terms and definitions are associated with domestic abuse: 

Domestic abuse: Assaultive/coercive behavior (physical abuse, sexual 

abuse, psychological abuse, economic control, stalking, isolation, threat, etc.) 

occurring within a relationship. 

Domestic relations: Individuals who: 

• Are currently married or were married 

• Have lived or are living together 

• Have dated or are dating 

• Were in or are currently in a sexual relationship 

• Are related by blood, adoption or marriage 

• Were engaged or are engaged to be married 

• Have children in common 

NOTE: Domestic relationships include minor children of any person 

listed above. 

Service provider: A group or agency whose objective is to assist individuals 

to identify, escape, or stop domestic abuse. 

Employment evaluator: Individual employed by the service provider who 

does the risk evaluation. 

Risk evaluation: Review and appraisal of the level of risk to the individual in 

participating in CalWORKs activities or domestic abuse services. The 

domestic abuse service provider completes this assessment. 


Domestic Abuse: Program Information 

Introduction This section provides information about the County’s Domestic Abuse policy, 

offer of referral for risk evaluation and the evaluation process, and program 

specifics. 

Policy The CalWORKs policy regarding domestic abuse is: 

Identifying 

victims of 

domestic abuse 

Verification of 


Offer of referral 

for risk 

evaluation 

All CalWORKs customers will be informed verbally and in writing 

(DV 900), at application, and Re-Evaluation (RE) of the availability of 

services to assist victims of domestic abuse. 

Individuals will be given the opportunity to confidentially self-identify or 

disclose domestic abuse. 

Individuals who have self-identified or disclosed domestic abuse will be 

referred to the local domestic abuse service provider for risk evaluation. 

If a child is abused, a Child Protective Services (CPS) referral will be 

made. 

On a case-by-case basis, the CalWORKs 48-month time limit, Welfareto-Work 

(WTW) program participation and certain other program 

requirements may be waived for an individual who is a victim of domestic 

abuse. 

The domestic abuse service provider will make the sole determination as 

to whether or not the individual can participate in WTW activities and to 

what extent. 

A victim of domestic abuse can be identified if the individual: 

Self-identifies or discloses domestic abuse. 

Checks question 13, “Domestic Abuse”, box on the SAWS 1. 

Is living in a domestic abuse shelter. 

Appears to have been abused. 

Once the individual has been identified as a victim of domestic abuse, his/her 

statement is sufficient verification. No other verification is required. 

Once the individual has been identified as a victim of domestic abuse, the 

Eligibility Worker (EW) will offer a referral for risk evaluation by the local 

domestic abuse provider and explain: 

Availability of domestic abuse services. 

All reports of domestic abuse remain confidential. 

Domestic abuse referrals and services are voluntary. 

Certain CalWORKs program requirements may be waived. 



Domestic Abuse: Program Information, Continued 

Referral 

process 

Refusal of risk 

evaluation 

If the individual accepts domestic abuse services, a referral to the service 

provider will be made. The table below shows the process for making the 

referral and processing the case. 


1 EW: 

Contacts the local service provider to schedule appointment for 

risk evaluation. 

Completes the HSS 711.56 and hand carries, mails or faxes a 

copy of the referral to the service provider. 

Note: In most instances the service provider will be able to see the 

individual within 30 minutes of contact. 

2 Customer attends individual orientation. (Intake only) 

Note: Job services attendance is not required at this time. 

3 EW schedules a return appointment to obtain all necessary forms and 

verification needed to determine eligibility. (Intake only) 

4 Service provider returns the HSS 711.56 to the EW with evaluation 

and recommendations. 

5 EW completes and forwards HSS 700 to WTW (with HSS 711.56 

attached) indicating the individual was referred to the domestic abuse 

service provider. 

6 Employment Services Specialist (ESS): 

Reviews the information on the HSS 711.56 and evaluates 

whether the individual is able to participate in WtW activities or 

should be in good cause. This is based on the service provider's 

recommendation. 

Informs the EW of the individual's participation status via the HSS 

700. 

If the individual refuses a referral to a domestic abuse provider for risk 

evaluation, the case will be processed and handled as normal. However, the 

EW should try to find out why the referral for risk evaluation has been 

refused. 

The chart below explains the process to follow when an individual refuses a 

risk evaluation referral. 

If the reason for refusal is… Then… 

The customer was a past victim and 

is not currently in an abusive 

relationship, 

Based on fear of accepting/going to 

the risk evaluation, 

Process the case following regular 

procedures and refer to WTW. 

Do not refer for risk evaluation. 

Waive WTW requirements and 

CalWORKs 48-months time limits. 




Waived 

program 

requirements 

Notice 

procedures 

Statewide 

Finger Imaging 

System (SFIS) 

Based on the information from the domestic abuse provider (from the 

HSS 711.56), certain program requirements may be waived for individuals 

who are referred to a domestic abuse service provider when it has been 

determined to be necessary and only as long as necessary. 

The chart below shows which program requirements may be waived and who 

makes the determination. 

Program Requirement Who Makes Determination 

CalWORKs 48-month time limits Quality Review Specialist (QRS) 

Work requirements ESS 

Teen school requirements ESS 

Paternity establishment and child 

support cooperation 

Program Integrity Division (PID) 

Quality Review Unit (QRU) (The EW 

will make the referral for good cause 

determination). 

An individual who has been identified as a victim of domestic abuse will be 

given the opportunity to decide how he/she would like to receive 

communications and correspondence from TAD in order to preserve his/her 

confidentiality and safety. 

Methods may include using: 

An alternative mailing address 

Hand delivery 

“No address” procedure 

The case record must indicate the need for alternate notice procedures and 

the method used to notify the individual. 

Victims of domestic abuse who have changed their names may generate a 

Statewide Finger Imaging System (SFIS) “match” consisting of two records 

with the same fingerprints and similar photos, but different personal 

information. EWs must verify the victim’s new identity (see the Statewide 

Finger Imaging System (SFIS) section of this chapter for more information). 

Confidentiality In addition to confidentiality requirements in place for all cases, the following 

confidentiality requirement applies to victims of domestic abuse and their 

children: 

Information about domestic abuse will not be released to any outside 

party, other governmental agency (except for the service provider) or any 

Human Services (HS)/WTW employee who is not directly involved in the 

case. 




Work 

registration 

changes 

Receiving 

inter-county 

transfers (ICTs) 

for victims of 


If the work registration status changes, for an individual exempt from 

Welfare-to-Work participation due to domestic abuse, the WTW ESS will 

make the change and notify the EW of the change. 

The Inter-County Transfer (ICT) process has been developed to ensure 

benefits continue, without interruption, in one county while the customer 

reapplies in the new county of residence. Information regarding a customer’s 

domestic abuse issues will only be released when the customer completes 

and signs the WTW 37 form - Permission to Release Domestic Abuse 

Information When Moving to Another County. If the WTW 37 is not received 

in the ICT packet, the assigned intake Eligibility Worker will obtain a signed 

copy. 

When the signed and dated WTW 37 form is received from the sending 

county, the EW will take the following actions: 

Step Action 

1 Image the document into C-IV. 

2 Inform the customer of local domestic abuse services which are 

available. 

Note: Domestic abuse services may be located by calling 

1-800-799-SAFE 



Safe At Home Program 

Introduction The Safe At Home Program was developed to help survivors of domestic 

abuse remain safe once they have escaped an abusive situation by using a 

Post Office Box for a mailing address and a substitute (fictitious) street 

address. 

Safe At Home 

eligibility 

CalWORKs and 

the Safe At 

Home program 

Safeguarding 

Safe At Home 

cases 

This section contains information regarding Safe At Home eligibility. 

In order to qualify for the Safe At Home program, individuals must enroll and 

provide specific information regarding being a victim of domestic abuse 

and/or stalking to the local agency operating the Safe At Home program. If a 

customer is not currently a Safe at Home participant, but wishes to be, 

he/she may contact the local designated agency or call the Secretary of 

State’s toll free number 1-877-322-5227. For a list of designated agencies in 

San Bernardino County see the Safe At Home enrolling agencies block in 

this section of the chapter. A list of enrolling agencies in the State of 

California is located on the TAD website. 

Once determined to be eligible for the Safe At Home program, the individual 

will be given a Post Office Box to receive his/her mail, a substitute (fictitious) 

street address, and an identification card which identifies the individual as a 

Safe At Home participant. 

When a customer provides a Safe At Home program card and a Post Office 

Box and fictitious address, both these address will be accepted and used in 

C-IV. An exception to this, is when there is suspected fraud, and a home 

visit is needed; the customer will be required to provide his/her actual 

physical address. 

Cases identified as Safe At Home cases, are confidential and should not be 

available to the general employee population. It is recommended that one 

Eligibility Worker in each office be assigned to carry these cases. 

When the customer’s actual address is obtained, this address will not be 

entered in C-IV or any other computer or automated system. It must be kept 

in a physical case file or other secure place. 



Safe at Home Program, Continued 

Safe At Home 

enrolling 

agencies 

The following agencies have been designated by the Secretary of State as 

Safe At Home enrolling agencies. 

Enrolling Agency City Telephone Number 

San Bernardino County 

DA – Victim Services 

Barstow (760) 256-4802 



Fontana (909) 356-3401 



Joshua Tree (760) 366-5741 



Rancho Cucamonga (909) 989-0056 



San Bernardino (909) 387-6556 



Police Based Units 

San Bernardino (909) 388-4900 



Desert Region 

Victorville (760) 243-8619 


DA – Bureau of Victim 

Services 


Doves of Big Bear 

Valley, Inc (DOVE) 

Big Bear Lake (909) 866-1546 

Doves of Big Bear 

Valley, Inc (DOVE) 

Blue Jay (909) 337-5300 

Morongo Basin Unity 

Home, Inc 

Joshua Tree (760) 366-9663 

Lucerne Valley Domestic 

Violence outreach, Inc 

Lucerne Valley (760) 248-2064 

Option House, Inc San Bernardino (909) 383-1602 

High Desert Domestic 

Violence Program, Inc. 


Victor Valley Domestic 

Violence Inc. – A Better 

Way 


Note: A list of enrolling agencies in the state of California is located on the 

TAD Website in Contacts. 


Service Providers 

Introduction This section provides information about domestic abuse service providers 

and the TAD offices they serve. 

Service 

providers 

The following is a list of domestic abuse service providers and the TAD 

district offices they serve: 

TAD Office Service Provider 

Ontario 

Rancho Cucamonga 

San Bernardino “E” 

Fontana 

Redlands 

Redlands 

(Mountain Areas) 

San Bernardino “Mass” 

(Mountain Areas) 

Colton 

San Bernardino “Mass” 

Del Rosa 

San Bernardino WTW 

Yucca Valley 

29 Palms 

Barstow 

Needles 

Victorville 

Hesperia 

Adelanto 

House of Ruth: 

599 N. Main St. 

Pomona 91767 

(909) 623-4364 

214 W. “E” St. 

Ontario 91762 

(909) 984-8282 

24-hour hotline: (909) 988-5559 

Option House: 

688 N. Arrowhead Ave., Suite 101 

San Bernardino 92402 

(909) 383-1602 

24-hour hotline: (909) 381-3471 

D.O.V.E.S.: 

41947 Big Bear Blvd #A 

Big Bear Lake 92315 

24-hour hotline: 1-800-851-7601 

Big Bear Outreach (909) 866-1546 

Crestline Outreach (909) 338-8104 

High Desert Domestic Violence: 

17096 Sequoia Rd., Suite A3 

Hesperia 92345 

(760) 949-4357 

Morongo Basin Unity Home: 

61738 Twenty-Nine Palms Hwy. 

Joshua Tree 92252 

24-hour hotline: (760) 366-9663 

Desert Sanctuary: 

P.O. Box 1781 

Barstow 92311 

24-hour hotline: (760) 256-3441 

Collect calls accepted. 

Victor Valley Domestic Violence: 

P.O. Box 2825 


24-hour hotline: (760) 955-8723 

Collect calls accepted. 


Overview 

Diversion 

Introduction This section provides information about the County’s Diversion program. 

Reference The following reference applies to material in this section: 

• EAS 81-215 



Basic Diversion Information 1-79 

Identifying Potential Diversion Candidates 1-82 

The Diversion Process 1-83 

Making the Diversion Decision: A Collaborative Approach 1-84 

Issuing Diversion: Basic Rules 1-86 

Issuing Diversion: The Process 1-87 

Diversion Issued via Vendor Payments 1-88 

Diversion Issued via Warrant/EBT 1-89 

Establishing the Diversion Period 1-90 

Secondary Diversion 1-91 

Impact of Diversion on Time Limits 1-93 

When a Diversion Recipient Reapplies for CalWORKs 1-95 

Example of a Reapplication After Diversion 1-96 


Basic Diversion Information 

Introduction This section provides basic information about Diversion, its purpose, terms 

and definitions, eligibility criteria, limits and means of application. 

Terms and 

definitions 

Purpose of 

Diversion 

payment(s) 

Diversion Candidate: A stable family with recent employment history who 

applies for CalWORKs cash aid (Diversion is not available for CalWORKs 

recipient customers). 

Diversion Period: The total dollar amount of Diversion issued, divided by 

the Maximum Aid Payment (MAP) for the Assistance Unit (AU). This is 

regardless of the actual number of months of need for which the Diversion is 

issued. 

Successful Diversion: When a family receives Diversion and then remains 

off CalWORKs for the entire Diversion period and an additional six months. 

Successful diversions can result in additional CalWORKs funds for the 

County. 

Secondary Diversion: For two-parent families when the U-Parent accepts a 

job and is expected to work over 100 hours a month before the application is 

approved and is no longer CalWORKs eligible. 

Diversion Services: Cash or noncash payments or services provided to a 

CalWORKs applicant, with the intent of diverting the applicant from long-term 

aid. 

Families who apply for cash aid are sometimes close to achieving financial 

self-sufficiency or have recently lost their abilities to support themselves due 

to various obstacles. Counties have the option of offering a lump sum 

payment to divert families from accepting monthly CalWORKs cash aid 

payments when the lump sum payment will help the family eliminate the 

barrier to financial self-sufficiency. An applicant family may qualify for 

Diversion if they are apparently eligible for CalWORKs cash aid. 

The Diversion payment is intended to meet a particular need or needs 

related to accepting or retaining employment. For example: The issuance of 

rent or car payments that help the family get on their feet or tools required to 

perform a specific job. With this help, and perhaps other assistance such as 

CalFresh, Medi-Cal, and/or Child Care, it is expected that the family can 

obtain immediate full-time employment. 

When Diversion funds are issued to, or on behalf of, a family, the application 

for CalWORKs cash aid is denied. 



Basic Diversion Information, Continued 

Diversion – 

situations and 

timeframes 

Diversion payments are generally issued to deal with a specific crisis 

situation involving current needs, not to extend beyond three months in the 

future, or past due payments. 

If Diversion is issued to meet future needs, such as advance payments for 

automobile loans or advance payments of rent for future months (extending 

beyond four future months), then the customer must meet regular 

CalWORKs requirements at the time of the Diversion issuance. Also, when 

Diversion extends beyond four future months, the payment counts as a 

month of aid for time limits. 

Refer to the information about Diversion applications and 48-month time 

limits for more information. 

Basic eligibility A customer may receive Diversion funds when all the following apply: 

Informing 

customers of 

Diversion 

What Diversion 

can be used for 

• He/she is apparently eligible for CalWORKs cash aid as described in the 

Immediate Need section of the Applications Chapter of this Handbook, 

• Diversion funds will meet a need that will result in a job already offered, 

retention of a current job, or long-term means of support if relocated, 

• Diversion will likely preclude the need for on-going cash aid beyond the 

Diversion period, and 

• The customer cannot meet the need with his/her existing resources. 

All customers applying for CalWORKs will be informed of the availability of 

Diversion. 

Diversion payments can be used for needs such as: 

• Tools 

• License fees or fees for background checks 

• Fines or assessments preventing employment 

• Car repairs, insurance, or other transportation costs 

• Clothing or uniforms 

• Child care – only when the care cannot be provided through other funds 

• Relocation assistance 

• Health care or appliances such as glasses, dental care, or hearing aids 

that can not be provided by Medi-Cal in time to divert the family from 

CalWORKs cash aid 



Basic Diversion Information, Continued 

Limits California counties can establish their own limits to diversion issuance 

amounts and frequency for a family. In San Bernardino County, a Diversion 

customer can receive no more Diversion for at least 12 months after 

issuance. Make exceptions to that standard only with Deputy Director 

approval. Some issuance amounts will require Deputy Director approval as 

described later in this Chapter. 

Diversion 

application 

Documenting 

the Diversion 

screening 

Families don’t actually apply for Diversion. As each CalWORKs applicant 

customer is interviewed and his/her application and Statement of Facts is 

reviewed, keep the Diversion program in mind. Offer Diversion services 

when: 

• Diversion funds will eliminate the customer’s barrier to self-sufficiency, 

and 

• The customer is likely to stay off cash aid for the Diversion period and an 

additional six months. 

Use the CW 88: Diversion Services Agreement Coversheet to help you make 

sure the customer understands the ramifications of accepting Diversion. 

When it looks as if a customer is a candidate for Diversion, use the 

SB CW 128, Diversion Screening Sheet, to: 

• Gather information necessary to help decide whether to issue Diversion 

to a customer, and 

• Share information with other staff members as necessary as described in 

the “Making the Decision” section later in this Chapter. 

Aid Codes Diversion is issued under one of the four Aid Codes described in the table 

below: 

Category Claiming Used to issue Diversion to apparently 

CalWORKs customers meeting… 

3J Federal The definition of an all-family or zero-parent 

family group. 

3Y State Qualified noncitizen status and meeting the 

definition of a two-parent family. 

3K Federal The definition of a two-parent family. 

3X State Qualified noncitizen status and meeting the allfamily 

definition. 


Identifying Potential Diversion Candidates 

Introduction This section lists the criteria for identifying a candidate for Diversion. 

Key factors to 

successful 

Diversion 

Diversion is more successful when it is issued to customers who are stable 

and likely to remain so with the help of a Diversion payment. 

Successful Diversion generally hinges on the following key factors: 

• Diversion will help the customer get a job or keep a current job enabling 

the family to be financially self-sufficient. 

• The customer has significant work history indicating the customer has 

marketable job skills and work habits. 

• The customer will be able to pay for routine expenses on a long-term 

basis without further help. 

• The family does not have a history of: 

− substance abuse 

− custody battle issues 

− unstable receipt of child support or other income 

− mental or behavioral health problems 

− homelessness 


The Diversion Process 

Introduction This section provides information about how the Diversion process works, 

and actions taken when Diversion is chosen or not chosen. 

How the 

Diversion 

process works 

Actions to take 

if Diversion is 

chosen 


if Diversion is 

not chosen 

The following table describes the Diversion process. The details for the 

stages are given later in this section. 


1 Customer applies for CalWORKs. 

2 Eligibility Worker (EW): 

Review’s customer’s needs and situation. 

Identifies the customer as a potentially successful Diversion 

candidate during the interview. 

Tells the customer about Diversion eligibility, benefits, and the 

consequences of accepting Diversion. 

Screens for Diversion eligibility and completes the Diversion 

Screen Sheet to document the process. 

Discusses the possibility of issuing Diversion with the ESP 

Employment Services Specialist (ESS). 

Arranges a Diversion conference with the customer and the 

WTW ESS. 

3 Customer, EW, and ESS decide whether to proceed with 

Diversion or with the application for CalWORKs. 

If all three parties (EW, ESS, and customer) agree Diversion is the best 

choice, the EW will: 

Review the CW 88, Diversion Services Coversheet, with the customer. 

Give the customer the list of vendors known to accept vouchers. 

Instruct the customer to find the least costly reputable provider of the 

goods or services and bring the information back to the EW. 

Guide the customer through the completion of the CW 88 once a vendor 

has been chosen. 

Issue the Diversion payment (accepting Diversion will cause the 

CalWORKs application to be denied). 

Process the CalFresh application if CalFresh were requested. 

Complete Notices of Action and narrate the case Journal. 

Refer the application to Medi-Cal if Medi-Cal was requested. 

If all three parties (EW, ESS, and customer) do not agree upon Diversion, 

continue with the original application for CalWORKs and narrate the decision 

in the case Journal. 


Making the Diversion Decision: A Collaborative Approach 

Introduction This section provides information about the collaborative approach to making 

the Diversion decision among the Eligibility Worker (EW), WTW Employment 

Service Specialist (ESS), and the customer. 

Working 

together 

When you believe a customer will benefit more from a Diversion payment 

than from CalWORKs cash aid, call a conference where the designated 

WTW ESS and customer join you in discussing Diversion. Each person has 

an important role in the Diversion determination. 

The EW The role of the EW is to identify apparently eligible families who could be 

diverted from becoming dependent on financial help from CalWORKs. 

The ES The role of the ESS is to shed light on the customer’s prospect of getting 

and/or keeping a job with help from Diversion. The EW does not have to 

make the decision on his/her own, but has input from a coworker who has 

experience in the business of employment. 

The customer The role of the customer is to be honest about their ability to take care of 

their family with minimal help and to agree to the terms of Diversion if they 

accept Diversion. 

The decision The mutual decision whether to proceed with Diversion or with CalWORKs 

cash aid determines what to do next: 

Conference 

outcome 

If… Then… 

Diversion is not agreed Continue with the original application for 

upon by all parties, benefits. 

All three parties agree The family finds the least costly reputable 

Diversion will be best provider of the good or service. 

for the family, 

The EW authorizes the Diversion voucher as 

instructed later in this chapter, and proceeds 

with any CalFresh and Medi-Cal applications. 

See the following sections for detailed instructions about how to proceed on 

the outcome of the diversion conference. 



Making the Diversion Decision: A Collaborative Approach, 

Continued 

Deciding 

against 

Diversion 

For most families, Diversion will not be an option. Sometimes Diversion 

seems to be a good thing for a family, but the result of the conference 

between the EW, customer, and ESS is Diversion would not be in the best 

interest of the family. 

Continue evaluating eligibility for the benefits originally requested when you 

decide against Diversion for a family. Make it clear to the customer it is only 

Diversion that is no longer being considered; the original application is still 

being evaluated. Narrate the outcome of the Diversion conference. 


Issuing Diversion: Basic Rules 

Introduction This section explains what to do once the determination to issue Diversion 

has been made including locating a provider, payment method, and level of 

approval. 

Basic rules for 

issuing 

Diversion 

Locating a 

provider 

Payment 

method 

Level of 

approval 

The basic rules for issuing Diversion are: 

• Check with the Child Care Unit when considering a child care payment 

for Diversion. Do not approve child care if the customer is currently 

receiving Child Care program services. 

• Advise the customer to find the least costly way for the County to meet 

the need. 

• Issue vouchers redeemable by providers of goods or services to help 

avoid misuse of Diversion funds whenever possible. 

• Encourage the customer to seek goods and services from the Vendor 

List located in the OR Handbook. The providers on the list have agreed 

to accept vouchers from the County. 

• Request the customer provide proof of the amount of the expenses to be 

covered by the Diversion payment. 

• Explain to the customer the CalWORKs application will be denied with 

the issuance of Diversion. 

• Continue processing any CalFresh and Medi-Cal requests if the customer 

wishes you to do so. 

The customer must find the least costly way for the need or needs to be met 

by a reputable provider. The family may begin searching with the merchants 

on the Vendor List but a provider not listed may be used as long as the 

provider agrees to the payment method approved by TAD management. 

HSS prefers Diversion be issued via vouchers directly to vendors whenever 

possible to ensure Diversion funds are spent as intended by the agency. 

Make sure the customer understands Diversion is paid in the following ways, 

in order of agency preference: 

1. Vouchers issued to providers 

2. Warrants issued to providers 

3. Issued to customers via EBT or warrant 

All Diversion issuance must be approved as follows: 

Diversion Amount Level of Approval 

Up to $1,000 EWS I 

$1,000 to $1,499.99 District Manager 

$1,500 and over Deputy Director 


Issuing Diversion: The Process 

Introduction This section provides information about the process of issuing a Diversion 

payment(s), and includes a table outlining the issuance process. 

The process The table below depicts the Diversion issuance process. 


1 EW, ESS, and customer decide to proceed with Diversion 

2 EW: 

• Explains to the customer: 

− He/she must find the least costly way for the need to be 

met. 

− The County issues vendor vouchers whenever possible 

and other payment methods. 

− The CalWORKs application will be denied. 

− The consequences of accepting Diversion using the CW 

88 Coversheet. 

• Gives the customer the Vendor List. 

3 Customer: 

• Locates a provider for items or services. 

• Verifies the cost of the items or services. 

• Gives the EW the proof of the costs and the names of 

providers. 

4 EW: 

• Calculates the total value of the diversion and completes the 

CW 88 with the customer. 

• Seeks approval from TAD management. 

• Tells the customer to pick up the voucher at a specific time 

dictated by District policy. 

• Tells the customer how to access benefits if not issued by 

voucher. 

• Authorizes the diversion payment (CalWORKs application 

will be denied). 

5 Provider provides the goods or services needed. 

6 Customer signs the voucher verifying services or goods were 

provided. 

7 Provider signs the voucher, attaches receipts, and sends it to 

Auditing. 

8 Auditing issues a warrant to the vendor. 


Diversion Issued via Vendor Payments 

Introduction This section provides information about Diversion issued via vendor 

payments and what to do when the vendor is or is not on the Vendor List. 

Provider is 

listed on 

Vendor List 

Provider is not 

listed on 

Vendor List 

If the provider is listed on the Vendor List, then the Eligibility Worker (EW): 

• Issues Diversion via voucher. 

If the provider is not listed on the Vendor List, then the EW: 

• Contacts the vendor to determine whether payment will be accepted via 

voucher. 

• Issues Diversion via voucher if the vendor will accept a voucher once the 

Vendor is added to the Resource Data Bank. 

If the vendor will not accept a voucher, with prior approval of the Deputy 

Director, the EW will issue a warrant to the vendor. 


Diversion Issued via Warrant/EBT 

Introduction This section provides information about issuance of Diversion payments via 

the warrant or EBT process. 

Diversion 

warrants 

Issue Diversion via voucher whenever possible to ensure Diversion is spent 

for the intended purpose. Issue Diversion directly to the customer as 

seldom as possible to avoid misuse of diversion funds. 

If the provider… Then… 

Hesitates to accept a voucher, • Explain the voucher redemption 

process. 

• Encourage the provider to accept the 

voucher. 

Will not accept a voucher, • Find out if a County of San Bernardino 

warrant will be acceptable payment. 

• Explain the warrant is used just like a 

check and issued directly from the 

County of San Bernardino. 

Will not accept a warrant, • Issue the Diversion directly to the 

customer via EBT or warrant. 


Establishing the Diversion Period 

Introduction This section provides information about establishing the Diversion period, 

and includes an example. 

Diversion 

period features 

Determining 

the Diversion 

period 

Diversion 

period example 

The Diversion period is a key feature of Diversion. The Diversion period is 

important because it establishes: 

• Whether a Diversion from CalWORKs was successful or not based on 

when any subsequent application is filed. 

• How Diversion payments will be counted in the 48-month CalWORKs 

time limit. 

The Diversion period is the number of months the customer would have been 

aided had he/she received the same amount of CalWORKs cash aid as s/he 

did the Diversion payment. 

To figure the number of months in the Diversion period, divide the total value 

of the Diversion payment by the Maximum Aid Payment (MAP) for the 

CalWORKs-eligible Assistance Unit (AU). Only whole months are counted in 

the Diversion period. Any fraction of a whole month is not counted. 

A single mother with two children received a Diversion payment of $1,500 for 

major car repairs. At the time she received the Diversion payment, MAP for 

three people was $538. 

$1,500 diversion ÷ $538 MAP = 2.79 months 

The Diversion period for this customer is 2 months. The 0.79 will not be 

included in the Diversion period (The MAP used is for illustration only; it may 

not reflect the current MAP amount). 


Secondary Diversion 

Introduction This section provides information about Secondary Diversion, explains what 

it is, and describes the process. 

Secondary 

Diversion 

explained 

Uses of 

Secondary 

Diversion 

An applicant customer who loses their “apparently eligible” status before 

CalWORKs cash aid is approved also loses their eligibility for Diversion. 

However, San Bernardino County has expanded Diversion to families who 

are no longer apparently eligible before CalWORKs is approved specifically 

because a U-parent accepts a job and will be working over 100 hours. When 

that is the case, the customer may be eligible to Secondary Diversion. 

A customer who becomes ineligible for cash aid for any other reason while 

the application is pending is not eligible for any type of Diversion. 

Issue Secondary Diversion to a customer to meet any need Diversion would 

cover as described earlier in this section. In addition, you may issue cash to 

meet the needs of the family until the first paycheck is received. 



Secondary Diversion, Continued 

The Secondary 

Diversion 

process 

The following table describes the Secondary Diversion process: 


1 Customer applies for CalWORKs. 


• Does not offer Diversion to the family because Diversion does 

not appear to be in the best interest of the family. 

• Continues with routine case processing. 

3 U-parent accepts a job where he or she will work more than 100 

hours monthly before the CalWORKs application is approved. 

4 EW: 

• Determines the customer is no longer eligible to CalWORKs. 

• Within three days of the discovery of ineligibility: 

− Reviews the case for the probability of a successful 

Diversion. 

− Documents the Diversion review on the SB-CW 128: 

Diversion Screening Sheet. 

− Calls a Diversion conference with the EW, ESS, and 

customer participating. 

• Follows the rules and procedures for issuing a routine Diversion 

payment if Secondary Diversion is deemed appropriate. 

• Denies the CalWORKs application regardless of the Secondary 

Diversion decision 

• Sends the appropriate denial Notice of Action (NOA) to the 

customer. 

• Acts on requests for CalFresh and Medi-Cal. 


The Impact of Diversion on Time Limits 

Introduction This section provides information regarding the impact of Diversion on time 

limits. 


time limit 

When a 

customer 

accepts 

Diversion 

Each month cash aid is received by the adult may count toward the 

maximum 48 months of assistance. Diversion can impact the time limits in 

different ways. When Diversion and regular CalWORKs are issued for the 

same month, both count toward the 48-month limit. It is important the 

customer understands his/her options when considering Diversion and when 

reapplying for CalWORKs. 

Make sure the customer accepting Diversion is aware: 

• Diversion must be considered toward the CalWORKs 48-month time limit, 

and 

• May be counted in the 48-month time limit again if the customer applies 

for CalWORKs cash aid later. 

• The Diversion payment can also be considered an overpayment and not 

counted in the 48-month limit for some customers. 

If the Diversion customer 

Then … 

reapplies for CalWORKs … 

Within the Diversion period, The customer must choose to allow the 

county to: 

• Recoup the Diversion payment 

through grant adjustment at the rate of 

at least 10% and not count any 

Diversion months toward the time limit, 

Or 

• Count the total Diversion period 

against the 48-month limit, and 

• Count again any month in the 

Diversion period where CalWORKs 

cash aid is issued to the customer for 

the same month. 

After the Diversion period, Count one month toward the 48-month 

CalWORKs limit. 



The Impact of Diversion on Time Limits, Continued 

Example: The 

time limit clock 

ticks twice 

In February, the customer was issued $1,746 Diversion as a down payment 

to purchase a car to enable her to continue working at her long-term, present 

job. Part of her job entails traveling to customers’ homes in her own vehicle. 

• The Diversion amount of $1,746 is divided by $582 (MAP for three at the 

time of Diversion), so the Diversion period works out to be the months of 

February, March, and April. 

• The customer reapplies for and receives CalWORKs in April and chooses 

not to have the Diversion treated as an overpayment. 

Months are applied to the CalWORKs 48-month limit for this case as follows: 

• Count February, March and April because the customer reapplied for aid 

during the Diversion period. 

• Count April again toward the time limit because a CalWORKs payment 

was issued. This is an example of the clock ticking twice. 


When a Diversion Recipient Reapplies for CalWORKs 

Introduction This section includes information regarding the customer who reapplies for 

CalWORKs after receiving Diversion, how the reapplication is handled, and 

the impact of Diversion on the reapplication. 

How to identify 

previous 

Diversion 

Handling a 

reapplication 

after Diversion 

The impact of 

Diversion on 

reapplication 

Reminder: two 

ticks of the 

clock 

Look in the case history for any application to find previous Diversion 

payments. Diversion payments are issued on Aid Codes 3J, 3Y, 3K, or 3X. 

When a customer who has received Diversion reapplies for CalWORKs: 

• Screen the application for Diversion as you would any application. 

• Use routine beginning date of aid rules if you approve the application 

The following table shows the consequences of a Diversion payment on the 

CalWORKs time limit. 

If the reapplication is … Then … 

Within the Diversion period, The customer may choose to allow the 

County to recoup the Diversion payment 

through 10% grant reduction. 

OR 

The customer may choose to have the 

total Diversion period count against the 

48-month time limit. 

Within six months after the end Count the first month of the Diversion 

of the Diversion period, 

Seven months of more after 

the end of the Diversion period, 

period toward the 48-month limit. 

Count the first month of the Diversion 

period toward the 48-month limit. 

Remember Diversion and CalWORKs received for the same month will 

cause the 48-month clock to “tick twice”. Refer to the section about 

Diversion and time limits, earlier in this Chapter, for more information. 


Example of a Reapplication After Diversion 

Introduction This section provides information and an example situation of reapplication 

after Diversion, and the varying consequences depending on the date of the 

reapplication. 

The situation A single mother with two children applied for CalWORKs on 01/5/2004. She 

received a diversion payment of $1,500 for major car repairs. 

The Diversion 

period 

The 

reapplication 

At the time the customer received Diversion, MAP for 3 was $538. The 

Diversion period was calculated as follows: 

$1,500 ÷ $538 = 2.79 

Therefore, the Diversion period is two whole months. The 0.79 partial month 

is disregarded. 

The following table shows the potential consequences when the customer 

reapplies both within and outside the Diversion period. 

Reapplication 

Date 

01/31/2004 – 

within the 

Diversion period 

03/05/2004 – after 

the Diversion 

period has ended 

12/14/2004 – nine 

months after the 

end of the 

diversion period 

Consequences 

The customer must decide to allow the County to do 

one of the following: 

• Recoup the Diversion payment through 10% grant 

reduction. 

• Count the total Diversion period against the 

48-month time limit for CalWORKs eligibility and 

count again any month in the diversion period in 

which CalWORKs cash aid is issued to the 

customer for the same month. 

• Follow data entry procedures for tracking the time 

limit. 

• The County will not recoup the Diversion payment. 

• Count only the issuance month against the 



limit. 

• The County will not recoup the Diversion payment. 

• Count only the issuance month against the 



limit. 

• The Diversion is considered a successful Diversion 

because the customer stayed off CalWORKs for the 

Diversion period and an additional six months. 


Overview 

Statewide Finger Imaging System (SFIS) 

Introduction This section provides information regarding the Statewide Finger Imaging 

System (SFIS). 


• EAS 40-105.3 

• ACL 10-03 



Statewide Finger Imaging System (SFIS): Basic Information 1-98 

Statewide Finger Imaging System (SFIS) Process 1-99 

Statewide Finger Imaging System (SFIS) Requirements 1-101 

Statewide Finger Imaging System (SFIS) Processing Priority 1-103 

Statewide Finger Imaging System (SFIS) Compliance 1-104 

Statewide Finger Imaging System (SFIS) Searches 1-105 

Statewide Finger Imaging System (SFIS) Resolution 1-107 


Statewide Finger Imaging System (SFIS): Basic Information 

Introduction This section provides information regarding the Statewide Finger Imaging 

System (SFIS), including its purpose, consideration as an eligibility factor, 

technical problems, and the confidential nature of information. 

SFIS purpose The SFIS was developed to detect and deter duplicate aid welfare fraud. By 

obtaining both fingerprint and photo images of applicants and recipients of 

aid, and matching the fingerprint images against images already in the 

database, possible instances of duplicate aid fraud will be detected. 

SFIS as an 

eligibility factor 

Technical 

problems 

SFIS 

Coordinator 

SFIS is an eligibility factor for CalWORKs. All those required to be fingerprint 

and photo imaged, as described on the following pages, must participate in 

the process. 

Note: Failure to provide the required images results in ineligibility for the 

entire CalWORKs Assistance Unit (AU). 

Do not deny or discontinue CalWORKs for a customer when he/she cannot 

comply due to technical SFIS problems, such as equipment failure, power 

outage, or lack of SFIS staff. 

When technical problems prevent SFIS compliance, schedule an 

appointment for the required AU or household members to complete the 

process within 60 days of the initial attempt. 

Eligibility Workers (EWs) will e-mail the SFIS Coordinator if a customer is a 

victim of domestic abuse with a prior SFIS record and needs to complete the 

SFIS process. San Bernardino Coordinators are: 

• Primary, Barry Gomez, bgomez@hss.sbcounty.gov, and 

• Backup, Darla Stafford, dstafford@hss.sbcounty.gov. 

Confidentiality The SFIS is used only to identify aid recipients in California in an effort to 

avoid duplicate aid fraud. The system will not share information with other 

systems, including law enforcement databases. 


Statewide Finger Imaging System (SFIS) Process 

Introduction This section provides information about the SFIS process, including 

responsibilities of Intake, Continuing, and Special Investigation Unit (SIU) 

workers. 

How SFIS 

works 

The table below shows the SFIS process in general. Details for each stage 

are given as this section progresses. 


1 The EW identifies the customer as a member of the population who must 

comply with the SFIS requirements and: 

If the customer is… Then… 

Not a victim of domestic 

abuse, 

• Complete the SFIS 15, and 

• Refer the customer to the clerical SFIS 

staff. 

A victim of domestic abuse, • Complete the SFIS 15 and check the 

Domestic Abuse boxes, 

• E-mail the SFIS Coordinator a copy of 

the SFIS 15 prior to imaging the 

customers fingerprint to have the old 

SFIS record inactivated, and 

• Refer the customer to the clerical SFIS 

staff. 

2 The customer responds to the SFIS compliance request and: 

When the customer… Then… 

Fails to appear for finger and Notification of a second appointment is sent 

photo imaging, 

to the customer. 

Fails to appear for the • CalWORKs and/or CalFresh application 

second appointment, 

is denied for the entire family, or 

• Case discontinuance actions are taken 

per current procedures. 

Appears for finger and photo The EW continues with routine case 

imaging and complies as 

required, 

processing. 

3 The SFIS Office Assistant (OA): 

• Receives the SFIS response within the response time specified by the type 

of search: 

• Priority search: 15 minutes 

• Normal search: by 7:00 a.m. the next day 

• Enter domestic abuse script in the comment tab of the SFIS program, if the 

Domestic Abuse box is checked. 

4 The EW, SFIS OA, and/or FIU: 

• Resolves any issues arising as a result of a “hit” within the SFIS. Refer to 

the SFIS Resolution section later in this chapter. Resolution may involve: 

• Discovery and correction of agency error 

• Discovery of potential fraud 

• Discovery of actual fraud 

Discovery of the need for an Inter-county transfer (ICT) 



Statewide Finger Imaging System (SFIS) Process, Continued 

Intake worker 


Continuing 

worker 


SFIS 

Coordinator 

SIU 


Intake Eligibility Workers (EWs) do the following in the SFIS process: 

• E-mail the SFIS Coordinator on victims of domestic abuse before the 

customer completes the imaging process. 

− Check the Domestic Abuse box on the SFIS 15. 

• Explain SFIS and give the same information in writing (TEMP 2173). 

• Identify people who are exempt from the SFIS process, either temporarily 

or permanently. 

• Refer non-exempt CalWORKs customers to SFIS clerical staff for SFIS 

processing. 

• Deny applications when any required family or household member fails to 

comply with SFIS requirements. 

• Authorize Immediate Need CalWORKs cash on a postponed verification 

basis when necessary due to SFIS equipment failure. 

• Complete the EW portion of the Resolution process for “hits” or “misses”. 

Continuing EWs do the following in the SFIS process: 

• Identify people who are exempt from the SFIS process, either temporarily 

or permanently. 

• E-mail the SFIS Coordinator on victims of domestic abuse before the 

customer completes the imaging process. 

− Check the Domestic Abuse box on the SFIS 15. 

• Refer rescheduling requests to SFIS staff. 

• Discontinue cases when any required family or household member fails 

to comply with SFIS requirements. 

• Refer customers notified of pending discontinuance to SFIS staff when 

they decide to comply. 

• Complete the EW portion of the Resolution process for “hits” or “misses”. 

The SFIS Coordinator will contact the SFIS Help Desk to have old record 

inactivated for victims of domestic abuse and notify the EW when the action 

is completed. 

The Special Investigations Unit do the following in the SFIS process: 

• Investigate “hits” as appropriate to determine if fraud was attempted or 

committed. 

• Compare fingerprint and photo images with images in matched records. 

• Record information in the free form text area of the SFIS hit record. 

• Post disposition codes onto the SFIS record to indicate their findings. 


Statewide Finger Imaging System (SFIS) Requirements 

Introduction This section contains information regarding SFIS requirements, who must 

comply, temporary and permanent exemptions, and actions to take when a 

customer is exempt. 

Who must 

comply: 


Temporary 

exemptions 

from 

requirements 

Victims of 

Domestic 

Abuse 

Fingerprint 

imaging 

The following customers must comply with SFIS requirements in order for 

any Assistance Unit (AU) member to receive CalWORKs: 

• Any parent and/or caretaker relative living in the home of an applicant or 

recipient child including non-needy relatives, minor parents, 

undocumented noncitizen parents, sanctioned, and penalized parents 

• Parents and/or caretaker relatives aided due to the presence of an 

excluded child or an unborn child 

• 18-years-olds aided as children. These persons must SFIS by the RE 

immediately following their 18 th birthdays. 

The following CalWORKs customers are exempt from meeting SFIS 

requirements for no more than 60 days: 

• People with both hands damaged or injured to the extent that finger 

imaging cannot be done. Examples may be persons with both hands in 

casts or bandages. A photo image will be taken if the person is able to 

come to the TAD office. 

• People with medically verified physical conditions that prevent them from 

coming to the TAD office. 

Victims of domestic abuse must comply with the SFIS requirements. The EW 

must verify the customer’s new identity from one of the following items: 

• Letter from the Social Security Administration, 

• Department of Motor Vehicles, or 

• Court order. 

When the image is submitted with the new identity, the SFIS “match” will show 

two records with the same fingerprints, similar photos, and different personal 

information. 

The customer’s index finger is used to complete the fingerprint imaging. If the 

length of the customer index fingernail is excessive and prevents the fingerprint 

from being properly imaged, the SFIS Office Assistant (OA) will request the 

customer to cut the nail to complete an accurate image. The customer may 

refuse to cut the nail. 

Note: SFIS is a condition of eligibility and if the customer refuses the AU will be 

denied/discontinued. 



Statewide Finger Imaging System (SFIS) Requirements, 

Continued 


when the 

customer is 

exempt 

Permanent 

exemptions 

The Eligibility Worker (EW) will do the following when a customer is 

temporarily exempt from SFIS: 

Step Action 

1 Inform the customer he/she is exempt for 60 days from the date 

the exemption was established by the EW or SFIS staff member. 

2 Complete the SFIS 15 and submit it to SFIS clerical staff. 

3 Enter Task to complete SFIS in 60 days. 

4 Narrate the exemption in the case journal. 

5 Send the customer an appointment to complete SFIS 

requirements when the exemption expires or at the end of 60 

days. 

6 Delete the Task when the customer complies with SFIS 

requirements. 

7 Discontinue aid for the entire AU if the customer fails to comply 

with SFIS requirements. 

The following customers are not required to participate in the SFIS process: 

• People missing all ten fingers 

• Refugee Cash Aid (RCA) recipients 

• People receiving only Medi-Cal 


Statewide Finger Imaging System (SFIS) Processing Priority 

Introduction This section provides information about the order information is processed 

and how it is prioritized, including priority processing, normal processing, and 

how the priority is identified. 

Search 

priorities 

overview 

Priority 

processing 

Normal 

processing 

How will clerks 

know the 

priority to use? 

The SFIS prioritizes the order information is processed. There are two 

processing priorities for SFIS: priority and normal. Information is processed 

on a first in, first out basis within each processing priority level. 

The SFIS priority levels result in different maximum search response times 

as described below. Information will flow as needed by Eligibility Workers 

(EWs) and other staff if the priorities are used appropriately. 

The results of priority searches will be returned to the SFIS workstation within 

an average of 15 minutes. This level is used for customers apparently 

eligible for CalWORKs Immediate Need (IN). 

The results of normal searches will be returned to the workstation no later 

than 7:00 a.m. the following day. This level is used for customers for whom 

CalWORKs IN will not be issued. 

Check the box on the SFIS 15 to indicate the search priority when you refer a 

customer to SFIS staff to comply with the SFIS rules. 


Statewide Finger Imaging System (SFIS) Compliance 

Introduction This section includes details of the applicant SFIS compliance procedure, 

and provides information regarding SFIS database compliance codes. 

Compliance 

procedure 

When an applicant customer or additional person is required to comply with 

SFIS requirements, follow the steps in the table below. 

Step Action 

1 Give the family the TEMP 2173 during the initial interview with the applicant 

customer, and explain: 

• SFIS requirements, 

• Failure of any required family or household member results in denial or 

discontinuance of benefits for the entire Assistance Unit (AU), and 

• Compliance is necessary before Immediate Need (IN) may be issued. 

2 Identify all family members who must comply with the SFIS requirements. 

3 Complete the SFIS 15 to refer all people who must comply: 

• Give the customer the original form and instruct them to see the SFIS clerk in 

the lobby after the interview. 

• Keep a copy of the SFIS 15 to flag the case SFIS compliance is still pending. 

4 

Note: For Victims of Domestic Violence follow instruction located in the “How 

SFIS Works” block. 

Do the following based on the customer’s response to the SFIS compliance 

request: 

When … Then … 

All required family member comply Continue with routine case 

with SFIS requirements, 

processing. 

Any required family member fails to Deny/discontinue the CalWORKs for 

comply, 

the entire AU according to existing 

denial/discontinuance rules. 

• Any family member has not • Deny the request for CalWORKs 

complied, and 

IN using current procedures, and 

• The family is otherwise eligible to • Inform the family they may 

CalWORKs Immediate Need (IN), 

and 

request IN again if they wish. 

• SFIS equipment and system are 

functional. 

Not everyone can comply due to • Issue CalWORKs IN, schedule 

SFIS equipment or system failure, SFIS appointment, and set 

temporary exemption; and 

• Deny the CalWORKs according to 

existing rules if any required 

person fails to comply after the 

CalWORKs IN issuance. 


Statewide Finger Imaging System (SFIS) Searches 

Introduction This section provides information about SFIS searches, closed and open 

searches, and describes the types of search results received by workers. 

Search types The SFIS has two search types: closed searches and open searches. The 

type of search determines whether a match of records within the system is 

an indicator of duplicate aid fraud or not. 

Closed search A closed search is the comparison of a newly acquired set of fingerprint 

images against a specific fingerprint image record already in the database. A 

closed search is done when there is an existing Central Index Number (CIN) 

in the SFIS system and an existing fingerprint in the SFIS database. If there 

is an existing CIN but no existing fingerprint, the system will do an open 

search. 

Open search An open search is a fingerprint-to-fingerprint comparison of a pair of newly 

acquired fingerprint images against all records in the database. If there is no 

existing CIN and/or no existing fingerprint in the database, an open search is 

done. 



Statewide Finger Imaging System (SFIS) Searches, Continued 

SFIS search 

results 

All SFIS results will be returned to the SFIS workstation that submitted the 

search. The SFIS workstation will forward copies of all results to the 

assigned Eligibility Worker (EW). 

The four types of results are described below: 

Result Description 

Open search, no hit An open search that results in no fingerprint 

match. The same person is not found on another 

CIN. This is the anticipated result and no further 

action is needed. 

Open search, hit An open search that results in a fingerprint 

match. The new fingerprint for a new person is 

found on another CIN. Resolution, or 

examination of the results for possible fraud or 

agency error, is required. Refer to the SFIS 

Resolution in this Chapter. 

Closed search, hit A closed search that results in a fingerprint 

match. The person’s fingerprints are listed under 

the correct CIN. This is generally an acceptable 

response to a closed search. However, in some 

circumstances the response may indicate the 

customer is on aid in another county. In this 

case, discuss the situation with the customer and 

the other county to resolve the issue. 

Closed search, miss A closed search that results in no fingerprint 

match. The new fingerprint does not match the 

existing fingerprint for that CIN. Resolution is 

required. 


Statewide Finger Imaging System (SFIS) Resolution 

Introduction This section provides information about SFIS Resolutions and how 

determinations are made, case action pending investigation, and Resolution 

codes used by staff and by the Special Investigations Unit (SIU). 

Resolution 

overview 

Resolution 

determination 

Case action 

pending 

investigation 

Resolution is the process of researching the reasons for: 

• An open search hit – a new fingerprint listed with a different CIN or 

• A closed search miss – the new fingerprint does not match the existing 

fingerprint for that CIN 

The Eligibility Worker (EW) is responsible for making the initial determination 

about the questionable response from the SFIS. The Special Investigations 

Unit is responsible for making the final determination regarding possible 

fraud. 

The results of Resolution will be either: 

• An administrative error such as a typographical input error or 

• Possible fraud. 

Any case with an open search hit or a closed search miss must have the 

results of the Resolution transmitted to the SFIS workstation supervisor and 

entered into the SFIS database. 

When SFIS search results with an open search hit or a closed search miss 

are received, determine if there is a reasonable reason for the search result 

or if the search result indicates possible fraud. Some of the steps to take in 

this process include: 

• Checking to see of the response was caused by a typographical error 

during input; 

• Comparing other information in the case record such as other names 

used, social security numbers, birth dates, and so forth; and 

• Asking the customer for an explanation regarding the search results. 

When confronting a customer with search results that indicate possible fraud, 

the customer may choose to withdraw the application or ask to discontinue 

aid, or the customer may contest the SFIS data and claim there is some sort 

of mistake. 

When the customer contests the result of the SFIS search, do not deny or 

discontinue aid until the matter has been investigated by SIU. Further case 

action will depend upon the results of the SIU investigation. 



Statewide Finger Imaging System (SFIS) Resolution, Continued 

The Resolution 

process 

Resolution 

codes 

The EW receives a printed sheet showing SFIS search results, and then 

evaluates those results. 

When there is … Then … 

No open search hit or No resolution action is required. Process the case 

closed search miss, and place printout in case file. 

An open search hit or • Enter the Resolution code from the list on the 

closed search miss, following page on the search result printout. 

• Sign your name and file number at the bottom 

of the printout. 

• Photocopy the coded printout and file it in the 

case with SSN and birth verification. 

• Place the coded printout in the designated 

SFIS workstation supervisor Resolution bin. 

The Resolution codes used by staff, and their descriptions, are listed below: 

Codes Description 

01 Open search: fingerprinted wrong person on CIN – the CIN 

actually belongs to two different individuals. For instance, a 

husband was fingerprinted on both his and his wife’s CIN. 

02 Open search: file clearance error – a mistake was made by the 

person doing the file clearance so that the fingerprints were 

attached to the wrong CIN. 

03 Open search: correctly has two CINs – although the customer 

does have two records on file, this is an appropriate situation 

such as minor consent. 

04 Closed search: fingerprinted the wrong person on the CIN – for 

example, the wrong person reported to the fingerprint 

workstation when the customer name was called. 

05 Closed search: file clearance error on file CIN – a different 

person’s fingerprints are incorrectly attached to the CIN. 

06 Closed search: file clearance error on applicant CIN – the 

person doing the file clearance chose the wrong CIN and 

captured fingerprints using the incorrect CIN. 

SIU codes SIU investigators will post the code to indicate the disposition of the 

investigation onto the hit record to indicate the result of the investigation. 

The codes used by SIU are: 

• NF: no fraud found 

• FA: fraud found, the customer was aided 

• FN: fraud found, the customer was not aided 

• PI: pending investigation 

• UP: under prosecution 




CHAPTER 2 

Deprivation 

Overview ........................................................................................................................2-1 

Deprivation: Overview ....................................................................................................2-2 

Deprivation: General Information ...................................................................................2-3 

Death Deprivation ..........................................................................................................2-4 

Incapacity Deprivation....................................................................................................2-5 

Unemployment Deprivation............................................................................................2-8 

Absence Deprivation ....................................................................................................2-11 

Absence Deprivation for Unborns and Child Support Requirements ...........................2-14 

Joint Custody ...............................................................................................................2-15 

Child Support Requirements: Overview .......................................................................2-16 

Child Support Requirements ........................................................................................2-17 

Child Support Good Cause Procedures.......................................................................2-20 

Child Support Non-Cooperation ...................................................................................2-23 

Child Support Voluntary Declaration of Paternity.........................................................2-27 

Child Support Unmarried Father (UMF) Requirements................................................2-29 

Child Support Services Referral Procedures ...............................................................2-31 


Overview 

Deprivation 

Overview This Chapter contains information regarding Deprivation and Child Support 

requirements. 

References The following references are applicable to in information under this topic: 

• ACL #03-18 

• ACIN #I-54-03, I-84-03, I-09-04, I-10-04, I-29-04, and I-44-04 

• EAS 41-400 and 82-500 

In this chapter This chapter contains the following topics: 


Deprivation 2-2 

Child Support Requirements 2-16 

CWPHB #4605 (04/11) DEPRIVATION 2-1

Overview 

Deprivation 

Introduction Deprivation of parental support and care is a specific eligibility factor required 

for CalWORKs. A child's deprivation is based on the status of his/her natural 

or adoptive parent(s), whether or not they are married. This section contains 

information regarding what constitutes deprivation and the requirements. 

References The following references are applicable to the information under this topic: 

• ACL #03-18 


• EAS 41-400, 41-401, 41-403, 41-405, 41-420, 41-430, 41-440, and 

41-450 

In this section This section contains the following topics: 


Deprivation: General Information 2-3 

Death Deprivation 2-4 

Incapacity Deprivation 2-5 

Unemployment Deprivation 2-8 

Absence Deprivation 2-11 

Absence Deprivation for Unborns and Child Support 

Requirements 

2-14 

Joint Custody 2-15 


Deprivation: General Information 

Introduction This section contains general information regarding deprivation including the 

types of deprivation and the rules. 

Types of 

deprivation 

A child is considered deprived of parental support or care if any of the 

following deprivation factors are met: 

• Death - Either parent is deceased. 

• Incapacity - Either parent in the home is physically or mentally 

incapacitated for at least 30 days. 

• Unemployment - The principal earner is unemployed or employed less 

than 100 hours per month at application/determination of deprivation. 

• Absence - Either parent is continually absent from the home in which the 

child is living. 

For details on requirements/documentation, see specific deprivation sections 

in this chapter. 

Rules The rules for deprivation are: 

1. If a child is deprived for more than one reason, eligibility can be 

established on any basis; however, unemployment deprivation should be 

the last choice. 

2. Deprivation is based on the person who is considered to be the legal 

parent unless rebutted by the mother, father or a court order. 

3. Deprivation of an adopted child is based on the status of the adoptive 

parent(s), not the natural parents. 

Evaluating 

deprivation 

Under Quarterly Reporting, deprivation is evaluated once per quarter based 

on the Data Month information. Any change in deprivation is effective the 

first of the QR Payment Quarter following the Data Month change. 


Death Deprivation 

Introduction This section explains Death deprivation. The death of either parent of a child 

is considered a deprivation. The documentation needed to verify a parent’s 

death is listed on this page. 

Explanation Death deprivation exists if either parent of a child is deceased. 

Documentation Any of the following are acceptable as evidence of the death of a parent: 

• A copy of the death certificate. 

• Award letter from the Social Security Administration based on the death 

of a parent. 

• Newspaper account of the person's death. 

• Other reliable evidence. 

Note: If no acceptable documentation of death exists, the parent is 

considered an absent parent and is subject to the child support requirements 

(see Absence Deprivation in this chapter). 


Incapacity Deprivation 

Introduction This section explains Incapacity deprivation. Deprivation exists when the 

parent of an eligible child has a physical or mental illness, defect or 

impairment that substantially reduces or eliminates the parent's ability to 

support or care for the child, for at least 30 days. 

Incapacity 

criteria 

Incapacity 

deprivation 

For Incapacity deprivation to exist, the incapacity must meet one of the 

following criteria: 

• Prevents the parent from working full-time at a job in which he/she was 

customarily employed and from working full-time on another job for which 

he/she has education, training, or experience, or which can be learned by 

on-the-job training. 

• Is the reason employers refuse to employ him/her for work he/she could 

do. This includes behavioral disorders that interfere with securing and 

maintaining employment. 

• Prevents the parent from accomplishing as much on a job as a regular 

employee and is the reason the parent is paid on a reduced basis even 

though working full-time. 

• Qualifies the parent for a job that is rehabilitative, therapeutic, or in a 

sheltered workshop not considered to be a full-time job. 

• Substantially reduces or eliminates the parent's ability to care for the 

child. 

If deprivation at the time of the original application was Incapacity, and that 

deprivation no longer exists, a determination of other deprivation must be 

made. 



Incapacity Deprivation, Continued 

Documentation Any of the following are acceptable evidence for establishing incapacity. See 

the documentation: specifics block for details. 

• CW 61 medical report or written medical statement 

• Benefit Award letter for SDI, DIB, Worker’s Compensation, or SSI/SSP 

Documentation: 

specific criteria 

CW 61 or written 

medical 

statement 

Re-evaluation 

of incapacity 

Referral to 

Department of 

Rehabilitation 

The CW 61 or written medical statement from a physician, licensed or 

certified psychologist, or by an authorized member of his or her staff with 

access to the patient’s medical records that provides information sufficient 

to substantiate the determination of incapacity and includes the following: 

• A diagnosis of the parent’s condition and explanation of the extent to 

which it prevents him or her from engaging in employment or why it 

reduces substantially, or eliminates the parent’s ability to support or care 

for the child. 

• The expected duration of the condition, and the date of the next 

scheduled examination or appointment. 

• The doctor’s name, address, and phone number. 

Where a written statement cannot be obtained without delay, for reasons 

beyond control of the customer, a verbal statement from the physician, 

licensed or certified psychologist, or an authorized staff member with access 

to the customer’s medical records verifying incapacity as specified above 

may be accepted pending written verification up to a maximum of 60 days. 

If obtained verbally, documentation in the case journal must include all the 

information above and: 

• The date the verification was received, 

• The name of the person who supplied the information, and 

• The name of the Eligibility Worker (EW) or other staff member who 

obtained the information. 

The customer’s condition is re-evaluated at each of the following times: 

• When the condition is expected to end. 

• When there is reason to believe the condition has changed. 

• At the yearly re-evaluation (RE), only if the condition is acute/permanent 

or expected to last more than a year. 

When determining Incapacity deprivation, the Eligibility Worker will refer any 

customer exempt from participation with Welfare-to-Work due to incapacity to 

the Department of Rehabilitation via the DPSS 282D. This referral is not a 

condition of eligibility. 



Incapacity Deprivation, Continued 

Documentation: 

specific criteria 

benefit award 

letters 

It is not uncommon for Social Security numbers to be listed twice on a SSA 

award letter or printout with differing codes at the end of each. These 

codes are strictly beneficiary or recipient ID codes issued by the Social 

Security Administration and indicate what type of benefit was applied for, 

not necessarily the type of benefit currently being received. 

The most common codes in these instances are: 

• AI – Aged Individual 

• AS – Aged Spouse 

• BI – Blind Individual 

• BS – Blind Spouse 

• BC – Blind Child 

• DI – Disabled Individual 

• DS – Disabled Spouse 

• DC – Disabled Child 

These codes represent claims for Supplemental Security Income (SSI), but 

again are not a definitive indicator of current receipt of these benefits. 

SSA award letters with the above codes following the customer’s Social 

Security number are not necessarily verification of disability and further 

verification is required. 


Unemployment Deprivation 

Introduction This section explains Unemployment deprivation. Unemployment deprivation 

exists when both parents are in the home and the Principal Earner (PE) is 

unemployed. This deprivation should be used only if the child is not eligible 

under another deprivation factor. 

Definitions 

To establish deprivation based on unemployment, the PE must be working 

less than 100 hours per month. Once Unemployment deprivation has been 

established, the 100-hour work rule does not apply. 

Unemployment deprivation is also known as U-parent deprivation. 

Employment - The hours a customer spends providing a service or product, 

whether the customer is an employee or self-employed. Any hours spent 

working to acquire earned income, whether the customer receives the 

income or not, is considered toward the 100 hour limit (e.g. hours spent 

distributing catalogues, delivering products, making phone calls or 

completing paperwork related to a business). 

Four-week period – A period of 28 consecutive days. It does not 

specifically relate to four calendar weeks (Sunday through Saturday). 

Full-Time Employed - Working 100 hours or more per month, or 

participating 100 hours or more per month in one of the following: 

On-the-job training - (JESD/OJT) 

Public Service Employment - (JESD/PSE) 

Welfare-to-Work (WTW) Experience 

Note: If a customer is working and participating in one or more of the above 

training programs, the hours are added together to determine full time 

employment. 

Principal Earner (PE) – The parent who earned the greater amount of 

income in the 24-month period preceding the latest application or request for 

CalWORKs. If both parents earned an identical amount, the Eligibility Worker 

(EW) in consultation with the parents, shall designate which parent is the PE 

and who: 

Is not employed, or 

Is employed fewer than 100 hours per month, or 

Is employed 100 hours or more in a month and work is intermittent and 

temporary (Employment was less than 100 hours in the two prior months 

and expected to be less than 100 hours in the following month). 

Week – A period of seven consecutive days. It does not specifically relate to 

a calendar week (Sunday through Saturday). 



Unemployment Deprivation, Continued 

When to 

establish 

unemployment 

deprivation 

Unemployment deprivation will be determined at the following times: 

• Intake 

• When the absent parent returns home 

• When deprivation changes from incapacity to unemployment and 

CalWORKs unemployment eligibility was not established at original 

application 

Requirements In order to establish Unemployment deprivation an applicant customer must 

meet all of the following requirements: 

• The PE must meet the definition of unemployed parent. 

• The PE must have been unemployed for at least four weeks (28 days) 

prior to the beginning date of aid. The four-week (28 day) period shall be 

adjusted daily to determine the four-week (28 day) period in which the 

applicant principal earner worked less than 100 hours. 

• The PE must apply for and accept any Unemployment Insurance Benefits 

(UIB) to which entitled. A PE who has not worked in employment covered 

by UIB Compensation Law is not apparently eligible to UIB, and is not 

required to apply for UIB to establish Unemployment deprivation. 

• The PE cannot be unemployed as a result of participation in a strike. An 

applicant/recipient customer is considered to be participating in a strike if 

he/she voluntarily stopped or slowed down work or interrupted the 

business activity of the employer. This includes stoppage by expiration 

of a collective bargaining agreement. 

UIB referrals Refer to Income Chapter of this Handbook, in the UIB section, for more 

information regarding who must apply and who is not required to apply for 

UIB. 

TAD 282 U/FFP Completion of the TAD 282 U/FFP, Unemployment Deprivation Worksheet, is 

required to determine Unemployment deprivation. C-IV does not currently 

save the calculation of the PE, nor does C-IV record the information 

regarding whether or not the PE: 

• Is employed or unemployed, 

• Has applied for UIB, and 

• Is participating in a strike. 



Unemployment Deprivation, Continued 


applicant hours 

An applicant PE is laid off April 8 th and last worked on April 7 th . The PE 

worked 40 hours per week in 03/2005 and 04/2005. The family applied for 

CalWORKs on April 13 th . The determination of the beginning date of aid 

(BDA) is illustrated below: 

Sun Mon Tues 

MARCH 

Wed Thurs Fri Sat 

1 2 3 4 5 6 7 

8 8 8 8 8 

8 9 10 11 12 13 14 

8 8 8 8 8 

15 16 17 18 19 20 21 

8 8 8 8 8 

22 23 24 25 26 27 28 

29 30 31 

8 8 8 8 8 

8 8 

Sun Mon Tues 

APRIL 

Wed Thurs Fri Sat 

1 2 3 4 

8 8 8 

5 6 7 8 9 10 11 

8 8 Laid off 

12 13 14 15 16 17 18 

Applies BDA 

19 20 21 22 23 24 25 

26 27 28 29 30 

The original four-week period is March 16 th through April 12 th . Since the PE 

work period worked 136 hours during this four-week period, a new four-week 

period needs to be identified. 

March 17 th through April 13 th = 128 hours 




March 21 st through April 17 th = 96 hours 

The qualifying four-week period in which the PE worked less than 100 hours 

is March 21 st through April 17 th . The BDA for this family is April 18 th , if 



Absence Deprivation 

Introduction This section contains information regarding Absence deprivation information, 

and examples of continued and non-continued absence. 

Definitions The following are definitions related to absence deprivation. 

Absence Deprivation - Either parent is continually absent from the home in 

which the child is living. 

Absent Parent - The natural or adoptive parent who is physically away from 

the home in which his or her child is living and meets the definition of 

continued absence. 

Continued Absence - The parent is physically away from the home and the 

nature of the absence results in an interruption or termination of the parent 

functioning as a provider of maintenance, physical care or guidance of the 

child. 

Alternatively Sentenced Parent - A parent who is a convicted offender that 

is permitted to live at home while serving a court imposed sentence that 

precludes him from providing support through paid employment. 

Department of Child Support Services (DCSS) - The agency responsible 

for assigning and collecting child support payments. 



Absence Deprivation, Continued 


continued 

absence 


non-continued 

absence 


Support 

Questionnaire 

The following are examples of continued absence: 

• Parents who are not married to each other and have not maintained a 

home together. 

• An alternatively sentenced parent (ASP). 

• A dissolution, annulment or legal separation action has been filed. 

• The absent parent is incarcerated, committed to an institution, deported 

or has voluntarily left the country because of threat of or the knowledge 

that he is subject to deportation. 

• There is a court injunction forbidding the absent parent from visiting the 

spouse or children. 

• The remaining parent has signed the Notice and Agreement for Child, 

Spousal, and Medical Support (CW 2.1 NA) and declared on the 

Statement of Facts that the other parent has left the family and continued 

absence exists. 

• Both parents are physically absent from the home and/or their 

whereabouts are unknown. 

• The child was adopted by a single parent. 

• The child lives for alternate periods with each of his/her parents who are 

separated or divorced. 

The following are examples of non-continued absence: 

• Absent on a temporary basis such as visits, trips, or short assignments 

undertaken in connection with employment. 

• Absent due to incarceration with release scheduled for less than one 

month. 

• Absent for the sole reason of being on active duty in the military service. 

• Absent due to seeking employment. 

When completing the Support Questionnaire (CW 2.1Q), the Eligibility 

Worker (EW) will choose “pending” for the Paternity Status for each child. 

EWs will not establish paternity, DCSS staff will. 

Once DCSS staff have established the child’s paternity, they will notify the 

EW. At that time, the Paternity Status on the Support Questionnaire will be 

updated. 



Absence Deprivation, Continued 

Determining 

Absence 

Deprivation 

Follow the steps below to determine Absence deprivation: 

Step Action 

1 Review the Statement of Facts to determine if a parent is absent. 

2 Determine if the parent meets the definition of absent parent. 

• If Yes: Continue to Step 3. 

• If No: Determine if another deprivation exists. 

3 Complete the forms required to establish Absence deprivation. 

• Support Questionnaire (CW 2.1Q) in C-IV 

• Notice and Agreement for Child, Spousal and Medical Support 

(CW 2.1NA). 

Note 1: If the applicant customer is a Pregnant Woman Only (PWO), for 

Step 3, complete the Notice and Agreement for Child, Spousal and Medical 

Support (CW 2.1NA) only. Do not complete the Support Questionnaire 

(CW 2.1Q) or the Support Questionnaire page in C-IV until the unborn is 

born. See the Absence Deprivation and PWOs section in this Chapter for 

more information. 

Note 2: If the child is an unborn, unless the applicant customer is a PWO, 

do not complete either the Support Questionnaire (CW 2.1Q) or the Notice 

and Agreement for Child, Spousal and Medical Support (CW 2.1NA) forms 

until the unborn is born. 


Absence Deprivation for Unborns and Child Support 

Requirements 

Introduction This section contains information regarding the Child Support requirements 

when the potentially eligible child is an unborn. Also included are the 

Absence Deprivation requirements for Pregnant Woman Only (PWO) 

Assistance Units (AUs). 

Child Support 

forms and 

unborns 

Support 

Questionnaire 

and unborns 

Absence 

Deprivation and 

PWOs 

If the child is an unborn, unless the applicant customer is a PWO, do not 

complete the Support Questionnaire (CW 2.1Q) or the Notice and Agreement 

for Child, Spousal and Medical Support (CW 2.1NA) forms for the unborn 

until the unborn is born. 

The Support Questionnaire (CW 2.1Q) is not a required form for an unborn. 

Do not complete the Support Questionnaire page in C-IV for the unborn’s 

absent or unmarried father until the unborn is born. 

When the CalWORKs applicant customer is a PWO and deprivation is 

Absence, complete and image the Notice and Agreement for Child, Spousal 

and Medical Support (CW 2.1NA) form only. Do not complete the Support 

Questionnaire (CW 2.1Q) in C-IV until the unborn is born. 

If deprivation is not Absence, do not complete the Child Support forms. The 

exception is when the unmarried father of the unborn is in the home. In this 

case, complete the Notice and Agreement and Support Questionnaire in C-IV 

after the unborn is born. 


Joint Custody 

Introduction Joint Custody exists when a court order designates that a child lives with 

each parent for specified periods of time. For CalWORKs purposes the 

caretaker relative will be decided on a case-by-case basis. 

Caretaker 

relative 

When parents share custody of a child the Eligibility Worker must determine 

which parent is the caretaker relative. Additional information regarding 

determining the caretaker relative is such situation can be found in the Care 

and Control of a Child section of the AU/Responsible Persons Chapter of this 

Handbook. 


Overview 

Child Support Requirements 

Introduction The California Child Support Enforcement Program was established for the 

purpose of identifying and locating absent parents, establishing paternity and 

enforcing the child and spousal support obligation. Certain customers 

applying for CalWORKs must comply with this program in order to be eligible 

for aid. This section includes the requirements. 


• ACL #03-18 


• EAS 82-502, 82-504, 82-506, 82-508, 82-510, 82-512, and 82-514 



Child Support Requirements 2-17 

Child Support Good Cause Procedures 2-20 

Child Support Non-Cooperation 2-23 

Child Support Voluntary Declaration of Paternity 2-27 

Child Support Unmarried Father (UMF) Requirements 2-29 

Child Support Services Referral Procedures 2-31 


Child Support Requirements 

Introduction The California Child Support Enforcement Program was established for the 

purpose of identifying and locating absent parents, establishing paternity and 

enforcing the child and spousal support obligation. Certain customers 

applying for CalWORKs must comply with this program in order to be eligible 

for aid. This section includes the requirements. 

Who must 

comply 

Child Support 

requirements 

Minor parent 

requirements 

Customers applying on behalf of a child must agree to cooperate with the 

Child Support Enforcement Program as a condition of CalWORKs eligibility. 

This includes: 

• The parent or caretaker with whom the child is living 

• The Unmarried Father (UMF) if included in the Assistance Unit (AU), see 

UMF Requirements in this Chapter 

• The minor parent if not living with his/her parent(s) 

Each customer listed above must comply with Child Support requirements by 

doing all of the following for each absent parent/aided unmarried father: 

• Signing and dating the Notice and Agreement for Child, Spousal and 

Medical Support (CW 2.1NA). 

• Providing all the information necessary to complete the Support 

Questionnaire (CW 2.1Q) in C-IV, unless the eligible children or 

potentially eligible child is an unborn. 

• Appearing at the Department of Child Support Services (DCSS) office 

when asked. 

• Providing the DCSS with verbal, written or documentary evidence for 

securing support. 

• Appearing as a witness at court hearings or proceedings. 

• Turning over direct child support payments to DCSS. 

The chart below describes for whom a minor parent must complete Child 

Support forms. 

If the minor parent…. Then Child Support forms… 

Lives with both of his/her parents, 

Is married and living with his/her 

spouse, 

Does not live with both or any of 

his/her parent(s), 

Is married and not living with his/her 

spouse, 

Must be completed for absent 

parent(s) of his/her child(ren) only. 

Must be completed for absent 

parent(s) of: 

• The minor parent, and 

• The minor parent’s child(ren). 

Note: If the potentially eligible child is an unborn, do not complete the 

Support Questionnaire (CW 2.1Q) in C-IV until the unborn is born. 



Child Support Requirements, Continued 

Minor parent 

referrals 

Unknown 

absent parent 

Support 

Questionnaire 

applicant 


Support 

Questionnaire 

Child Support 

forms 

completion 

When completing Child Support forms for an absent parent of a minor parent, 

and the minor parent is in his/her own case, the paper CW 2.1Q and 

CW 2.1NA must: 

• Be signed by the minor parent, 

• Be imaged into the C-IV system, but the information will not be entered 

into the C-IV Support Questionnaire, and 

• Sent to DCSS via inter-office mail. 

The chart below refers to actions DCSS will take when the absent parent in a 

Support Questionnaire is believed to be unknown. 

If the… Then, DCSS will… 

Absent parent is 

unknown, usually in 

Foster Care or Caretaker 

Relative cases, 

Customer only gives the 

absent parent’s name, 

with no other information, 

• Research their database to obtain missing 

information 

• Set a task for the EW to update the Support 

Questionnaire if the information is found 

• Do further research to obtain missing 

information 

• Change the status to unknown and let the 

EW know of the change in status if no 

further information is found 

The correct applicant must be selected for the Support Questionnaire in C-IV. 

It must either be the parent or caretaker relative of the child(ren) (if the parent 

of the child is a minor parent, select the minor parent). 

Note: The applicant on the Support Questionnaire cannot be the absent 

parent. Refer to UMF Support Questionnaire completion block in this chapter 

when both parents are in the home and are not married. 

When completing the Support Questionnaire (CW 2.1Q) in C-IV, the Eligibility 

Worker (EW) will choose “pending” for the Paternity Status for each child. 

EWs will not establish paternity, DCSS staff will. 

In some cases, the Child Support Officer (CSO) will have the parent 

complete an additional CW 2.1Q. In such cases, the CSO will forward the 

case copy of the CW 2.1Q to the Eligibility Worker (EW). 



Child Support Requirements, Continued 

DCSS 

determination 

Once DCSS staff has made the paternity determination, the Child Support 

Officer (CSO) will notify the EW. The EW will then follow the chart below. 

If DCSS… Then … 

Establishes EW updates the Parentage Status on the Support 

paternity, Questionnaire accordingly. 

Excludes the • DCSS completes a new CW 2.1Q and: 

absent parent as − Sends the form to the EW for case information 

the father, 

− Sets a follow up Task in C-IV for the EW 

• EW reviews CW 2.1Q information and: 

− Enters “Not Applicable” as the Parentage 

Status in the C-IV Support Questionnaire for 

the excluded father 

− Creates a new Support Questionnaire in C-IV 

for the new CW 2.1Q 

− Images the new CW 2.1Q in C-IV 

− Journals actions taken 


Child Support Good Cause Procedures 

Introduction This section contains information regarding Good Gause determination and 

procedures. 

Good Cause 

determination 

Good Cause 

interface 

information 

The applicant/recipient customer may claim Good Cause for not cooperating 

with the Child Support program if it is not in the best interest of the child. 

Good Cause may be claimed when: 

Cooperation with the Department of Child Support Services (DCSS) will 

result in serious: 

– Physical harm to the child, parent or caretaker relative, 

– Emotional harm to the child, parent or caretaker relative, and/or 

One of the following circumstances exist: 

– The child was conceived as a result of incest or rape, 

– Adoption proceedings are pending a court hearing, 

– The applicant/recipient customer is being assisted by a public or 

private social agency to resolve the issue of whether to keep the child 

or to relinquish the child for adoption, or 

– Any other reason that would be contrary to the best interest of the 

child. 

When a customer claims good cause for not cooperating with the Child 

Support program, the Eligibility Worker (EW) must create a Good Cause 

claim in C-IV. 

If the Good Cause claim 

is created with a 

Pending status… 

Before a referral has 

been sent to DCSS, 

After a referral has been 

sent to DCSS, 

Then C-IV will… 

Not send the information entered into the 

Support Questionnaire to DCSS. 

Note: When the Good Cause status changes 

to any other status besides Pending or 

Granted, the referral will be sent to DCSS. 

Send an update to DCSS on the absent 

parent’s record indicating Good Cause 

claimed, thereby suspending actions on the 

case. 

Note: Closing, denying, or withdrawing a 

Good Cause claim triggers C-IV to resume 

sending case information to DCSS. 

Note: Although Good Cause is claimed, the customer is still responsible for 

providing as much information as possible to complete the Support 

Questionnaire in C-IV. See the “Customer refuses to provide information for 

Support Questionnaire” block in this section of the handbook for required 

action when the customer refuses to provide the information. 



Child Support Good Cause Procedures, Continued 

Good Cause 

procedures 

The table below describes the process to follow when a customer claims 

Good Cause. 


1 Customer: 

Completes the CW 2.1NA checking the Good Cause box; 

Provides the EW with the Support Questionnaire (CW 2.1Q) 

information for input into C-IV, and 

Completes the Good Cause form (CW 51). 

2 EW: 

Creates a Good Cause claim in C-IV (see “Creating a Good 

Cause claim in C-IV” block of this handbook section), and 

leaves it in Pending Status, 

Images into C-IV the signed: 

– CW 2.1Q , 

– CW 2.1NA, and 

– CW 51. 


Note: EWs can direct any questions to Elaine Knick via email. 

3 Program Integrity Division (PID): 

Pulls a report of all Good Cause claims in C-IV, 

Assigns Good Cause claim to a PID worker, 

Reviews the Good Cause claim, 

Makes the final Good Cause determination, 

Updates the C-IV Good Cause screens, and 

Journals findings. 

If Good Cause… Then C-IV will… 

Exists, Not send the Support Questionnaire 

information to DCSS via the California Child 

Support Automation System (CCSAS) 

interface. 

Does not exist, Send the Support Questionnaire information 

to DCSS via the CCSAS interface. 




Customer 

refuses to 

provide 

information for 

Support 

Questionnaire 

Good Cause 

denial 

Claiming Good 

Cause after 

Noncooperation 

The customer is required to provide information to complete the Support 

Questionnaire (CW 2.1Q) in C-IV when claiming Good Cause; however, if the 

customer refuses to provide the information, the EW will add “Refused to 

state” as the parent name on the Support Questionnaire. 

When the Good Cause claim is granted, no further action on the Support 

Questionnaire is required. However, if the Good Cause Claim is denied, the 

PID Good Cause worker will do the following: 

Step Action 

1 Request the customer complete, sign and return the CW 2.1Q, and 

If the CW 2.1Q is… Then PID will… 

Returned, Image the CW 2.1Q in C-IV, and 

Edit the Support Questionnaire in 

C-IV. 

Not Returned, Set a Task with: 

– Type: Sanction/Penalty (This 

is a Priority Level 1 Task type in 

the Process Approach to Case 

Excellence (PACE)), 

– Long Description: CW 2.1 Q 

was requested on xx/xx/xx and 

due xx/xx/xx. Customer failed to 

return CW 2.1Q, take action to 

discontinue parent(s), and 

– Due date: Three (3) business 

days from the date the Task is 

set. 

E-mail the EW/Master Assignment 

Queue (MAQ) to apply a Child 

Support non-cooperation penalty. 

Note: Task Type, Sanction/Penalty, 

is a Priority Level One Task and 

requires immediate action. 

2 Deny the Good Cause claim in C-IV. 

If PID denies the Good Cause claim, the customer will be given another 

opportunity to cooperate with DCSS before applying the non-cooperation 

penalty. 

When a customer who is currently penalized for non-cooperation claims 

Good Cause the DCSS non-cooperation penalty will be removed effective 

the first of the month in which the customer claimed Good Cause. If the 

claim is subsequently denied, the non-cooperation penalty will continue 

effective the first of the month following denial of Good Cause. 




Creating a 

Good Cause 

claim in C-IV 

When a customer claims good cause for failure to cooperate with Child 

Support requirements, action must be taken in C-IV to prevent information 

from being sent to DCSS. 

Once all known information is entered into the Support Questionnaire and “I 

claim good cause and refuse to cooperate at this time” has been 

selected from the Certification and Agreement drop down menu, the EW 

must click on Save and complete the following actions: 

Step Action 

1 Click Edit on the Support Questionnaire just saved. 

2 Click on the Claim Good Cause button. (The Good Cause Detail 

page appears.) 

3 Select the appropriate Claim Reason (box is multi-select). 

Note: Check “Other” if CW 51 is pending and claim reason is not 

yet known. 

4 Enter the date Good Cause was claimed in the Claim Date field. 

5 Click on the Save and Return button. (The Good Cause List page 

appears showing the Pending status.) 

6 Click the Close button. 

Tasks Occasionally, a Task Type of Child Support Non Co-op is generated when 

the customer may have claimed Good Cause with DCSS. The Long 

Description will state the customer “Claimed Good Cause at IVD. Review 

eligibility for Good Cause”. The EW must contact the Good Cause worker in 

PID to verify eligibility for Good Cause. 

Note: The Long Description for the Child Support Non Co-op Tasks must 

be reviewed to prevent imposing erroneous penalties against the customer. 

CWPHB #4635 (08/12) DEPRIVATION 2-22.1

Child Support Non-Cooperation 

Introduction This section contains information regarding: 


penalties 

Non-coop and 

penalties 

Parent or 

needy 

caretaker 

relative 

• Application, 

• Penalties, and 

• Subsequent cooperation. 

There are three types of penalties for Department of Child Support 

Services (DCSS) Non-cooperation: 

• Ineligibility for CalWORKs (parent or needy caretaker relative), 

• 25% financial penalty and ineligibility to Medi-Cal, and 

• Ineligibility to Medi-Cal only. 

The following table lists the types of non-cooperation and the corresponding 

penalties (see “DCSS penalties” block for more information). 

Who Type of non-cooperation Penalty Action 

Non-needy 

caretaker 

relative 

Refuses to assign support 

rights 

• Refuses to complete 

DCSS forms 

• Fails to cooperate 

with paternity 

establishment, or 

• Child support 

enforcement process 

Does not cooperate in 

identifying and providing 

relevant information about 

any third party who may 

be liable for medical care 

or services 

Fails to cooperate by: 

• Refusing to assign 

support rights, 

• Complete forms, or 

• Cooperate in child 

support enforcement 

or third party medical 

services 

Ineligible to: 

• CalWORKs, and 

• Medi-Cal 

• The Assistance Unit’s 

(AU’s) final calculated 

grant is reduced by 

25% 

• Parent/caretaker 

relative is ineligible to 

Medi-Cal 

• 

Note: If parent or 

caretaker relative 

becomes pregnant, the 

Medi-Cal must be restored 

Customer is ineligible to 

Medi-Cal only 

Deny or discontinue the 

customer from the 

following programs: 

• CalWORKs, and 

• Cash-based Medi-Cal 

• Reduce AU’s final 

calculated grant by 

25% 

• Deny/discontinue 

parent/caretaker 

relative’s cash-based 

Medi-Cal 

• DCSS will notify the 

Eligibility Worker 

(EW), and 

• EW will discontinue 

the customer from 

cash-based Medi-Cal. 

No penalty assigned No action necessary. 



Child Support Non-Cooperation, Continued 


Medi-Cal 

Removing the 

970 restriction 

code 

DCSS 25% 

penalty 

When the 25% non-cooperation penalty is applied, the parent or caretaker 

relative is ineligible to Medi-Cal. If the parent or caretaker relative becomes 

pregnant, eligibility for Medi-Cal must be restored by removing the restriction 

on the Medi-Cal in MEDS. The EW will contact the MEDS Office Assistant 

(OA) and request the restriction be removed. The pregnant parent or 

caretaker relative is eligible to full scope Medi-Cal until 60 days postpartum. 

The EW will set a task for the restriction to be reapplied if the penalty is still in 

effect after the 60 days postpartum period. 

Whenever a Non-Compliance Detail page is completed in C-IV for any 

program (MC, CalWORKs, etc.) for Child Support, C-IV sends an EW 20 

transaction to MEDS that includes a 970 restriction code. 

When the 970 restriction code no longer applies and needs to be removed in 

MEDS, the EW will end date the non-compliance record (do not Remove, 

only Edit the existing record) prior to running Eligibility Determination 

Benefit Calculation (EDBC) in C-IV. 

If EDBC was completed prior to end dating the record or the non-compliance 

record was removed, the EW will need to submit a MEDS Update and Medi- 

Cal Card Request (TAD 110P) to the MEDS Office Assistant (OA) to have 

the restriction code removed from MEDS. 

The DCSS penalty of 25% can be applied more than one time to the same 

Assistance Unit (AU). These are the cases where there is more than one 

customer who must cooperate with DCSS, and he/she fails to do so. The 

EW will apply the 25% penalty for each individual who fails to cooperate. 

Example In cases where there is an aided senior parent and an aided minor parent, 

both with children who have absence deprivation, each parent must 

cooperate with DCSS. When both fail to cooperate, then a 25% penalty is 

applied for the senior parent and 25% penalty is applied for the minor parent. 

This must be applied for each penalized person. 

Subsequent 

cooperation 

When a parent or needy caretaker relative cooperates with DCSS or assigns 

rights as required, the non-cooperation penalty is removed effective the first 

of the month in which cooperation occurs. 




Subsequent 

application 

Customer noncooperation 

process 

If an applicant customer is denied or a recipient customer is penalized 25% 

due to non-cooperation with DCSS and the entire case is subsequently 

discontinued, use the following chart to determine if the penalty continues if 

the customer reapplies. 

If the application is… Then… 

Restoration, or reapplication, The customer is considered to have 

cooperated with DCSS when the Child 

Support Questionnaire is completed and 

the customer indicates his/her agreement 

on the CW 2.1 NA and signs the form. 

End date the penalty prior to the 

application month. 

Note: If the customer fails to cooperate, 

DCSS will notify the worker and the 

penalty will be reinstated. 

Rescind of the discontinuance, The penalty will continue. 

The following chart describes the process when a customer refuses to 

cooperate. 


1 Customer has not cooperated with DCSS. 

2 DCSS notifies the EW, via a Task, of the non-cooperation. 

3 EW: 

Sends a timely Notice of Action (NOA) to notify the customer a 

penalty will be applied. 

Takes the appropriate action based on the “Non-Cooperation 

and corresponding penalties” chart. 




Child Support 

Offices 

TAD offices will refer to the following Child Support Offices: 

CHILD SUPPORT OFFICE TAD OFFICES SERVED 

Loma Linda CSS 

10417 Mountain View 

Loma Linda, CA 92354 

Ontario CSS 

191 N. Vineyard Ave. 

Ontario, CA 91764-4497 

Victorville CSS 

15456 W. Sage St. 


DCSS contacts The following chart is a list of DCSS contacts: 

San Bernardino, Del Rosa, Fontana, 

Yucca Valley, Colton 

Ontario, Rancho Cucamonga 

Victorville, Hesperia, Adelanto, 

Barstow, Needles 

DCSS Officer Phone # Absent Parent’s Last Name 

CASES NOT YET OPEN 

Davis, Brad (909) 478-6937 Aaa – Gonzalez, Martz 

Antillon, Sophie (909) 478-7180 Gonzalez, Maru – Owens, Jaz 

Garcia, Veronica (909) 478-6934 Owens, JB - Zzz 

CASES WITH NO ORDERS 

Casto, Terese (909) 478-6052 Aaa - Hayezz 

Beasley, Chris (909) 478-7235 Hayf - Pelzzz 

Camacho, Brandon (909) 478-7240 Pem - Zzz 

CASES WITH ORDERS 

Powell, Sheryl (909) 478-6026 Aaa – Burkm, Z 

Bedwell, Patty (909) 478-6016 Burkn, A – Diaz, Q 

Wrzalinski, Vince (909) 478-7366 Diaz, R – Gonzalez, Mart 

Flores, Diana (909) 478-7346 Gonzalez, Maru – Mb, Z 

Misener, Sherri (909) 478-7335 Mcco, A – Profz, Z 

Karlson, Clay (909) 478-7346 Prog A, - Stamz 

Boyd, Marnyce (909) 478-7335 

ONTARIO 

Stampq - ZZZ 

Tran, Janeth (909) 945-4218 

Thornton, Kathleen (909) 945-4373 

Sanchez, Hector (909) 945-4562 

McEwen, Karen 

VICTORVILLE 

(760) 843-4926 

Reyes, Emily (760) 243-8357 

The main number for customer inquiries (public contact) is (866) 901-3212 

for all offices. 


Child Support Voluntary Declaration of Paternity 

Introduction This section contains information regarding definitions and information about 

when to use the Declaration of Paternity, who may use the exception 

declaration, who can’t use exception forms, and Eligibility Worker (EW) 

procedures. 

Definition The Declaration of Paternity allows the unmarried parent the right to forego 

the court process to establish paternity. 

When to use A voluntary Declaration of Paternity is used when the parents of a child(ren) 

are not married, and paternity has not been established or declared. 

Who may use Unmarried parents receiving or applying for CalWORKs may make a 

declaration of paternity. Completing the voluntary Declaration of Paternity 

does not exempt the applicant/recipient customer from the requirement to 

cooperate with DCSS. 

Exception When either parent is a minor, the Declaration of Paternity cannot establish 

paternity until 60 days after both minor parents are emancipated or 60 days 

after the eighteenth birthday of both minors, whichever occurs first. 

Who can’t use A mother who was married to someone other than the biological father 

when the baby was born cannot use the Declaration of Paternity. 

Forms CS 910 "How a Declaration of Paternity Can Help You and Your New 

Baby" is given whenever parents of a child are unmarried, and paternity 

has not been established. 

CS 909 Declaration of Paternity is offered to the applicant/recipient 

customer for completion whenever parents of a child are unmarried, and 

paternity has not been established. 



Child Support Voluntary Declaration of Paternity, Continued 

CW procedures The following chart explains the procedures for reviewing Voluntary 

Declaration of Paternity. The EW: 

Step Action 

1 Reviews the Statement of Facts (SAWS 2) or Support 

Questionnaire (CW 2.1Q) to determine if parents are unmarried. 

2 Reviews the Support Questionnaire to determine if paternity has 

been established. 

3 • Determines if paternity has been established. If yes, sends 

the Support Questionnaire to DCSS. 

4 Informs the unmarried parent of the availability and option to 

establish paternity by offering the CS 910 

5 Gives the CS 909 to the applicant/recipient if he/she chooses to 

establish paternity. 

6 Narrates in the case journal if CS 910 and/or CS 909 have been 

offered, and the applicant/recipient's response. 

Note: No penalty applies for declining either completion of, or for non-receipt 

of the CS 909. If the customer has questions that cannot be answered by 

the EW, the CS 909 is complete except for signatures, and forwarded to 

DCSS for completion. 


Child Support Unmarried Father (UMF) Requirements 

Introduction This section contains information regarding unmarried father requirements, 

the process, determining if paternity has been established, forms completion 

requirements, voluntary declaration of paternity, and child support forms. 

Unmarried 

Father 

requirements 

UMF Support 

Questionnaire 

completion 

The unmarried father (UMF) in the home must comply with the Department of 

Child Support Services (DCSS) in certain situations. The Eligibility Worker 

(EW) must determine if paternity has been established and if/when forms 

must be completed. This page provides instructions for determining: 

If paternity has been established. 

When to offer paternity forms (CS 909 and CS 910). 

When Child Support forms (Support Questionnaire, CW 2.1Q, and 

CW 2.1NA) must be completed. 

When both parents are in the home and the parents are unmarried: 

Select the unmarried mother as the applicant/custodial parent, and 

Only complete the Support Questionnaire on the UMF (never for mother). 

Note: The EW must never assign the Primary Applicant as the absent parent 

on the CW 2.1Q. 

Process The chart below shows the process for determining cooperation 

requirements of an unmarried father. The EW: 

Step Action 

1 Determines if paternity has been established. 

If yes, stop here. 

If no, proceed to step 2. 

2 Attempts to establish Paternity by Voluntary Declaration. 

3 Completes paternity forms as necessary and sends to DCSS. 

Note: Completion of paternity forms does not exempt the customer from the 

requirement to cooperate with DCSS. 



Child Support Unmarried Father (UMF) Requirements, Continued 

Establishing 

paternity 

Forms 

completion 

requirements 

Child support 

forms 

The table below describes when paternity has been legally established. 

If… And… Then paternity… 

Paternity forms have Forms have been Has been legally 

been offered, signed and returned, established. 

Forms have been Has not been 

refused or not returned, established. 

The UMF’s name is Child was born on or Has been legally 

on the Birth 

after 1/1/97, 

established. 

Certificate, 

Child was born prior to May not have been 

1/1/97, 

legally established. 

Paternity forms may need to be completed when a UMF is in the home. The 

chart below explains when paternity forms are required. 

If paternity… Then… 

Has been legally 

established, 

Has not been legally 

established, 

Forms have been refused 

or not returned, 

No further action is necessary. Child Support 

forms are not needed. Do not complete the 

Support Questionnaire in C-IV. 

Paternity forms must be offered (see “Child 

Support Voluntary Declaration of Paternity” 

section) and complete Child Support forms. 

Complete Child Support forms. 

The following forms meet the child support requirement: 

Support Questionnaire (CW 2.1 Q), 

Notice and Agreement for Child, Spousal, and Medical Support 

(CW 2.1 NA) 

Note: Do not complete the Support Questionnaire (CW 2.1 Q) in C-IV: 

For an unborn’s absent or unmarried father until the unborn is born, or 

If paternity has been legally established. 


Child Support Services Referral Procedures 

Introduction The section contains information regarding the Department of Child Support 

Services (DCSS) referrals, including the critical information on the Child 

Support Questionnaire (CW 2.1Q). 

Support 

Questionnaire 

completion 

Mandatory 

Support 

Questionnaire 

fields 

Assist the customer in providing as much information as possible for the 

completion of the Support Questionnaire (CW 2.1Q) in C-IV. While it is not 

always possible to obtain information for the data fields listed, there are six 

critical data fields regarding the absent parent on the Support Questionnaire 

(CW 2.1Q). Completion of these fields with the correct information will assist 

DCSS in identifying and locating the absent parent. These fields are the 

absent parent’s: 

• Name (Last Name, First Name, Middle Name/Initial, and Suffix), 

• Gender, 

• Social Security Number (SSN), 

• Date of Birth, 

• Physical Address (Street Number, Street Name, Street Suffix, Unit 

• Number, City, State, Zip Code, and Country), and 

• Last Known Employer. 

If the customer is not sure of the correct information for any of the fields 

mentioned above, leave that field blank, with the exceptions of: 

• Name – if either the first and/or last name is not known, enter “Unknown” 

in that field. 

• Physical Address – if part of the address is known, such as the state or 

country, enter that information. 



Child Support Services Referral Procedures, Continued 

Places to look 

when the six 

critical fields 

are blank 

The Eligibility Worker (EW) may explore the following areas when a customer 

does not complete the six critical data fields on the Support Questionnaire 

(CW 2.1Q). 

If the… Then… 

Child was born after 

September 1996, and the 

absent parent’s name is on 

the birth certificate, 

Customer states he/she 

receives court ordered child 

support, 

Absent parent pays medical 

insurance, 

Customer was married to 

the absent parent, 

Customer was previously 

married, shared health 

insurance, or loans with the 

absent parent, 

Customer previously 

received public assistance, 

The absent parent may have filled out a 

paternity declaration at the hospital. This 

declaration has all the absent parent’s 

information needed for the Support 

Questionnaire. 

The customer may be able to get the needed 

information off the paperwork they have 

received. 

His/her social security number may be found 

on the insurance forms/cards. 

He/she can call the Internal Revenue 

Service (IRS) at 1-800-829-1040 and 

request a copy of his/her last tax return. 

The customer may be able to get information 

from: 

• Marriage certificate 

• Old insurance forms 

• Loan documents 

The previous case records and history may 

have the needed information. Review: 

• C-IV 

• Welfare Database Archive (WQ System) 

• Previous case records from closed files. 




Who to refer All CalWORKs customers for whom the Support Questionnaire is mandatory 

must be referred to DCSS. This requirement is met by: 

Referral 

procedures 

Single parent 

adoption cases 

• Forwarding the Support Questionnaire information to DCSS, via an 

electronic interface, and 

• Completing and providing the TAD/CS 2.1 form to the customer at 

completion of the application interview. 

All Transitional Assistance Department (TAD) offices must follow the steps in 

the table below when referring customers to DCSS. 

Step Action 

1 Obtain as much information from the customer as possible for the 

completion of the Support Questionnaire. 

2 Review the Support Questionnaire for completeness. This 

information will be sent to DCSS via an electronic interface. 

3 Complete the TAD/CS 2.1 form: 

• Give the form to the customer, and 

• Inform the customer DCSS will be contacting them to set up 

the required interview. 

Note: Should customers have any questions, they can contact 

DCSS at (866) 901-3212, Monday through Friday from 8:00 am to 

5:00 pm. 


Note: Anytime information has been added to or deleted from the Support 

Questionnaire and saved, C-IV will send all Support Questionnaire 

information to DCSS via an electronic interface, during an overnight batch. 

The deprivation for children adopted by a single parent is continued absence, 

and the Support Questionnaire must be completed. However, DCSS does 

not need to establish paternity and will not pursue child support for these 

cases. To help identify these cases and stop the interface with DCSS, the 

EW will follow the chart below when completing the Support Questionnaire 

page in C-IV for the adopted child. 

Step Action 

1 Select Not Applicable for the Parentage Status of the child(ren). 

2 Enter Single Parent Adoption as the name of the absent parent 

under the Noncustodial or Unmarried Parent section. 

3 Journal action taken. 




Incorrect DCSS 

referral 

TAD/CS 2.1 

form 

Referral followup 

information 

When a Support Questionnaire has been completed incorrectly or in error, 

the EW must not delete (remove) it from C-IV. To stop the interface from 

sending information to DCSS, the EW will change the Parentage Status of 

all the children on the Support Questionnaire to Not Applicable. This will 

stop all transactions on that Support Questionnaire to DCSS and allow the 

EW to create a correct Support Questionnaire. 

Note: For specific instructions about how to treat incorrect Support 

Questionnaires, refer to the C-IV User Guide under “Child Support 

Questionnaire, Correcting.” 

The TAD/CS 2.1 form must be completed and provided to all customers for 

whom the Support Questionnaire is mandatory. Provide the completed 

TAD/CS 2.1 form to the customer when the application interview is complete. 

DCSS will send out a Case Opening Response packet (DCSS 0047) when a 

referral is received, advising the customer a child support case has been 

opened. This packet is generated based on information entered on the 

Support Questionnaire. DCSS will then attempt to contact the customer to 

conduct an interview. 

If DCSS was not successful in contacting the customer, they will send out a 

Notice of Interview Hours (DCSS 0533). It is then the customer’s 

responsibility to contact DCSS within 10 days of receipt of the letter in order 

to avoid a penalty. If the EW is aware the customer received this letter, 

he/she must encourage the customer to contact DCSS immediately and 

advise him/her that failure to do so may result in a finding of non-cooperation, 

resulting in the reduction or discontinuance of benefits. 




Child support 

Tasks 

Throughout the child support process, EWs are required to take action on a 

case depending on Tasks generated by DCSS, via an interface with C-IV. 

See the table below for a list of Tasks EWs must take action on by the 

established due date. 

Task Action Required 

Excess Child Support 

Contact the customer and set up an 

Direct Child Support 

overpayment account as needed. 

{Custodial Parent Name} IV-D 

Non-Coop 

Apply penalty following timely notice. 

{Custodial Parent Name} IV-D Remove penalty following timely 

Coop 

notice. 

{Absent Parent Name} living with Follow procedures to do an add 

applicant 

person. 

{Absent Parent Name} not living Follow procedures to remove the now 

with applicant 

Paternity Established for {Child 

Absent Parent. 

Name} 

Update the information on the Support 

Paternity Excluded for {Child 

Name} 

Questionnaire. 

Health insurance provided by Contact the customer to gather and 

{Policy Holder Name} for {Member verify correct information and update 

Name} 

the Other Health Care pages in C-IV. 

Note: The assigned due date for these Tasks is ten days from the day they 

were generated. 




CHAPTER 3 

Assistance Unit/Responsible Persons 

Assistance Unit/Responsible Persons: Overview ..........................................................3-1 

Responsible Persons: Overview ....................................................................................3-2 

Caretaker Relatives: Required Relationship .................................................................3-3 

Proof of Relationship......................................................................................................3-5 

How to Verify Relationship .............................................................................................3-6 

Care and Control of a Child............................................................................................3-7 

Nonparent Caretaker Relatives: Needy or Non-Needy? ...............................................3-9 

Assistance Unit: Overview ...........................................................................................3-11 

Assistance Unit Basics.................................................................................................3-12 

Classifying Family Members ........................................................................................3-14 

Assistant Unit (AU) Members.......................................................................................3-15 

Pregnant Woman Only (PWO) AU...............................................................................3-18 

Non-AU Members ........................................................................................................3-19 

Excluded Members ......................................................................................................3-21 

Non-persons.................................................................................................................3-23 

California Registered Domestic Partners/Same Sex Spouses.....................................3-26 

AU Classification Table ................................................................................................3-28 

Temporary Absence: Overview....................................................................................3-29 

Temporary Absence of a Family Member ....................................................................3-30 

Temporary Absence: Exceptions to the Rule..............................................................3-31 

Examples of Temporary Absence ................................................................................3-33 

CWPHB #4605 (04/11) TABLE OF CONTENTS PAGE 1 of 1

Overview 

Assistance Unit/Responsible Persons 

Overview An Assistance Unit (AU) is a group of related persons living in the same 

home who have been determined eligible to CalWORKs. There are other 

related persons who live in the home with the CalWORKs AU whose income 

and resources may have an impact on the eligibility and benefits of the 

CalWORKs AU. 

An AU must have an adult who meets the definition of a caretaker relative in 

order to receive CalWORKs. If the person applying for CalWORKs does not 

meet the definition of caretaker relative, then that person cannot receive 

CalWORKs for the applicant child(ren). 

Family members can be temporarily absent from the home and still receive 

CalWORKs and/or have their income and resources used to determine 

eligibility to CalWORKs for the family. 

This chapter contains the following information: 

• Caretaker relatives, who they are and the importance of care and control, 

• Who must be included in the AU and how to classify family members, 

and 

• Who can be considered temporarily absent. 


• ACL #03-18 and 09-05 


• EAS 44-133 and 44-206 

• EAS 82-800 and 82-808 



Responsible Persons 3-2 

Assistance Unit 3-11 

Temporary Absence 3-29 

CWPHB #4605 (04/11) AU/RESPONSIBLE PERSONS 3-1

Overview 

Responsible Persons 

Introduction Determining the responsible persons means establishing the caretaker 

relative. Establishing the caretaker relative is a two-part determination. First, 

the caretaker must meet the required relationship to the applicant child. 

Second, the caretaker must have care and control of the applicant child. 

This section explains what the required relationship criteria are, how to verity 

them and how to determine who has care and control. 


• EAS 82-804 and 82-808 



Caretaker Relatives: Required Relationship 3-3 

Proof of Relationship 3-5 

How to Verify Relationship 3-6 

Care and Control of a Child 3-7 

Non-parent Caretaker Relatives: Needy or Non-needy? 3-9 


Caretaker Relatives: Required Relationship 

Introduction This section contains the basic rules for establishing the relationship between 

the caretaker and applicant child. A caretaker must meet the relationship 

requirement to be a caretaker relative and receive CalWORKs for a child. 

Caretaker 

relatives – Who 

are they? 

People who do 

not meet the 

relationship 

requirement 

Except for a Pregnant Woman Only (PWO) case, a deprived child must live 

with a caretaker of the required relationship in order to receive CalWORKs 

cash aid for that child. 

The caretaker relative may be any relation by blood, marriage, or adoption 

who lives with the child. A caretaker relative may be a: 

• Parent, grandparent, sibling, great-grandparent, uncle or aunt, nephew or 

niece, great-great grandparent, great uncle or aunt, first cousin, greatgreat-great 

grandparent, great-great uncle or aunt, or first cousin once 

removed 

• Stepfather, stepmother, stepbrother, stepsister, or California registered 

domestic partner. 

• Spouse (including same-sex spouse) or California registered domestic 

partner of any person named above even after the marriage or 

partnership has been terminated by death or dissolution 

• Person who legally adopts the child or that person’s relatives. 

Note: If A and B are first cousins, A’s children are first cousins once 

removed to B and B’s children are first cousins once removed to A. A’s 

children and B’s children are second cousins. 

The following are examples of people caring for children who do not meet 

the relationship requirement: 

• Legal guardians who do not meet the required relationship rule 

• Friends of the child’s family 

• Neighbors of the child’s family 

• Relatives of a half-sibling’s non-mutual parent 

• Step-grandparents, when not the spouse of a natural or adoptive 

grandparent 

• Second cousins 

Example: Mom and unmarried father live in the same home. Living with 

them are Mom’s child from a previous relationship and their one mutual child. 

Mom leaves the home. The unmarried father does not meet the relationship 

requirement to be the caretaker relative for Mom’s child from a previous 

relationship. 



Caretaker Relatives: Required Relationship, Continued 

When the 

relationship 

requirement is 

not met 

If a caretaker does not meet the relationship requirement to a child, the 

caretaker cannot receive CalWORKs for that child. The application must be 

denied. 

Note: If the caretaker is not a relative but has legal guardianship, refer the 

caretaker to the Department of Children’s Services (DCS). See the Foster 

Care (FC): Miller vs. Youakim section of the Applications Chapter of this 

Handbook for information regarding possible referral to Foster Care. 


Proof of Relationship 

Introduction The relationship of the parent/caretaker relative to the child must be verified. 

This section includes information regarding how to verify relationship and the 

types of verification, which can be used. 

Relationship 

verification 

requirement 

Forms of acceptable verification of the relationship are given in the order of 

preference and include: 

• Birth certificate, or series of birth certificates, proving parentage and 

family lineage 

• Bureau of Vital Statistics or local government records of birth and 

parentage 

• Adoption records 

• Marriage certificates or records 

• Court records of parentage 

• Declaration of California registered domestic partnership 

• Divorce records or termination of California registered domestic 

partnership 

• Paternity records 

• Juvenile court records 

• Indian census records 

• U.S. government census records 

• NUMI file screen print from the Social Security Administration for people 

born January 1, 1978 or later listing the individual’s name, date of birth, 

place of birth, and parents’ names 

• School records 

• Insurance policies 

• Church records of parentage or relationship, including statements from a 

priest or minister 

• Baptismal records of birth and parentage 

• Screen print of the birth record from the San Bernardino County 

Recorder’s Data Base 

• TAD 25, Relationship of Caretaker to Child(ren) form, only as detailed on 

the following page of this Handbook 

For complete information about verification of the relationship requirement, 

see the chart in the following section. 


How to Verify Relationship 

Verification 

process 

When proof of 

the required 

relationship is 

not available 

The table below shows how to make sure the relationship requirement has 

been met. 

If the … Then … 

Relationship is between parent Ask for birth verification for the child listing 

and child, 

the parents and the child. 

Relationship is between a Ask for the child’s birth verification and the 

nonparent caretaker relative same for any family members necessary 

and child, 

to positively link the child to the caretaker 

relative. 

Parent or caretaker relative • Request any closed assistance case, 

does not have proof of • Give the parent or caretaker a TAD 

relationship, 

622 with the information needed to 

request a copy of birth verification from 

the vital records bureau where the 

persons involved were born, 

• Have the applicant sign the HSS 623 

and hold it in the case, 

• Continue with the HSS 623 process 

only when the applicant is unable to 

verify the relationship within 90 days, 

and 

• If other proof is unattainable, the 

caretaker relative must complete and 

sign the TAD 25. 

Proof of the relationship does The caretaker relative must complete and 

not exist or never existed, sign the TAD 25. 

The TAD 25, Relationship of Caretaker to Child(ren) form, will only be 

accepted as proof of the relationship when all the following conditions are 

met: 

• All other options for verification have been explored and exhausted, 

• The caretaker relative gives a written statement on the TAD 25 explaining 

why they cannot provide other proof of the relationship, 

• The caretaker signs the form under penalty of perjury, and 

• There is no conflicting or questionable evidence regarding the 

relationship. 


Care and Control of a Child 

Introduction One of the factors in determining the caretaker relative is to determine who 

exercises care and control of the child. 

Care and 

control factors 

The caretaker relative is the adult relative who has the primary responsibility 

for care and control of the child for whom aid is requested. 

The following factors shall be considered when determining responsibility for 

care and control. One factor may not be the sole basis for the determination 

of who is the caretaker relative. The factors include, but are not limited to: 

• Deciding where the child attends school or child care, 

• Dealing with the school on educational decisions and problems, 

• Controlling participation in extracurricular and recreational activities, 

• Arranging medical and dental care services, 

• Claiming the child as a tax dependent, and 

• Purchasing and maintaining the child’s clothing. 



Care and Control of a Child, Continued 

When parents 

share custody 

of a child 

When parents share custody of a child, the Eligibility Worker (EW) must 

determine which parent is the caretaker relative. Once the determination is 

made, the EW must document that determination in the case journal and 

explain how that determination was reached. Use the following chart to 

determine the caretaker relative when parents share custody of a child. 

When the 

And … Then the caretaker 

child… 

relative is … 

Stays with one This parent has majority care and control The parent the child stays 

parent most of the of the child, 

with most of the time. 

time, The other parent has majority care and The parent who has 

control of the child, 

majority care and control. 

Spends equal Each parent has an equal share of care The parent who applies for 

time with each and control, 

aid first providing the other 

parent, 

parent is not applying for or 

receiving aid for the child. 

One parent is designated by court order as The parent designated by 

the primary caretaker relative for public 

assistance under Civil Code Section 

4600.5(h), 

court order. 

• Is already on aid with one parent, and The parent currently 

• The other parent applies for aid for that 

child, 

receiving aid for that child. 

• Both parents file separate applications • Designated by the 

for that child, and 

parents, and 

• Both parents would be eligible, • Documented by a 

CA 13, Caretaker 

Relative Agreement 

form. 

• Both parents file separate applications The parent who applied 

for that child, and 

first. 

• Both parents would be eligible but 

refuse to designate the caretaker 

relative, 

When the child 

visits the other 

parent 

Eligibility and the caretaker relative determination do not change while the 

child visits the non-custodial, non-caretaker parent. See the Temporary 

Absence section of this Chapter for more information. 


Nonparent Caretaker Relatives: Needy or Non-Needy? 

Introduction A nonparent caretaker relative can be needy and receive CalWORKs 

benefits for themselves or non-needy and not receive CalWORKs for 

themselves. This section explains who can be needy or non-needy. 

Needy 

nonparent 

caretaker 

relatives 

Non-needy 

nonparent 

caretaker 

relatives 

Needy vs. nonneedy 

When the 

parent returns 

to the home 

Needy nonparent caretaker relatives: 

• Are not financially self-sufficient according to CalWORKs income 

standards, 

• May receive CalWORKs cash aid if otherwise eligible for and willing to 

comply with program requirements, and 

• May decline to apply for cash aid for themselves without penalizing the 

rest of the Assistance Unit (AU) 

Note: The spouse of a needy nonparent caretaker relative is classified as a 

Non-person and is not included in the AU. 

Non-needy nonparent caretaker relatives: 

• Are financially self-sufficient, 

• Do not receive cash aid, 

• Do not have to meet program requirements, and 

• Do not adversely affect CalWORKs eligibility for the AU with their income 

or resources. 

The terms “needy” and “non-needy” are used solely to indication whether or 

not the nonparent caretaker relative is included or not included in the 

Assistance Unit (AU). Nonparent caretaker relatives are not responsible for 

the support of mandatory AU members. 

When the parent returns to the home, in most circumstances, the parent 

becomes the caretaker relative and a change of payee is completed. But, 

when the nonparent caretaker relative retains care and control of the 

child(ren), that caretaker relative will remain the payee and can be needy or 

non-needy. Follow the chart below when the parent returns to the home: 

When … Then … 

The nonparent 


retains care and control 

of the child(ren), 

The parent has care 

and control of the 

child(ren), 

• The nonparent caretaker relative remains the 

payee, and can be needy or non-needy, and 

• The parent is added to the case. 

• The parent becomes the caretaker relative, 

and 

• A change of payee from the nonparent 

caretaker relative to the parent is completed. 



Nonparent Caretaker Relatives: Needy or Non-Needy?, 

Continued 

When parent 

and nonparent 

relative share 

care and 

control 

When both the parent and nonparent relative share care and control of the 

child(ren), determining which parent is the caretaker relative payee is based 

on which person has the majority care and control of the child(ren). When 

this situation occurs, use the chart below to determine which person will be 

the payee/caretaker relative. 

When… Then… 

The nonparent relative has the 

majority care and control, 

The parent has the majority care 

and control, 

• The nonparent relative is the 

payee/caretaker relative, and 

• Can be needy (aided) or nonneedy 

(unaided). 

• The parent is the 

payee/caretaker relative, and 

• The nonparent relative is not 

aided. 


Overview 

Assistance Unit 

Introduction This section covers how to establish the Assistance Unit (AU), including how 

to classify the family members. Classification categories include: 

• AU Members, 

• Non-AU Members, 

• Excluded Members, and 

• Non-persons. 


• EAS 44-133 and 44-206 

• EAS 82-820, 82-824, 82-828, 82-832, 82-833, and 82-836 



Assistance Unit Basics 3-12 

Classifying Family Members 3-14 

Assistance Unit (AU) Members 3-15 

Pregnant Woman Only (PWO) AU 3-18 

Non-AU Members 3-19 

Excluded Members 3-21 

Non-persons 3-23 

California Registered Domestic Partners/Same Sex Spouses 3-26 

AU Classification Table 3-28 


Assistance Unit Basics 

Introduction An Assistance Unit (AU) is a group of related persons living in the same 

home who have been determined eligible for CalWORKs cash aid. This 

section contains some basic AU rules. Information regarding who must be 

included in the AU, can be included, and must be excluded is located in the 

following sections of this Chapter. 

Basic AU rules The basic rules for establishing an AU are as follows: 

• No CalWORKs eligibility exists unless the family includes one of the 

following: 

− An unborn child or 

− A child under age 18 (or as described in the Child’s Eligibility Chapter 

of this Handbook for 18 year olds) 

AND 

− A natural or adoptive parent of the child or 

− A natural or adoptive caretaker relative of the child 

• The child or unborn in the family must be deprived of parental support or 

care as described in the Deprivation Chapter of this Handbook. 

• The child(ren) and parent(s)/caretaker relative(s), and other family 

members living in the home, must meet all other CalWORKs eligibility 

requirements once it is established there is an unborn or child who: 

− Lives with a natural or adoptive relative of the required relationship 

and 

− Is deprived. 

Minimum 

requirements 

The Assistance Unit (AU) must include at least one of the following: 

• An eligible child; 

• A caretaker relative of: 

− An SSI/SSP child, 

− A Kin-GAP child, or 

− A child receiving federal, state, or local foster case maintenance 

payments; 

• A pregnant woman; 

• The caretaker relative of a child who is sanctioned by Welfare-to-Work 

(WtW); or 

• The parent of a Maximum Family Grant (MFG) child when there are no 

other eligible children. 

Combining AUs Two or more AUs living in the same home must be combined when: 

• A caretaker relative in one AU marries a caretaker in the other AU; 

• Two caretaker relatives in the home have separate children and also 

have an eligible child in common; or 

• There is only one caretaker relative. 



Assistance Unit Basics, Continued 

Mandatory 

inclusion and 

adoption 

For mandatory inclusion both the sibling for sibling and parent for sibling links 

are broken for an adopted child. 

Situation: In the home are a mother, her adult sister, and the mother’s two 

biological children, a son and daughter. The sister adopted the son. 

AU composition: Assuming the mother has care and control of the 

daughter and her sister has care and control of the son, AU composition is as 

follows: 

• First AU – mother and her daughter. 

• Second AU – sister and her adopted son. 

The adoption of the son broke the parent for child and sibling for sibling 

mandatory inclusion links that would have included the son and his adopted 

mother in his biological mother’s AU. 

Note: Adoption does not break a caretaker relative relationship. A biological 

relative may be eligible to receive aid for an adopted child as a nonparent 

caretaker relative as long a care and control requirements are met. 


Classifying Family Members 

Purpose Family members who live together will be assigned a classification in the 

case. 

The 

classifications 

Classifications of family members allow the Eligibility Worker (EW) to begin 

the sorting process to determine: 

• Which unaided people have little or no impact on the cash case, 

• Whose resources to use in the resource eligibility determination, 

• Whose income to use in determining financial eligibility for the Assistance 

Unit (AU), and 

• Which people must comply with program requirements. 

Classifications are established for each individual when CalWORKs is 

approved, but are subject to change throughout the life of the case. For 

instance, an AU Member can become a Non-AU Member, an Excluded 

Member, or Non-person. It all depends on what is happening with each 

individual in the family. Classifications are reevaluated when the family 

reports changes. 

The classifications are: 


• Non-AU Members, 

• Excluded family members, and 



Assistance Unit (AU) Members 

Introduction An Assistance Unit (AU) is a group of related persons living in the same 

home who have been determined eligible for CalWORKs cash aid. This 

section contains information regarding who must be included in the AU. 

Who they are AU Members are people who are living in the same home and must be 

included due to mandatory inclusion rules or choose to be included. 

Examples include: 

Mandatory 

inclusion 

Mandatory 

Inclusion 

examples 

• The applicant child and eligible siblings or half-siblings, 

• The eligible parent of the applicant child and any other eligible children, 

• Persons with immunization, school attendance, and Intentional Program 

Violation (IPV) penalties, 

• Needy nonparent caretaker relatives, 

• Nephews, nieces, and grandchildren, and 

• Essential persons. 

The AU must include the following persons when living in the same home 

and eligible at the time of the initial application or at the beginning of the 

Quarterly Reporting (QR) Payment Quarter following the mandatory reporting 

of the individual on the QR 7: 

• The applicant child; 

• Any eligible sibling or half-sibling of the applicant child who has 

deprivation and meets the age requirement; and 

• Any parent, except for Alternatively Sentenced Parents (ASPs) of: 

− The applicant child, or 

− The applicant child’s eligible siblings or half-siblings who have 

deprivation and meet the age requirement. 

Note: Adoption breaks the parent for child and sibling for sibling mandatory 

inclusion links. 

The following examples explain when persons must be included in or 

excluded from the AU. 

Example 1: 

A CalWORKs continuing case consists of mom, her child (absence 

deprivation), mutual child (unemployment deprivation) and unmarried father 

(UMF). The UMF was unemployed but recently returned to work and is 

currently working 120 hours per month. His income makes the case 

ineligible to receive CalWORKs. The mutual child continues to have 

unemployment deprivation as the 100 hour work rule does not apply to 

continuing cases and he/she meets all other eligibility requirements. The 

mutual child and the UMF must be included in the AU. Because the UMF’s 

income makes the family ineligible to CalWORKs, the CalWORKs program is 

discontinued. 



Assistance Unit (AU) Members, Continued 

Mandatory 

Inclusion 

examples 

(continued) 


AU Members 

Example 2: 

Mom’s CalWORKs case is discontinued 10/31 for exceeding the income limit 

for the AU (the UMF is full-time employed and his income makes the 

CalWORKs case ineligible). Mom re-applies for CalWORKs for herself and 

the non-mutual child on 11/1. The non-mutual child has absence deprivation. 

The UMF and mutual child are in the home and the UMF is full-time 

employed, working over 100 hours per month. Because this is an Intake 

case, there is no deprivation for the mutual child as the UMF is employed fulltime. 

CalWORKs is approved for mom and the non-mutual child only. 

Example 3: 

A CalWORKs continuing case consists of mom, her child with absence 

deprivation, mutual child with unemployment deprivation and UMF. The 

UMF begins receiving UIB which makes the entire family ineligible for 

CalWORKs. Because the mutual child has deprivation and meets all other 

eligibility requirements, he and the UMF must be included in the AU. Since 

the UIB makes the family ineligible to CalWORKs, the CalWORKs program is 

discontinued. 

Example 4: 

A CalWORKs continuing case consists of mom (SSI recipient) and her two 

children ages 16 and 4 both with absence deprivation. The father of the 

4-year old moves into the home and is full-time employed. He and mom are 

not married. Although the 4 year old child is not deprived due to 

unemployment, he is deprived due to incapacity. Because the mutual child 

has deprivation and meets all other eligibility requirements, he is mandatorily 

included in the AU along with the UMF. The UMF’s income is used to 

determine the CalWORKs benefit. 

Example 5: 

A CalWORKs continuing case consists of mom and her two children ages 13 

and 2 both with absence deprivation. The father of the 2-year old moves into 

the home and is full-time employed. He and mom are not married. The 

2-year old no longer has deprivation and is not eligible to receive 

CalWORKs. The 2-year old and the UMF are not mandatorily included in the 

AU and the UMF’s income is not used to determine the CalWORKs benefit. 

It is important AU Members are correctly identified because: 

• Their needs are included in the AU and Family MAP counts, 

• Their resources are used in the eligibility determination, 

• Their income is used in the financial Eligibility Determination and Benefit 

Calculation (EDBC) processes, and 

• They must comply with CalWORKs program requirements. 

Note: There are exceptions to the information above. Please see the 

exceptions in the Penalized persons and MFG children blocks in this section. 



Assistance Unit (AU) Members, Continued 

Penalized 

persons 

While persons with immunization, school attendance, and IPV penalties are 

considered AU Members, their needs are not included in the AU and Family 

MAP counts. 

Note: C-IV assigns the Role of MMO (Medi-Cal Member Only) to penalized 

persons. 

MFG children Maximum Family Grant (MFG) children are considered AU Members, but 

their treatment is similar to Excluded Members. MFG children’s: 

• Needs are not included in the Family Maximum Aid Payment (MAP) 

unless they are felony drug convicts, fleeing felons, or probation/parole 

violators with their own separate income; 

• Needs are not included in the AU MAP; 

• Resources are included in eligibility determinations; 

• Income is included in the financial Eligibility Determination and Benefit 

Calculation (EDBC) processes until the income is child support or from 

the Social Security Administration (SSA) or other government program 

and is based on an absent parent’s disability or retirement. 

Optional 

persons 

Alternatively 

Sentenced 

Parent (ASP) 

Note: C-IV assigns the Role of MMO to MFG children. 

Optional persons are not otherwise required to be included in the AU, but can 

be included at the request of the customer (applicant/recipient). Examples 

include: 

• Nonparent caretaker relatives; 

• Other eligible children, such as nieces, nephews, cousins, and 

grandchildren; and 

• Essential persons: 

− Stepparents (including same-sex spouses) 

− California Registered Domestic Partners 

− Alternatively Sentenced Parents (ASPs) 

An Alternatively Sentenced Parent (ASP) is a parent who is a convicted 

offender and is permitted to live at home while serving a court imposed 

sentence that precludes him or her from supporting the family through paid 

employment. 

An ASP may be designated a caretaker relative payee. 


Pregnant Woman Only (PWO) AU 

Introduction This section contains the requirements for a Pregnant Woman Only (PWO) 

Assistance Unit (AU), which is also known as an AU of one. 

PWO 

requirements 

Cal-Learn 

exception 

A PWO AU or AU of one is established when an AU with a pregnant woman 

without an eligible child meets all the following conditions: 

• Medical verification of pregnancy has been provided; 

• The pregnant woman, and unborn child, if born and living with the 

mother, would be eligible to CalWORKs; 

• The pregnancy is in the last trimester; and 

• The pregnant woman cannot be included in another AU. 

A PWO AU or AU of one is established when an AU with a pregnant Cal- 

Learn participant without an eligible child meets all the following conditions: 

• Medical verification of pregnancy has been provided; 

• The pregnant woman, and unborn child, if born and living with the 

mother, would be eligible to CalWORKs; and 

• The pregnant woman cannot be included in another AU. 

Note: Pregnant Cal-Learn participants do not need to be in their third 

trimester in order to be eligible to CalWORKs as a PWO AU or AU of one. 

They can be in their first or second trimesters as long as they meet the 

conditions listed above. 


Non-AU Members 

Introduction Non-AU Members are family members who the Assistance Unit (AU) has the 

option to exclude or are not included in the AU due to regulation. This 

section includes information regarding how to identify Non-AU Members. 

Who they are Non-AU Members are people who: 

• Are immediate family members of the people included in the AU, and 

• The AU has the option to exclude, or 

• Are not included in the AU due to regulation. 

Examples of Non-AU Members are: 

• Undocumented noncitizen parents, stepparents, siblings/children, and 

California registered domestic partners, 

• Unaided stepparents, stepsiblings, and California registered domestic 

partners, 

• Unaided senior parents and their other children, 

• Excluded fathers in Pregnant Woman Only (PWO) cases, 

• Unaided spouses of aided children, 

• Alternatively Sentenced Parents (ASPs) when not included in the AU, 

• Unaided half-siblings excluded for no deprivation, and 

• Potential AU Members determined ineligible prior to Authorization of 


Who they aren’t The following people cannot be designated as Non-AU Members: 

• Parents of child(ren) for whom aid is requested, and 

• Siblings and half-siblings of any child for whom aid is requested. 

Since the above people are potentially eligible, depending on their 

circumstances, they must be classified as: 


• Excluded Members, or 


Exception: Potential AU Members whose applications are “held over” 

pending their report on the QR 7 (benefits are decreasing) and have a 

change that occurs in the QR 7 Submit Month that causes AU ineligibility will 

be treated as Non-AU Members for the upcoming QR Payment Quarter. 



Non-AU Members, Continued 


Non-AU 

members 

Non-AU Members impact the CalWORKs case for the AU because their: 

• Resources are sometimes considered in the eligibility determination 

process as described in the Resources Chapter of this Handbook, 

• Needs are included in the Family MAP, but not the AU MAP, and 

• Income is used in the financial eligibility determination and benefit 

calculation processes. 


Excluded Members 

Introduction Excluded Members are persons who are not included in the Assistance Unit 

(AU) because they are excluded by law, are sanctioned, or have reached the 

CalWORKs 48-month time limit. This section includes information regarding 

how to identify Excluded Members. 

Who they are Excluded members are people who: 


Excluded 

Members 

• Are not included in the AU because they are excluded by law, are 

sanctioned, or have reached the CalWORKs 48-month time limit, and 

• Would otherwise be required to be part of the AU based on their 

relationship to other AU members. 

Excluded Members include those persons who: 

• Are Welfare-to-Work (WtW) sanctioned; 

• Are fleeing felons; 

• Are probation/parole violators; 

• Are 48-month CalWORKs time expired adults; 

• Are felony drug convicts convicted after 12/31/1997; 

• Are strikers and nonparent caretaker relatives; 

• Were found guilty of committing an IPV prior to 01/01/1998, and the 

sanction is still in place; 

• Fail to verify citizen or noncitizen status; and 

• Refuse to assign child support rights. 

Excluded Members impact the CalWORKs case for the AU because their: 

• Needs are not included in the family Maximum Aid Payment (MAP) 

unless they are felony drug convicts, fleeing felons, or probation/parole 

violators with their own separate income; 

• Needs are not included in the AU MAP; 

• Resources are included in eligibility determinations; and 

• Income is included in financial Eligibility Determination and Benefit 

Calculation (EDBC) processes, with the exception of Maximum Family 

Grant (MFG) children with child support income or benefits from the 

Social Security Administration (SSA) or other governmental programs 

based on an absent parent’s disability or retirement. 

MFG children MFG children are considered AU Members, but their treatment is similar to 

Excluded Members. See the AU Members section of this Chapter for more 

information. 



Excluded Members, Continued 

Strikers An applicant or recipient customer is considered a striker if he/she has: 

• Voluntarily stopped work, slowed down work, or otherwise interrupted the 

business activities of the employer as part of a concerted activity; or 

• Been denied Unemployment Insurance Benefits (UIB) because he/she 

has voluntarily left work due to a trade dispute. 

Stoppage or slowdown of work by employees in good faith is not considered 

participation in a strike and the person is not a striker when: 

• A lockout has occurred; or 

• The action was necessitated by an imminent health or safety hazard or 

abnormally dangerous working conditions at the place of employment as 

determined by the Division of Occupational Safety and Health. 

When the striker is living in the home with the aided child, use the table 

below to determine the striker’s impact on the AU and/or his/her AU 

classification. 

When the striker is … Then … 

The biological or adoptive parent of The entire AU is ineligible to 

the aided child, 


The nonparent caretaker relative of The striker is an Excluded Member 

the aided child, 

or Non-Person. Allow the customer 

to make the determination of his/her 

classification. 

Not the caretaker relative or The striker is an Excluded Member. 

biological or adoptive parent of the 

aided child, 


Non-persons 

Introduction Non-persons are family members who have no impact on the CalWORKs 

case. Non-persons are ineligible to receive CalWORKs and are not included 

in the Family and Assistance Unit (AU) Maximum Aid Payments (MAPs). 

Additionally, Non-persons’ income and resources are not considered when 

determining the family’s eligibility to CalWORKs. 

Who they are Examples of Non-persons include: 

• Siblings of an aided child who are not aided due to age requirements, 

• Non-needy caretaker relatives, 

• Spouses of needy or non-needy nonparent caretaker relatives, 

• SSI/SSP, SSI only, and SSP only recipients, 

• Cash Aid Program for Immigrants (CAPI) recipients, 

• Federal, State or local (County Pay) Foster Care children (not receiving 

Wraparound services), 

• Kin-GAP children, 

• Unrelated adult males or females who do not have a mutual child with the 

parent of aided child(ren), and 

• Unaided, unmarried parents when the mutual child has no deprivation. 


Non-persons 

A Non-person’s: 

• Needs are not included in the Family Maximum Aid Payment (MAP), 

• Needs are not included in the AU MAP, 

• Resources are not considered in the eligibility determination process, and 

• Income is not used in the financial Eligibility Determination and Benefit 

Calculation (EDBC) processes. 



Non-persons, Continued 

SSI/SSP, SSI 

only, and SSP 

only recipients 

Foster Care 

children 

Because the evaluation of needs, resources, and income has already been 

done for the SSI/SSP, SSI only, or SSP only recipient, their needs, 

resources, and income will not be considered a second time during the 

CalWORKs eligibility determination. 

If the only eligible child in the home receives SSI/SSP, SSI only, or SSP only, 

that child is not eligible to receive CalWORKs cash aid. However, the 

caretaker relative of the child may be eligible for CalWORKs cash aid if they 

otherwise meet eligibility requirements. 

If the caretaker relative receives SSI/SSP, SSI only, or SSP only and is 

therefore ineligible for CalWORKs cash aid, that person may still be the 

payee for the child’s cash aid case. 

Note: SSI/SSP, SSI, or SSP should not be confused with employmentbased 

benefits for retirees, survivors, or disabled persons. Since wagebased 

benefits, also called RSDI or SSA benefits, are not based on 

neediness, receipt of employment-based benefits does not result in 

ineligibility for CalWORKs cash aid but the benefits will be considered in the 

financial Eligibility Determination and Benefit Calculation (EDBC) processes. 

Families sometimes include a child for whom Foster Care funds are issued. 

These funds can be Federal, State, or local (County Pay). 

Since the financial needs of the foster child are being met through those 

funds, that child will not be considered part of the CalWORKs AU. The 

Foster Care money will have no impact on the amount of CalWORKs the AU 

will receive. 

The needy caretaker relative of a child receiving Foster Care funds may 

receive CalWORKs cash aid if otherwise eligible. 

Foster Care cases and their companion cases must be assigned to the 

nearest Foster Care Unit. 



Non-persons, Continued 

Wraparound The Wraparound program provides family-centered, strength-based 

alternatives to group home placement. The goal of Wraparound is to take 

children out of high-level group home placements and “wrap” them and their 

families in flexible services allowing children to live in family-like settings in 

their own communities. Wraparound services are provided through a 

contractor to eligible children and their families. 

Although Foster Care funds are used to provide Wraparound services, the 

payments are not made directly to the child’s family nor are they used to 

provide for that child’s daily basic needs. Therefore, the Foster Care 

payment for Wraparound services is not considered a duplicate aid payment. 

That child will be included in the AU, and the family can receive CalWORKs 

benefits, provided all other eligibility requirements are met. 

Children receiving Wraparound services are AU members unless they are 

otherwise excluded. 


California Registered Domestic Partners/Same-Sex Spouses 

Introduction This section contains information on the inclusion of the California Registered 

Domestic Partner (RDP) and Same-Sex Spouse in the Assistance Unit (AU). 

Definitions California Registered Domestic Partner: A person with a declaration of 

domestic partnership registered with the California Secretary of State or 

member of a legal union validly formed in another state that is equivalent to a 

California RDP. 

Same-Sex Spouse: A person married to someone of the same sex. Samesex 

marriages occurring in California between June 16, 2008 and November 

4, 2008 are recognized as valid marriages by the State of California and 

therefore valid for the purposes of CalWORKs. Marriages occurring in other 

states during that time period are also valid marriages. 

Eligibility RDPs and same-sex spouses have the same rights and responsibilities as 

stepparents to the eligible children of the customer for the purposes of 

determining CalWORKs eligibility and Welfare-to-Work program 

requirements. The customer has the option of including or excluding the 

RDP or same-sex spouse in the AU. 

Example 

budgets 

Note: If the RDP or same-sex spouse adopts the customer’s eligible 

child(ren), the RDP or same-sex spouse is considered a parent and a 

member of the AU. Eligibility requirements for two-parent families will be 

applied. 

For CalWORKs budgeting purposes, a RDP/same-sex spouses’ income and 

needs are treated in the same manner as stepparents. The RDP/same-sex 

spouse is considered an optional person in determination of the number of 

the persons in the AU. If he/she is included in the AU, his/her income and 

needs are counted as a member of the AU. If he/she is not included in the 

AU, his/her income and needs are considered when living in the home. 

Example 1: An AU consists of mom, three children and RDP. Mom has 

earned income of $200 per month. The RDP has earned income of $475 per 

month. The grant is computed as follows: 

Earned income for the family ........................................................$675 

$112 Earned Income Disregard....................................................- 112 

Subtotal.........................................................................................$563 

50% Earned Income Disregard.................................................-281.50 

Total Net Nonexempt Income (NNI) (dropped cents) ...................$281 

Nonexempt AU MAP for Five........................................................$825 

Net Nonexempt Income .................................................................-281 

Potential Grant Amount ................................................................$544 



California Registered Domestic Partners/Same-Sex Spouses, 

Continued 

Example 

budgets 

(continued) 

Example 2: An AU consists of mom, three children, and same-sex spouse. 

The same-sex spouse chooses not to be included in the AU. Mom has 

earned income of $200 per month. The same-sex spouse has earned 

income of $475 per month. The grant is computed as follows: 

Earned income for the family ........................................................$675 

$112 Earned Income Disregard.....................................................-112 

Subtotal.........................................................................................$563 

50% Earned Income Disregard.................................................-281.50 

Total Net Nonexempt Income (NNI) (dropped cents) ...................$281 

Nonexempt Family MAP for Five ..................................................$825 

Net Nonexempt Income (NNI) .......................................................-281 

Potential Grant Amount ................................................................$544 

Nonexempt AU MAP for Four .......................................................$725 

Actual Grant Amount (lesser of potential grant amount 

Or AU MAP)..............................................................................$544 


AU Classification Table 

Introduction This section includes a classification table to assist Case Workers in 

classifying persons in the home as Assistance Unit (AU) Members, Non-AU 

Members, Excluded Members, and Non-persons. 

Classification 

table 

Use the table below to assist in classifying persons in the home as AU 

Members, Non-AU Members, Excluded Members, and Non-persons. 

If the person is a(n)… Then classify as… 

Applicant eligible to CalWORKs, 

Recipient eligible to and receiving CalWORKs, 

Alternatively sentenced person (ASP) when included as an essential person, 

AU Member 

Child receiving Wraparound services, 

Person with an Immunization penalty, 

Person with a School Attendance penalty, 

Person with an Intentional Program Violation (IPV) after 12/31/1997, 

Maximum Family Grant (MFG) child, 

Undocumented noncitizen parent, stepparent, child, sibling, or California 

registered domestic partner, 

Unaided stepparent, stepsibling, or California registered domestic partner, 

Unaided senior parent or his/her child, 

Excluded father in a Pregnant Woman Only (PWO) case, 

Non-AU Member 

Unaided spouse of an aided child, 

ASP when not included in the AU, 

Unaided half-sibling excluded for no deprivation, 

Potential AU Member determined ineligible prior to Authorization of 

CalWORKs, 

Welfare-to-Work sanctioned, 

Social Security Number (SSN) disqualified, 

Sanctioned for failure to verify citizen or noncitizen status, 

Sanctioned for refusal to assign child support rights, 

Fleeing felon, 

Excluded Member 

Felony drug convict convicted after 12/31/1997, 

Probation or parole violator, 

48-month CalWORKs time expired adult, 

IPV sanction prior to 01/01/1998 and sanction still in place, 

SSI/SSP, SSI only, SSI only, or Cash Assistance Program for Immigrants 

(CAPI) recipient, 

Foster Care (includes Federal, State, or local) or Kin-GAP child, 

Non-needy non-parent caretaker relative, 

Spouse of needy or non-needy non-parent caretaker relative, 

Non-person 

Sibling unaided due to age requirement, 

Unrelated adult male or female who does not have a mutual child with the 

parent of an aided child, 

Unaided, unmarried parent of a mutual child unaided for no deprivation 


Overview 

Temporary Absence 

Introduction Any member of the Assistance Unit (AU) may be considered temporarily 

absent from the home. When an AU member meets the temporary absence 

requirements, he/she can continue to receive CalWORKs. This section 

covers the requirements that must be met for a person to be considered 

temporarily absent from the AU. 

Reference The following reference is applicable to the information under this topic: 

• EAS 82-812 



Temporary Absence of a Family Member 3-30 

Temporary Absence: Exceptions to the Rule 3-31 

Examples of Temporary Absence 3-33 


Temporary Absence of a Family Member 

Introduction Any member of the family can be temporarily absent from the home. This 

section will assist in determining: 

• Temporary absence versus long-term absence from the home, 

• When to continue to issue cash aid for a family member who is absent, 

and 

• When to count income and resources of a family member who is absent. 

The basic rule A family member can be absent from the home for one full calendar month 

and still: 

• Retain the assigned classification in relationship to the Assistance Unit 

(AU), 

• Remain eligible to CalWORKs during the absence, and 

• Adhere to program participation and verification requirements. 

Determining 

factors 

One full 

calendar month 

time limit 

After a person has been gone for one full calendar month that person 

becomes ineligible to CalWORKs, unless an exception is met. 

Discontinuances follow the family composition change rules of Voluntary Midquarter 

changes. 

The following factors will be considered when determining temporary 

absence status. A single factor may not be conclusive. The factors include, 

but are not limited to: 

• The actual family circumstances even if they are inconsistent with a court 

custody order, 

• If the caretaker relative is involved in making the major and minor 

decisions regarding the child, 

• If the person has the ability to return or the caretaker relative has the 

ability to require the return of the child to the home, 

• If the person intends to return to the home, or 

• If the person is contributing to the costs for the child’s needs. 

Any member of the AU will be considered temporarily absent when absent 

from the home for one full calendar month or less. 

People who are absent for longer than one full calendar month become 

ineligible to CalWORKs cash aid unless they meet one of several specific 

exceptions. People who meet an exception remain eligible to their portion of 

the CalWORKs cash grant during the absence. 


Temporary Absence: Exceptions to the Rule 

Introduction This section contains information regarding the exceptions to the one full 

calendar month rule for temporary absence. Persons who meet the 

exception will continue to be aided in the CalWORKs Assistance Unit (AU). 

Exceptions to 

the one full 

calendar month 

rule 

People who meet the exceptions to the one full calendar month rule: 

• Retain the assigned classification in relationship to the AU 

• Remain eligible CalWORKs during the absence, and 

• Must adhere to verification requirements and program participation as 

closely as possible. 

Refer to the chart below for situations where an AU member may remain 

absent and eligible for cash aid for more than a calendar month. 

When the person is… And… Then… 

Incarcerated on the first day Will remain so for a full The person is considered 

of a month, 

calendar month or more, permanently absent. 

A child, In a public hospital, The child may be gone for 

two full calendar months and 

be considered temporarily 

absent. 

Any hospitalized person other Is in a medical hospital, The person is considered 

than a child in a public psychiatric care facility, or temporarily absent for the 

hospital, 

drug and/or alcohol 

duration of the hospital stay 

rehabilitation treatment however long that stay may 

facility, 

be. 

Absent due to employment, The person is considered 

temporarily absent for the 

duration of the employment, 

Absent attending school, There is no school with the The person is considered 

including vocational school same program in the vicinity, temporarily absent for the 

leading to employment, 

duration of the educational 

program. 

A child who attends a school The child has a current The child shall be considered 

that meets the special need Individualized Education Plan temporarily absent for the 

of the child, 

(IEP), and no school that 

meets the child’s needs is 

located close enough to the 

child’s home to allow the child 

to live at home, 

duration of the schooling. 

A child temporarily in a group • The home does not The child is considered 

home due to a crisis situation receive Foster Care funds temporarily absent for the 

as determined by Children’s for the child, and 

duration of the crisis. 

Services staff, 

• The caretaker continues 

to have care and control 

of health and welfare 

decisions for the child, 



Temporary Absence: Exceptions to the Rule, Continued 

Public 

hospitals 

There are 22 designated public hospitals in California. Theses 22 hospitals 

are: 

• Alameda County Medical Center 

• Arrowhead Regional Medical Center (ARMC) 

• Contra Costa Regional Medical Center 

• Kern Medical Center 

• LA County Harbor/UCLA Medical Center 

• LA County Martin Luther King Jr. Charles Drew Medical Center 

• LA County Olive View UCLA Medical Center 

• LA County Rancho Los Amigos National Rehabilitation Center 

• LA County University of Southern California Medical Center 

• Natividad Medical Center 

• Riverside County Regional Medical Center 

• San Francisco General Hospital 

• San Joaquin General Hospital 

• San Mateo Medical Center 

• Santa Clara Valley Medical Center 

• Tuolomne General Hospital 

• UC Davis Medical Center 

• UC Irvine Medical Center 

• UC San Diego Medical Center 

• UC San Francisco Medical Center 

• UC Los Angeles Medical Center (includes Santa Monica/UCLA Medical 

Center) 

• Ventura County Medical Center 


Examples of Temporary Absence 

Introduction This section includes a series of examples of temporary absence. Use these 

examples to assist in determining whether or not a family meets the 

temporary absence requirements. In Quarterly Reporting, a person leaving 

the home is a Voluntary and not a Mandatory Report. 

Example 1: the 

funeral 


family reunion 


big fight 

Example 4: 

parent in drug 

rehab 

Situation: A mother, in a Cycle 1 family, leaves to be with relatives on April 

16 th after a death in the family and returns home on May 27 th . 

Action: The mother remains eligible for May because she was not absent 

for a full calendar month. Additionally, the mother left in a Data Month (April) 

and returned prior to the end of the quarter (May 31 st ). 

Situation: A mother, in a Cycle 1 family, leaves to be with her relatives for a 

family reunion on April 16 th and does not return until June 3. 

Action: Since the mother left the home is a Data Month (April) and did not 

return until after the end QR Payment Quarter (May 31 st ), the mother is 

ineligible to CalWORKs beginning June 1 st . 

Note: Had the family been Cycle 2, the mother would have left in a Begin 

Month (April) returned home in a Submit Month (June) prior to the end of the 

QR Payment Quarter. No ineligibility would have occurred. 

Situation: A couple has an argument on April 27 and the father of the 

children leaves. The couple reconciles and the father returns on May 25. 

Action: Because the father was not absent for a full calendar month, the 

father remained eligible the whole time he was absent. 

Situation: A father, in a Two-Parent Cycle 2 family, goes into a drug 

rehabilitation treatment facility on April 15 th . He is expected to be out of the 

home for at least three months. 

Action: A person in a drug or alcohol rehabilitation treatment facility is 

considered temporarily absent for the duration of the stay. The father 

remains eligible to CalWORKs while he is in the in facility as long as he 

meets all of the eligibility requirements. 



Examples of Temporary Absence, Continued 

Example 5: 

summer with 

Dad 

Situation: A child, in a Cycle 1 family, goes to visit his father on June 10 

and returns to the home on August 29 to go back to school. 

Action: Since the child left the home is a Submit Month (June), any action to 

discontinue the child would not be taken until the end of the Quarter in which 

the QR 7 on which the child leaving must be reported is received (August QR 

7 due in September), as the child leaving the home is a Voluntary midquarter 

change. Because the child was back in the home by the end of that 

quarter (September 30 th ), no action to discontinue will be taken. 

Note: Had the family been Cycle 2, the child would have left the home in a 

Data Month (June) and returned to the home in the following Begin Month 

(August). The child is ineligible after July 31 (end of the QR Payment 

Quarter). When the child returns, the mother must apply to add him back to 

her case. 




CHAPTER 4 

Children and Eligibility 

Overview ........................................................................................................................4-1 

Age Requirements .........................................................................................................4-3 

Proof of Child’s Age .......................................................................................................4-4 

Verifying a Child’s Age ...................................................................................................4-6 

Eligibility Requirements: 18 Year-Olds..........................................................................4-7 

18 Year-Olds with Disabilities ........................................................................................4-9 

Maximum Family Grant (MFG): Overview and Definitions...........................................4-13 

MFG: Applying the MFG Rule and Exemptions ...........................................................4-15 

MFG: Verifying Exemptions .........................................................................................4-17 

MFG Determinations – Examples of Family Situations................................................4-18 

MFG: Eligibility Requirements......................................................................................4-20 

MFG Financial Eligibility and Grant Determination Rules ............................................4-21 

MFG Child Only AU......................................................................................................4-22 

Immunizations ..............................................................................................................4-24 

Verification of Immunization: The First Two Months of Aid .........................................4-26 

Verification of Immunization: On-going Cases .............................................................4-28 




Immunization Penalty...................................................................................................4-29 

Imposing the Immunization Penalty .............................................................................4-30 

Family Member Changes During a Penalty Period ......................................................4-31 

School Attendance: Overview and Definitions .............................................................4-32 

School Attendance: Policy ...........................................................................................4-33 

School Attendance: Rules............................................................................................4-34 

School Attendance: Verification ...................................................................................4-36 

School Attendance: Penalty .........................................................................................4-38 

School Attendance: Imposing the Penalty ...................................................................4-40 

School Attendance: Family Member Changes During a Penalty Period......................4-41 

Minor Parents...............................................................................................................4-42 

Minor Parents Case: Establishing the Payee...............................................................4-43 

Forms: Minor Parent in an Acceptable Living Arrangement.........................................4-44 

Exemptions from the Acceptable Living Arrangement Requirement............................4-46 

Minors Living Independently ........................................................................................4-48 

Children and Family Services (CFS) Referrals ............................................................4-50 

Summary: Examples of Required Forms .....................................................................4-52 

Completing Casework after the CFS Referral..............................................................4-53 

CFS Referral Locations................................................................................................4-55 

When the Second Parent of the Minor Parent Moves In..............................................4-56 

Minor Parent Turns 18 .................................................................................................4-57 

Teens Turning 18 Years Old – Seamless Determination Eligibility..............................4-58 




The Cal-Learn Program .............................................................................................4-64 

Cal-Learn Referral Procedures ..................................................................................4-68 

Cal-Learn Registration ...............................................................................................4-70 

Beginning Cal-Learn Participation..............................................................................4-71 

Cal-Learn Supportive Services ..................................................................................4-74 

Cal-Learn Bonuses and Penalties..............................................................................4-85 

Cal-Learn Bonuses ....................................................................................................4-87 

Cal-Learn Penalty ......................................................................................................4-88 

Ending Cal-Learn Participation ..................................................................................4-90 




MARCH 15, 2013 

SUBJECT: Cal-Learn Program Reinstatement 

DISTRIBUTION: CalWORKs, Employment 

Services, Child Care, 

TAD Office Procedures 

FILE: CWPHB – In Front of Chapter 4 

ESPHB – In Front of Handbook 

TOPHB – In Front of Handbook 

CCPHB – In Front of Handbook 



Overview The California Department of Social Services (CDSS) released All County 

Letter (ACL) 12-60 instructing counties to reinstate the Cal-Learn program. 

The purpose of this Interim Instruction Notice (IIN) is to update previous 

information issued, remove the Cal-Learn program from the Employment 

Services Program (ESP), and return all case actions back to the Cal-Learn 

Eligibility Worker (EW). All previous Cal-Learn regulations have been 

reinstated, including the issuance of bonuses and Cal-Learn penalties. 

Along with this change, new vendors have been chosen to provide case 

management services through 6/30/13; further instructions will be issued 

when vendor information and duties change. 

Obsolete The information in this IIN obsoletes Cal-Learn information provided in the 

following: 


IIN #12-081 

IIN #13-002 

Content This IIN contains the following topics: 


Transition Process 2 

Case Management Vendors 4 

The Cal-Learn Program 6 

Cal-Learn Registration 10 

Cal-Learn Participation 12 

Cal-Learn Supportive Services 15 

Bonuses and Penalties 26 

Ending Cal-Learn Participation 31 


IIN #13-011 (03/13) DM:SMB:ker PAGE 1 OF 32

Transition Process 

Overview This section provides information regarding the transition of cases assigned 

the Pregnant and Parenting Teen (PPT) indicator in C-IV from the 

Employment Services Program (ESP) to the Cal-Learn program. 

Transition from 

ESP to 

Eligibility 

Temporary 

vendor 

transition 

duties 

Vendor 

referrals 

Discontinued 

Cal-Learn 

cases 

Cal-Learn 

cases not 

referred to 

vendors 

Cal-Learn cases have transitioned from ESP back to a shared responsibility 

between the Cal-Learn Eligibility Worker (EW) and a Case Manager through 

a designated Cal-Learn vendor. Each vendor was provided a list of active 

Cal-Learn teens requiring case management services. 

Cal-Learn cases forwarded to the vendor will be provided the following forms 

by the Case Manager: 

Cal-Learn Registration Program Information Orientation 

Appointment (CL 1) 

Cal-Learn Program Requirements (CL 2) 

Cal-Learn Notice of Report Card Submittal Schedule (CL 8) 

Names of active Cal-Learn teens were forwarded to the appropriate vendor 

for case management services, and an informational flyer regarding program 

transition was mailed to each participant. 

New Cal-Learn teens must attend orientation with the Cal-Learn EW but will 

not be referred to a Cal-Learn vendor. For additional information, see the 

“Cal-Learn orientation” block in this Interim Instruction Notice (IIN). 

A list will be compiled by the Legislative Research Unit (LRU) on the third 

working day of each month, which will include all Cal-Learn cases which 

have been discontinued the previous month. This list titled “Cal-Learn 

Discontinuance” will be: 

Posted to the C-IV Resource Center: Where Cal-Learn EWs are to 

review and ensure that a CL 700 was sent to the assigned Cal-Learn 

vendor informing them of the discontinuance. 

E-mailed to both Cal-Learn vendors 

Some Cal-Learn cases were not referred for case management services but 

must continue to participate in the program. Teens not referred to a Case 

Manager are still subject to Cal-Learn regulations and are eligible to many of 

the Cal-Learn program resources, such as: 

Bonuses, 

Bus passes/mileage reimbursement, and 

Ancillary services. 

Cal-Learn EWs will receive report cards and determine eligibility accordingly, 

but will not impose any penalties on teens who have not been referred to a 

case management vendor. 



Transition Process, Continued 

Deregistering 

the WTW 

program 

Restoring 

sanctioned 

Cal-Learn 

teens 

All Cal-Learn teens with an open WTW program must be deregistered from 

WTW no later than 3/31/13. A list titled “Active Cal-Learn with Open WTW”, 

has been posted to the C-IV Resource center, which includes Cal-Learn cases 

with an open WTW program. Employment Service Specialists (ESSs) must 

complete the following to deregister Cal-Learn WTW programs: 

Step Action 

1 Access the Cal-Learn case in C-IV. 

2 Determine the case has an open Cal-Learn program in C-IV. 

3 Complete the following on the Work Registration Detail page: 

End Date:12/31/12 

Retain the current work registration Status of either 

Mandatory or Exempt, and 

Ensure the PPT Indicator on the Work Registration Detail 

page remains “Yes”. 

4 Go to the WTW Status Detail page and add: 

Status=Deregistered, and 

Status Reason=Not Currently WPR. 

Note: Ensure the PPT Indicator on the WTW Program Detail 

page remains “Yes”. 


All pregnant/parenting teens (otherwise known as Cal-Learn teens) currently 

sanctioned in the WTW program must have benefits restored as of 1/1/13. 

The reinstatement of the Cal-Learn program invalidates the WTW imposed 

sanctions with penalties being assessed by the designated Case Manager and 

Cal-Learn EW. 


Case Management Vendors 

Overview This section contains information regarding the Cal-Learn case management 

vendors. 

Case 

management 

vendors 

Prior to the suspension of the Cal-Learn program, case management 

services were facilitated by the Maternal, Child, Adolescent Health (MCAH) 

program. New vendors have now been assigned this duty, with the following 

agencies designated to handle case management services for the Cal-Learn 

program: 

Aspiranet 

Walden Family Services 

Case flags Eligibility Workers (EWs) will no longer create a Special Need and Referral 

in C-IV indicating Walden or Aspiranet as the case management provider. 

EWs will use the following case flags to track referred Cal-Learn cases in 

C-IV: 

Cal-Learn: Walden 

Cal-Learn: Aspiranet 

Case flag list A list of active Cal-Learn cases that have been referred to Walden or 

Aspiranet, titled “Active Cal-Learn Cases”, has been posted to the C-IV 

Resource Center. This list must be reconciled no later than 3/31/13. EWs 

must complete the following: 

Step Action 

1 Access the case in C-IV. 

2 Select the Case Flag link from the Task Navigation bar. 

3 Click the Add button, to add a case flag. 

4 Click the Select button under Title. 

5 Select the radio button next to one of the following case flags, as 

appropriate: 

Cal-Learn: Walden 

Cal-Learn: Aspiranet 

6 Click the Select button. 

7 Complete the following on the Case Flag Detail page: 

Name: Select the Cal-Learn teen’s name 

Begin Date: Date the teen was referred for case 

management services. 

Notes: Type “Cal-Learn teen referred to (vendor’s name) 

for case management services”. 

Click Save 




Case Management Vendors, Continued 

Referrals Cal-Learn EWs will not refer cases to either Cal-Learn vendor. Each vendor 

was provided a list of cases requiring services, and additional referrals must 

not be forwarded by Cal-Learn EWs. 

Contacting the 

Cal-Learn 

vendor 

When communicating with a Case Manager, use the following vendor 

contact information: 

Vendor Contact Email Address Phone 

Name 

Number 

Aspiranet Henry McKee hmckee@aspiranet.org (909) 

Jamie Cooks jcooks@aspiranet.org 890-9022 

Ex. 3535 

Walden 

Family 


Leslie Miles lmiles@waldenfamily.org (951) 

Mary Frame mframe@waldenfamily.org 

788-5905 

Fax 

Number 

(909) 

890-3672 

(951) 

788-5903 

Mailing Address 

164 W. Hospitality 

Ln. Suite 1 

San Bernardino, CA 

92408 

3576 Arlington Ave 

#106 

Riverside, CA 92506 


The Cal-Learn Program 

Overview This section contains general information regarding the Cal-Learn program. 

Cal-Learn 

program- 

general 

A parent’s lack of basic education is a major barrier to self-sufficient families. 

When teens start families before they graduate from high school or obtain an 

equivalent (General Education Development - GED), the likelihood the family 

will live in poverty and rely on public assistance is greater than for those 

families where the parents have at least a high school education. 

The goal of the Cal-Learn program is to guide pregnant and parenting teens 

toward achieving a high school diploma. To assist in accomplishing this 

goal, teen parents may receive: 

Case management services through one of the designated vendors 

(Aspiranet or Walden Family Services) who provide guidance in obtaining 

educational, health, and social services. 

Supportive services through the Transitional Assistance 

Department (TAD) CalWORKs Eligibility Worker (EW), such as 

transportation, school supplies and child care to help overcome obstacles 

to school attendance. 

Financial bonuses or penalties through the CalWORKs Eligibility 

Worker (EW), based on school performance. 

Definitions The following are definitions pertaining to the Cal-Learn program: 

Cal-Learn criteria: All CalWORKs pregnant and parenting teen/pre-teen 

custodial parents must participate in the Cal-Learn program unless they are 

exempt, deferred, or have a high school diploma or equivalent. 

Cal-Learn teen: Any customer in the Assistance Unit (AU) who is pregnant 

and/or a parent, under the age of 19, who does not have a high school 

diploma or equivalent (GED). 

Case management services: A designated Cal-Learn vendor will provide 

assistance to teen/pre-teen parents to obtain educational services necessary 

to earn a high school diploma or equivalent. These may include health 

services, parenting skills or suitable living arrangements. 

Deferral: Cal-Learn requirements are suspended while a Cal-Learn teen 

has a condition that temporarily prevents full-time school attendance. Case 

management services will continue during the deferral period. 

Exemption: A teen parent may not be registered for Cal-Learn services 

when circumstances prevent full-time school attendance for more than three 

months. Case management services are not provided to teen parents 

exempt from Cal-Learn. 

Supportive Services: Services that assist the Cal-Learn teens in attending 

school regularly, such as child care and transportation costs. 



The Cal-Learn Program, Continued 

Who must 

participate in 

Cal-Learn 

Next steps 

when a teen 

earns a 

diploma or 

turns 20 

Cal-Learn EW 


Cal-Learn is mandatory for AU members who meet all of the following 

conditions: 

Under 19 years old, 

Pregnant or a parent residing with his/her child, 

Included in the same AU as his/her child, and 

Have not earned a high school diploma or equivalent. 

Teens who meet the Cal-Learn criteria must participate in the Cal-Learn 

program unless exempted or deferred. Teen parents who turn 19 years old 

while they are in the Cal-Learn program and have not graduated from high 

school or its equivalent may participate in the program until they turn 20 

years old. 

When the teen parent earns a high school diploma or equivalent, or turns 

20 years old, he/she is referred to Welfare to Work (WTW) activities 

through the Employment Services Program (ESP). Although the former 

Cal-Learn customer may become exempt from meeting ESP requirements, 

he/she is expected to continue working toward becoming a financially 

self-sufficient family through employment. 

Specialized EWs manage the Cal-Learn programs. This worker is referred 

to as the Cal-Learn EW. The job responsibilities of the Cal-Learn EW 

include, but are not limited to: 

Carrying the CalWORKs program with the teen’s Cal-Learn program. 

Interfacing with designated case managers about the needs and 

welfare of referred Cal-Learn teens. 

Completing the Cal-Learn Orientation with the teen. 

Communicating with Cal-Learn teens about program eligibility, issuance 

of support services, and bonuses/penalties. 

Authorizing and issuing supportive services. 

Administering bonuses and penalties. 

Referring teens to ESP when they are no longer required to participate 

in Cal-Learn 

Note: Penalties may only be imposed on Cal-Learn teens who have been 

referred to a case management vendor. Teens not receiving case 

management services are not subject to a penalty. 




Cal-Learn 

eligibility 

criteria 

When to refer 

teen parents to 

Cal-Learn 

Voluntary 

Cal-Learn 

participation 

Cal-Learn 

Self-Appraisal 

form (CL 27) 

All pregnant (even if not receiving Pregnancy Special Needs (PSN)) and 

parenting teens who do not have their high school diploma will be eligible to 

receive Cal-Learn program resources (up to their 19 th birthday). 

Teens who meet the Cal-Learn criteria must participate in the Cal-Learn 

program unless exempt or deferred. 

EWs review for Cal-Learn eligibility at: 

Application, reapplication, or restoration 

Annual Re-evaluation (RE) 

Report of pregnancy 

Report of the birth of a child 

Inter-County Transfer (ICT) in 

Note: The Cal-Learn program may be created manually by the EW, or 

automatically in C-IV when Eligibility Determination Budget Calculation 

(EDBC) is run, accepted and saved. Automation of the Cal-Learn program 

ensures all parenting and pregnant teens are referred to the Cal-Learn 

program so that their required participation and services are met. C-IV 

creates an automated Journal entry when the 

Cal-Learn program is automatically opened. 

Current or former Cal-Learn teens who are 19 years old and attending school 

full-time may volunteer to participate in the Cal-Learn program up to age 20. 

The chart below instructs the EW about how to continue services for 

voluntary Cal-Learn participants: 

If the Cal-Learn teen was… Then the EW must… 

Previously referred to a Advise the designated Case Manager to 

Cal-Learn vendor, 

continue participation. 

Not previously referred to a Not refer to a case management 

Cal-Learn vendor, 

vendor, and 

Allow the teen access to Cal-Learn 

resources up to age 20. 

The Cal-Learn Self Appraisal (CL 27) form is completed for all pregnant and 

parenting teens receiving CalWORKs at application or when a 

pregnant/parenting teen is identified as living in the home. This form is used 

to determine the teen’s eligibility to participate in the Cal-Learn program. 




Teen parent of 

a Maximum 

Family Grant 

(MFG) child 

Many families are aware of the Maximum Family Grant (MFG) rule, which 

states that benefits will not increase for any child born into a family that has 

received cash aid continuously for 10 months prior to the birth of the child. 

Even though cash assistance may not increase, the newborn is still 

considered an AU member for eligibility purposes. Therefore, the pregnant 

and/or parenting teen cash aid customer must participate in the Cal-Learn 

program. 

It is important for staff to remind customers to report any pregnancy in the 

family. 

Note: For more information regarding MFG children, including the nested 

teen, see the “MFG” and “Teens Turning 18 Years Old – Seamless 

Determination of Eligibility” sections of the CalWORKs Policy Handbook 

(CWPHB). 


Cal-Learn Registration 

Overview This section contains information regarding the Cal-Learn registration 

process. 

Registration 

and approval 

process 

Reverse 

referral 

Cal-Learn 

Forms 

The Cal-Learn registration and approval process is described in the table 

below: 


1 Intake Eligibility Worker (EW) or C-IV system identifies the pregnant 

or parenting teen. 

2 Intake EW: 

Completes the electronic Cal-Learn Self-Appraisal (CL 27) form, 

using information provided by the teen. 

Processes the CalWORKs application. 

3 Intake EW or C-IV system opens the Cal-Learn program. 

4 Intake EW assigns program to the Cal-Learn EW. 

Reverse referrals will not be received from the Cal-Learn vendors. In the 

event that a Cal-Learn teen contacts a Cal-Learn vendor, he/she will be 

referred to the local district office. 

The following table lists the required Cal-Learn forms to be sent by the 

Cal-Learn EW, as appropriate: 

Form 

Number 

Form Name 

CL 1 Cal-Learn Registration Program Information Orientation Appointment 

CL 2 Cal-Learn Program Requirements 

CL 3 Cal-Learn Notice of Participation Problem 

CL 4 Cal-Learn Notice to Parent/Legal Guardian of Cal-Learn Participant 

CL 8 Cal-Learn Notice of Report Card Submittal Schedule 

CL 9 Cal-Learn Notice of Good Cause Determination 

NA 310 Cal-Learn Exemption/Deferral Notice 

CL 11 Cal-Learn Notice of Incomplete Grades 

CL 15 Cal-Learn Case Management Information Intercounty Transfer Form 

CL 16 Cal-Learn Case Management Information Intercounty Transfer Form 

CL 27 Cal-Learn Self Appraisal Form 

CL 700 Cal-Learn Communication Form 

CL 753 Cal-Learn Travel Claim form 

CL 735.2 CalWORKs Attendance Report form 

NA 113 Approval/Denial Supportive Services-Cal-Learn 

NA 374 Cal-Learn Sanction 

NA 836 Discontinuance of Supportive Services-Cal-Learn 

NA 370 Discontinuance/Cal-Learn 

NA 373 Cal-Learn Bonus 



Cal-Learn Registration, Continued 

Report card 

submittal 

schedule 

Sending 

encrypted 

emails 

Cal-Learn 

orientation 

The Cal-Learn EW must contact the school where the teen is attending to 

determine when report cards are issued. Once the report card schedule is 

obtained, the Cal-Learn EW will complete the CL 8 indicating the report card 

is due to the Cal-Learn EW or Case Manager (if assigned) 10 days after the 

date the school issues the report card. 

All forms/information containing Personally Identifiable Information (PII) 

e-mailed to the Cal-Learn vendor must be encrypted by typing the following 

phrase in the e-mail subject line: 

“Encrypted Email from the County of San Bernardino.” 

Note: When Utilizing the encryption method, the word “Email” must be 

capitalized and must not include a hyphen or the encryption method will not 

function properly. 

The Cal-Learn EW will conduct orientation on all new Cal-Learn cases. The 

Cal-Learn EW will contact the teen to schedule the Cal-Learn orientation (via 

the CL 1) within five business days of receiving the case. 

When the teen… Then the Cal-Learn EW… 

Completes orientation, Completes and/or provides the following 

forms to the customer: 

CL 2, 

CL 8, and 

CL 27. 

Fails to attend orientation, Sends the following forms to the customer: 

CL 2, 

CL 3, 

CL 4, and 

CL 8. 


Cal-Learn Participation 

Overview This section contains information regarding Cal-Learn participation and the 

exemption and deferral process. 

Cal-Learn teen 

participation 

Deferrals or 

exemptions 

Cal-Learn teens who are not exempt must participate in the program. The 

Cal-Learn teen must: 

Attend orientation 

Cooperate with the designated Case Manager (as appropriate), 

Attend school or equivalent activities 

Maintain an acceptable Grade Point Average (GPA) 

The consequence for failing to participate without good cause is a penalty 

applied each time the report card is due. No other punitive action can be 

taken. 

Note: Penalties are only applied to Cal-Learn teens who have been referred 

to a Case Manager. 

Occasionally a teen may advise the Case Manager or Cal-Learn Eligibility 

Worker (EW) of a problem that keeps him/her from attending school. The 

Case Manager or Cal-Learn EW works with the teen to resolve the problem 

or comes up with the best solution for the teen. In some cases the Cal-Learn 

teen may need to be evaluated for an exemption or deferral: 

Exempt because of circumstances that prevent full-time school 

attendance for more than three months. 

Example: Teen needs transportation and no services are available for a 

period of four months. Teen is not registered for Cal-Learn services. 

Defer because of a condition that temporarily prevents full-time school 

attendance. 

Example: Teen gives birth and doctor requests post-partum recovery 

period. Cal-Learn requirements are suspended, but teen is registered for 

Cal-Learn and is provided services by the designated Case Manager. 

Teen parents who are exempt from Cal-Learn will not receive any services 

provided by the Cal-Learn vendor. Because of this, it is very important that 

exemption reasons and solutions be explored thoroughly prior to approval. 

Whenever possible, defer the teen rather than exempting him/her from 

the program. 

Note: When a teen is assigned a Case Manager, the Cal-Learn EW will be 

notified via the CL 700 of any deferral/exemption requests; otherwise the 

Cal-Learn EW will determine if a teen is eligible to be exempt or deferred 

from program requirements. 



Cal-Learn Participation, Continued 

Evaluating for a 

deferral or 

exemption 

The table below outlines circumstances when a Cal-Learn teen may be 

eligible to an exemption or deferral: 

Exemption Deferral 

Has an extended illness (over three 

months) or physical disability 

preventing school attendance. 

Expelled from school and enrollment 

in another school cannot be 

arranged. 

Cannot obtain child care or 

transportation for three or more 

months. 

Receives Foster Care benefits. 

Needs supportive services which are 

temporarily unavailable. 

Has a special need that deprives the 

teen the ability to meet the program 

requirements. 

Recovery time following child birth. 

Note: Cal-Learn EWs must not defer Cal-Learn teens who have not been 

referred to case management vendors. All Cal-Learn program resources are 

available to Cal-Learn teens; see the “Cal-Learn cases not referred to 

vendors” block in the “Transition Process” section of this IIN. 



Cal-Learn Participation, Continued 

Deferral and 

exemption 

process 

The Cal-Learn deferral and exemption process is described in the following 

table: 


1 Cal-Learn teen tells the designated Case Manager or Cal-Learn 

EW of problems preventing full time school attendance, and: 

If the teen contacts the… Then 

Case Manager, Go to step 2. 

Cal-Learn EW, Go to step 3. 

2 Designated Case Manager discusses the problem with the teen to 

determine if a solution can be found. 

If a solution… Then the Case Manager will… 

Can be found, Stop here, the teen does not need to be 

exempt or deferred from the program. 

Cannot be found, E-mail a CL 700 form, referring the teen 

to the Cal-Learn EW to be evaluated for 

a deferral or exemption. 

3 Cal-Learn EW: 

Evaluates the situation by : 

Reviewing the received CL 700 (if received from the Case 

Manager), 

Discussing the problem with the Cal-Learn teen and Case 

Manager, as appropriate. 

Obtains any necessary verification. 

Approves or denies a deferral or exemption as appropriate. 

Sends a NA 310 - Cal-Learn Notice of Exemption/Deferral to 

the teen. 

Immediately e-mails CL 700 to the Case Manager advising 

him/her of the approval or denial, as appropriate. 

Journals actions in C-IV. 

Sets a Task for one month prior to the deferral/exemption 

expiration date. 

Note: When a Cal-Learn teen who has been referred to a Case 

Management vendor is subsequently exempted, the Case Flag must be end 

dated. 


Cal-Learn Supportive Services 

Overview This section contains information regarding Cal-Learn Supportive Services. 

Supportive 

services 

Supportive services for Cal-Learn teens include: 

Child Care: Provided through the Transitional Assistance Department’s 

(TAD’s) Child Care Eligibility Workers (EWs). 

Transportation: Bus passes and tickets, parking, etc. 

Ancillary: Vouchers issued to Cal-Learn teen to cover education 

expenses, which may include: General Education Development (GED) 

fees, gym clothes, school supplies, books, and back packs (if school 

lockers are not available). 

Note: Tuition is not a covered supportive service expense. 



Cal-Learn Supportive Services, Continued 

Cal-Learn Child 

Care 

Cal-Learn 

Transportation 

The following table describes the Child Care process: 


1 Cal-Learn teen discusses Child Care need with the Case Manager or the Cal- 

Learn EW. 




2 Designated Case Manager refers the teen to the Cal-Learn EW by forwarding a 

CL 700 requesting Child Care. 

3 Cal-Learn EW refers the teen to a Child Care EW either by completing a CL 700 

or by forwarding the CL 700 which had been received from the assigned Case 

Manager. 

If the Cal-Learn EW… Then he/she… 

Receives a CL 700 from the Forwards the CL 700 to the 

assigned Case Manager, 

designated Child Care EW. 

Does not receive the CL 700 

(because the Cal-Learn teen has 

not been referred to a Cal-Learn 

vendor), 

 

 

Completes a CL 700, and 

Forwards to the designated Child 

Care EW. 

4 Child Care EW: 

Contacts Cal-Learn teen and Child Care provider. 

Writes child care contract. 

Sets up Child Care program in C-IV. 

E-mails a CL 700 to the Cal-Learn EW and designated Case Manager (if 

applicable) advising of child care contract and expiration date of services. 


Journals Child Care services are provided. 

Advises the Child Care EW of any changes to the CalWORKs and Cal- 

Learn programs that may affect the Child Care program. 

6 Cal-Learn teen: 

Contacts the Child Care EW once child care services are requested. 

Signs child care contract. 

Complies with Child Care program requirements. 

7 Child Care EW completes Service Agreement to issue benefits. 

Often the Cal-Learn teen requires transportation to school and to take his/her 

child to the child care provider. The Cal-Learn EW must choose the least 

costly form of transportation to meet the needs of the Cal-Learn teen. 

Normally the issuance of a bus pass is the best choice for transportation. If 

bus transportation is not available, reimbursing mileage for the use of a 

personal vehicle may be necessary. In very infrequent occasions, gas card(s) 

may be provided as a temporary solution. 




Bus Passes or 

tickets 

Whenever possible, bus passes or tickets are provided to the Cal-Learn teen. 

The following table describes the transportation process: 


1 Cal-Learn teen discusses transportation need with his/her 

designated Case Manager or Cal-Learn EW. 




2 Designated Case Manager refers the Cal-Learn teen to the 

Cal-Learn EW for bus pass issuance. 


Approves transportation request. 

Completes a Service Arraignment in C-IV. 

Sends an e-mail to the appropriate District Issuance Inbox, 

requesting the AIOA to issue a bus pass. 

Advises Cal-Learn teen that transportation was approved and 

when to pick up. 

Sends a CL 700 to the designated Case Manager (if applicable) 

confirming the issuance of a bus pass. 

4 Authorized Issuance Office Assistant (AIOA) issues bus passes to 

the Cal-Learn teen in the district office according to the procedures 

in the TAD Office Procedures Handbook (TOPHB). 


Picks up bus pass in district office. 

Signs a Valuable Issuance Acknowledgement (FIN 115) 

Signs the bus pass, if required. 




Student ID 

cards for bus 

transportation 

Reimbursement 

for Cal-Learn 


costs 

The Cal-Learn teen may need to show the bus driver student 

identification (ID) when using a bus pass. If the school does not issue 

student ID cards, Human Services (HS) Personnel will make a Cal-Learn 

Student ID card for the Cal-Learn teen. When referring the Cal-Learn teen to 

HS Personnel to obtain a student ID card, advise the teen: 

To call HS Personnel at (909) 386-3700 to set up an appointment. 

Student IDs are made every Tuesday at 9 a.m. 

The ID card will have the Cal-Learn teen’s name and “TAD Cal-Learn” 

printed on it with the teen’s picture. It does not expire. 

For districts served by Victor Valley Transit Authority: 

The Issuance Clerk will automatically issue Victor Valley Transit Authority 

Student IDs to all Cal-Learn teens who receive a bus pass. 

The ID card will have the Cal-Learn teen’s name, the word “Cal-Learn” 

and the effective dates. 

The ID card is good for four months. A new card must be issued upon 

expiration. 

In certain circumstances it may be necessary to reimburse the Cal-Learn 

teen for travel costs to go back and forth to school and to go to the child 

care provider. Prior approval from the designated Case Manager and 

Cal-Learn EW is required. Travel costs may be reimbursed for: 

Use of a personal vehicle when bus transportation is not available. The 

reimbursement for personal vehicle use is 38.1 cents a mile. There is 

no capped amount. 

Use of a personal vehicle when bus transportation is available. The 

Cal-Learn teen will be reimbursed the cost of a local bus pass. 

Parking, if required for school activity. The Cal-Learn teen must provide 

verification unless metered parking. There is no capped amount. 

Bus fare, if not supplied by the TAD office. The Cal-Learn teen must 

provide verification. Limited to cost of a local bus pass. 




Steps for 

reimbursing 


The following table describes the process for reimbursing transportation 

costs to the Cal-Learn teen: 


1 Cal-Learn teen discusses need to pay for own transportation and requests expense 

reimbursement with designated Case Manager or 

Cal-Learn EW. 




2 Designated Case Manager refers Cal-Learn teen to the Cal-Learn EW. 


Explains to the Cal-Learn teen how to complete and submit the 

CL 753 Cal-Learn Travel Claim form and CL 735.2 CalWORKs Attendance Report 

form. 

Approves request (may discuss with Case Manager). 

Sends NA 113 to Cal-Learn teen, including enough CL 753 and 

CL 735.2 forms for future months as needed. 

4 Cal-Learn teen, on or after the last day of the month: 

Completes CL 753 for each trip made to school or child care provider. 

Has instructor or school attendance secretary or teacher sign CL 735.2 for each 

school day attended. 

Turns in the above forms with any receipts required to the Cal-Learn EW. 


Reviews CL 753 and reconciles trips reported against the CL 735.2. 

Totals the approved expenses in the “County Use Section” on the CL 753. 

Calculates the reimbursement. 

Images all forms and receipts into the C-IV system. 

E-mails his/her EWSI requesting approval for the travel reimbursement. 

Completes a Need and Service Arrangement in C-IV. 

6 Supervisor approves the payment by replying to the Cal-Learn EW’s e-mail. 


Images a copy into C-IV of the approval e-mail from the designated Supervisor by 

using the ImageNow virtual printer. 

E-mails the appropriate “District Issuance” Inbox, requesting the AIOA to issue the 

travel reimbursement. 

8 AIOA completes the Payment Request Detail page and issues the reimbursement via 

Electronic Benefit Transfer (EBT or warrant. The Issuance Method will be defaulted 

to: 

EBT: When the Payee on the Payment Request is the same as the Payee on the 

active CalWORKs program. 

Warrant: When the CalWORKs program is not active or the Payee on the 

Payment Request is not the same as the Payee on the CalWORKs program. 

9 HS Auditing mails the reimbursement warrant to the Cal-Learn teen within five days 

when Warrant is selected as the Issuance Method. 




Costs for bus 

passes 

The following table below lists the county costs for bus passes. 

Agency Name Operation Hours Type Cost Service Area 

Omnitrans 

909-379-7100 

Web: 

Omnitrans.org 

 

 

 

Weekdays: 4 am – 

10:30 pm 

Saturdays: 6 am – 

8 pm 

Sundays: 8 am – 

6:30 pm 

Daily pass 

31 day pass 

Student pass 

$4.00 

$47.00 (good for 

31 consecutive 

days of use from 

the first day used) 

$35.00 

San 

Bernardino 

Valley 

Victor Valley 

Transit 

760-948-4710 

Web: 

vvta.org 

 

 


9:00 pm 

Saturdays 7:00 am – 

8:00 pm 

Daily bus ticket 

31 day pass – 

suburban 

Adult 

$3.50 

$50.00 

Victor Valley 

Sub area 

Morongo Basin 

Transit 

Authority 

(MBTA) 

1-800-794- 

6282 

Web: 

mbtabus.com 

MV 


760-255-3330 

Weekday service runs for 

approximately 15½ hrs a 

day. 

Saturday service runs for 

approximately 14¾ hrs. 


6 pm 

Saturdays: 9 am – 

6 pm 


suburban 

Student 


County 

Adult 


County 

Student 

County Adult day 

pass 

County Student 

day pass 

Monthly pass 

(good for 30 

days of unlimited 

use within the 

same month) 

$40.00 

$75.00 

$65.00 

$5.50 

$4.50 

$30.00 Adult 

monthly 

$20.00 Student 

monthly 

Morongo 

Basin Sub 

area 

Daily bus ticket $4.00 Barstow area 

Adult monthly $43.00 

and 

bus pass (good 

surrounding 

only in month 

issued) 

communities 

Student monthly 

bus pass 

$38.00 




Costs for bus passes (continued) 


Mountain Area 

Regional 

Transit 

Authority 

(MARTA) 

909-878-5200 

Web: 

 

 

 

Weekdays: 6:35 am – 

6:30 pm 

Saturdays: 6:35 am – 

6:30 pm 

Sundays: 8:45 am – 

6:30 pm 

10-Ride Pass 

Dial a Ride 

Adult Fixed 

Route and Offthe-Mountain 

(OTM) 

$8.50 

$20.00 

$40.00 

$15.00 

San Bernardino 

Mountains and/to 

City of San 

Bernardino – 

service available 

through Redlands 

Employment 

Marta.cc 

Student $7.50 

Services Program 

(ESP) 

Gas Card(s) Gas card(s) will be issued as a temporary solution only. The amount issued 

should be for: 

Approximately a week’s worth of transportation needs, and 

Only until the Cal-Learn teen can pay for her/his own gasoline. 

The Cal-Learn teen must submit a travel claim at the end of the month. 

The value of the gas card(s) will be deducted from that month’s travel 

reimbursement (see “Reimbursement for Cal-Learn transportation costs” 

block in this Interim Instruction Notice (IIN) section.) 

Note: The total value of the gas card(s) issued cannot be more than the cost 

of a local bus pass when bus transportation is available. 




Steps taken to 

issue gas 

card(s) 

Cal-Learn 

ancillary 

services 

Follow the process below to issue gas card(s): 


1 Designated Case Manager or Cal-Learn EW discusses 

transportation needs and appropriateness of gas card(s) to 

temporarily pay for gas with Cal-Learn teen. 


Explains to the Cal-Learn teen how to complete and submit the 

CL 753 Cal-Learn Travel Claim and CL 735.2 CalWORKs 

Attendance Report. 

Approves request after discussion with Case Manager (if 

applicable). 

Determines number of gas card(s) needed. 

Completes Service Arrangement. 

E-mails the appropriate “District Issuances” Inbox. 

Sends a NA 113 with CL 753 and CL 735.2 to Cal-Learn teen. 

Advises the Cal-Learn teen that transportation was approved 

and when to pick up gas card. 

Sends a CL 700 notifying the designated Case Manager (if 

applicable) that the gas card was approved and issued. 

3 AIOA issues the gas cards according to the TAD Office Procedures 

Handbook (TOPHB). 

4 Cal-Learn teen picks up gas card(s) in the district office. 

Ancillary services are offered for education related expenses. The 

designated Case Manager and the Cal-Learn teen determine what expenses 

are needed. Expenses must be related to getting a diploma or GED. A 

request is sent to the Cal-Learn EW to authorize payment to the vendor in 

the form of a voucher. 

Example: Cal-Learn teen requests supplies totaling $37.25 to complete a 

physical science class project. The Cal-Learn EW approves the expenses 

and completes a Service Arrangement in C-IV. 

If unsure about approving a specific request or if the request is other than for 

books and more than $75, contact the Program Development Division (PDD) 

through appropriate channels for guidance. 




Issuing ancillary 

services 

Follow the process below to issue ancillary services. 


1 Cal-Learn teen discusses education needs with Case manager or 

Cal-Learn EW, and: 

Picks out the needed items at the school or store (which 

accepts vouchers). 

Obtains a pre-receipt that lists the items needed, including tax 

and store name and address. 

Turns the pre-receipt into the Cal-Learn EW (Cal-Learn teen 

may call Cal-Learn EW to make arrangements to drop off prereceipt 

and pick up voucher). 

If the teen contacts the… Then he/she… 

Case Manager, E-mails a CL 700 to the Cal- 

Learn EW, recommending 

specific ancillary expenses. 

Cal-Learn EW, Go to stage 2. 


Approves ancillary request. 

Images paperwork into the C-IV system. 

Completes Service Arrangement in C-IV. 

E-mails the appropriate “District Issuances” inbox, requesting 

the AIOA to issue the voucher. 

3 AIOA: 

Prepares voucher per Service Arrangement and pre-receipt. 

Issues voucher to Cal-Learn teen. 

4 Cal-Learn Teen: 

Picks up and signs the Valuable Issuance 

Acknowledgement (FIN 115) and voucher in the district office. 

Purchases supplies or services with voucher. 

5 Store/Service Provider: 

Provides products or services to Cal-Learn teen. 

Accepts and signs voucher. 

Mails voucher to Human Services (HS) Auditing according to 

the instructions found on the back of the voucher. 




Reimbursement 

for ancillary 

expenses 

Occasionally the Cal-Learn teen or his/her parent may purchase ancillary 

services and request reimbursement. The table below lists the process for 

reimbursing ancillary expenses. 


1 Cal-Learn teen discusses education needs with Case Manager or Cal-Learn 

EW, and: 

Turns the original receipt with store name and address into the 

Cal-Learn EW. 

Advises the Cal-Learn EW whose name should be on the reimbursement. 

If the teen contacts the… Then he/she 

Case Manager, E-mails a CL 700 with attached 

receipt to the Cal-Learn EW 

recommending specific ancillary 

expenses. 

Cal-Learn EW, Goes to stage 2. 


Approves ancillary request. 

Images all paperwork into C-IV. 

Completes a Service Arrangement in C-IV. 

E-mails his/her Supervisor requesting approval of the ancillary request. 

3 Supervisor authorizes reimbursement by replying to the Cal-Learn EW’s e-mail. 


Images the Supervisor’s approval e-mail into C-IV using the ImageNow 

virtual printer. 

E-mails the appropriate “District Issuances” inbox to request payment by the 

AIOA. 

5 AIOA issues the reimbursement according to the procedures found in the 

TOPHB. 

Note: When a Cal-Learn teen is not the Payee on the CalWORKs program, 

ancillary services and reimbursements will not be issued via EBT, but will be 

issued as a warrant from HS Auditing. 




Overpayments Supportive services are generally issued in advance to assist the Cal-Learn 

teen in attending school. If the Cal-Learn teen fails to follow-through with 

school or an activity for which supportive services were issued, the 

designated Case Manager (if appropriate) will inform the Cal-Learn EW of 

the teen’s failure to comply with requirements. The Cal-Learn EW must 

process the overpayment in the C-IV system for collection. 

Example: In September, a Cal-Learn teen received school supplies and a 

bus pass. The teen failed to attend school at all during the quarter. The 

value of the school supplies and the bus pass are a collectable 

overpayment. In December, the designated Case Manager sent a CL 700 

to the Cal-Learn EW informing him/her of the noncompliance. 

Note: For additional information, see the overpayment procedures in the 

Income Chapter of the CalWORKs Policy Handbook (CWPHB). 


Bonuses and Penalties 

Overview This section contains information regarding Cal-Learn bonuses and 

penalties. 

Report cards The Cal-Learn teen must submit report cards to the designated Case 

Manager or Cal-Learn EW for evaluation. The teen must submit up to four 

report cards per school year and provide proof when a high school diploma 

or equivalent is received. 

Not passing 

high school 

exit exam 

Good cause 

criteria 

The Cal-Learn teen is eligible to bonuses for acceptable school grades and 

for earning a high school diploma or equivalent. The Cal-Learn teen is also 

subject to penalties for failure to provide report cards, earning a Grade Point 

Average (GPA) below 1.0, or otherwise not cooperating with the 

Cal-Learn vendor. 

Note: Penalties are only imposed on teens who have been referred for case 

management services. 

If a student does not pass the high school exit exam (even though he/she is 

receiving a certificate of completion of high school requirements) and is not 

getting a diploma, he/she is not eligible to receive the $500 bonus or exit the 

Cal-Learn program. The $500 bonus will be issued once documentation is 

received indicating graduation from high school or its equivalent. The 

Cal-Learn Eligibility Worker (EW) will leave the Cal-Learn program open. 

Good cause occurs when an event is beyond the teen’s control and 

substantially deprived the teen of the ability to make adequate progress in 

school, and no home study or other special arrangements could be made 

with the school. 



Bonuses and Penalties, Continued 

Good Cause 

process 

Bonus and 

penalty basics 

The good cause determination process is described in the table below: 


1 Cal-Learn teen tells the designated Case Manager or Cal-Learn EW of 

reasons for not making adequate progress in school. 

If the teen contacts the… Then… 

Case Manager, Go to stage 2. 

Cal-Learn EW, Go to stage 3. 

2 Designated Case Manager: 

Discusses good cause with the teen. 

E-mails a CL 700 form requesting a good cause determination to the 

Cal-Learn EW. 


Reviews the Good Cause determination request. 

Requests verification, when appropriate. 

Approves or denies good cause as appropriate. 

Immediately e-mails the CL 700 to the designated Case Manager (if 

appropriate) advising of good cause determination. 

Sends notice (CL 9) to the teen and head of the Assistance 

Unit (AU) regarding the good cause determination. 

Journals actions in C-IV. 

Bonuses will be issued or financial penalties imposed based on the 

Cal-Learn teen’s progress in school. The following is an overview of the 

bonuses and penalties: 

When the teen… And it is… The Cal-Learn EW will 

authorize… 

Submits a report card 

showing at least a ‘C’ or 

2.0 GPA, 

 

 

Timely, or 

Late with good cause, 

$100 bonus. 

$50 penalty. 


showing a ‘D’ or 1.0 GPA, 


showing an ‘F’ GPA 

(anything under 1.0), 

Fails to submit a report 

card, 

Receives a high school 

diploma or equivalent, 

Late without good 

cause, 

Timely, or 

Neither a bonus or penalty. 

Late with good cause, 

Late without good 

cause, 

$50 penalty. 

Either timely or late, $100 penalty. 

Note: $100 penalties are 

applied over a two month 

period. 

$500 bonus. 


to a case management vendor. 




Authorizing 

bonuses and 

penalties 

Cal-Learn and 

attendance 

penalties 

The following process will take place when a Cal-Learn teen provides a 

report card to either the Cal-Learn EW or designated Case Manger: 

If the report card is sent to the… Then he/she will… 

Cal-Learn EW, Complete a bonus/penalty 

determination, 

Issue/impose the bonus/penalty as 

appropriate, and 

Notify the Case Manager (if 

appropriate) via CL 700 of any 

actions taken. 

Case Manager, E-mail the CL 700 to the Cal-Learn 

EW with the teen’s current GPA, 

and 

Request a bonus/penalty 




School attendance requirements do not apply to Cal-Learn teens. If a 

TAD 144 is received indicating the Cal-Learn teen has missed 20 or more 

days of school in a school year, school attendance penalties will not be 

imposed. 

Bonus rules The Cal-Learn bonus: 

Is issued for the month in which the report card was due, even if 

mid-quarter. 

Will be issued if the Cal-Learn teen was eligible in the month the bonus 

was earned, even if since discontinued from cash assistance. 

Is given to the AU of which the Cal-Learn teen is a member when the 

bonus is paid. 

Is paid to the parent or caretaker relative if it is a $100 bonus. 

Is paid to the Cal-Learn teen if it is a $500 bonus. 

Will be issued no later than the month following the receipt of the report 

card from the Cal-Learn teen, or the CL 700 from the designated Case 

Manager (if appropriate). 

Cannot be used to offset an overpayment. 

Is exempt income in the CalFresh allotment computation. 

Is authorized for each Cal-Learn teen in the AU. 

Is not included in the calculation of a Homeless Assistance (HA) 

payment. 




How to issue a 

bonus 

Rules about 

penalties 

The Cal-Learn EW will issue the bonus upon receipt of the report card and/or 

the CL 700 from the designated Case Manager, following the steps below: 

Step Action 

1 Creates a Service Arrangement in the C-IV system to issue the 

bonus. 

2 E-mails the appropriate “District Issuances” inbox to request 

payment by the AIOA. 

3 Sends a Notice of Action (NOA) to notify the AU of the bonus. 

4 Journals issuance of the bonus. 

5 E-mails a CL 700 to the designated Case Manager (if appropriate) 

advising the bonus was issued. 

Note: The AIOA will process the bonus payment according to the 

procedures in the TOPHB. 

The Cal-Learn penalty: 

Is applied for one month when the penalty amount is $50. 

Is applied equally over two months when the penalty amount is $100 

($50 per month). 

Is subtracted after the grant has been computed, prior to any 

overpayment adjustments. The AU will receive any remaining grant 

amount, even if the amount is less than $10. 

Will be applied even if the grant amount before the penalty is less than 

the penalty amount. 

Example: Total grant authorized: $35 

Subtract penalty amount: $50 

Resulting grant amount: $0 

Unimposed penalty amount: $15 

Any unimposed penalty amount, as the $15 in the above example, will 

not be applied to any other month. 

Is applied as necessary for each Cal-Learn teen in the AU. 

Is applied to the AU in which the Cal-Learn teen is a member when the 

penalty is applied. 

Is not included in the calculation of an overpayment adjustment and will 

be applied mid-quarter, as it is a County Initiated change. 






How to impose 

a penalty 

Imposing and 

tracking 

penalties 

The Cal-Learn EW will impose the penalty when the CL 700 is received from 

the designated Case Manager. The penalty is imposed when 10-day 

advance notice can be sent advising the family the grant will be decreased, 

as follows: 

Step Action 

1 Determine the penalty month using timely notification rules. 

2 Enter the penalty in the C-IV system. 

3 Send a NOA to notify the AU of the penalty and grant decrease. 

4 Journal case actions.. 

5 E-mail a CL 700 to the designated Case Manager to verify the 

penalty was imposed. 

Penalties are imposed and tracked in the C-IV system. To penalize the 

family for the correct number of months, be careful with start and stop dates. 

The Cal-Learn EW will determine the penalty reason and make necessary 

entries in the C-IV system. 

Penalty 

reason 

Late report 

card, no good 

cause, 

adequate 

progress 

Report card 

shows “F” 

GPA 

No report 

card 

submitted 

Amount Start Stop Monthly 

Amount 

$50 Future month Future month $50 

$100, applied 

over a two 

month period 

$100, applied 

over a two 

month period 

Future month The month 

after future 


after future 

Note: Future month is also known as “High Date.” 

IIN #13-011 (03/13) DM:SMB:ker PAGE 30 OF 32 

$50 

$50

Ending Cal-Learn Participation 

Overview This section contains information when a Cal-Learn teens ends participation, 

through discontinuance or by aging out of the program. 

Special note 

regarding 

CalFresh 

companion 

programs 

When the teen parent reaches age 18 and is too old to remain on a 

CalWORKs program with his/her parent, the teen and his/her child will 

establish a CalWORKs program for themselves. If the teen and child still live 

in the household with the senior parent(s), they remain in the original 

CalFresh household. 

Discontinuance When a Cal-Learn teen moves out of San Bernardino County, is discontinued 

from cash aid, or does not meet the Cal-Learn criteria, notifications must be 

made. C-IV completes the following: 

Discontinues the Cal-Learn teen when CalWORKs Eligibility 

Determination Benefit Calculation (EDBC) is run, accepted, and saved, 

Generates a discontinuance NOA for the Cal-Learn program, and 

Updates the Status and Status Reason of the teen when he/she no 

longer meets the program requirements. 

The Cal-Learn Eligibility Worker (EW) will complete the following actions: 

Step Action 

1 Run and accept EDBC to discontinue the Cal-Learn teen. 

2 Send the appropriate NOA. 

3 E-mail the CL 700 to the designated Case Manager and Child 

Care EW, as appropriate, advising of the discontinuance. 

4 Access the Need Detail page for the Need Type: Parenting with 

Status: Indicated and update the following: 

Status: Met 

End Date 

Status Reason: Referral Created 

5 Access the Referral Detail page to ensure the Need Status on 

the displays as Met. 


Note: In the event a Cal-Learn teen submits a new application following 

discontinuance (and the case is not restored back to the previous application 

date), the Cal-Learn vendor will not be reassigned, and the Cal-Learn teen 

will not be referred for case management services. 



Ending Cal-Learn Participation, Continued 

No longer 

required to 

participate 

When a Cal-Learn teen is no longer required to participate in the Cal-Learn 

program due to age, scholastic achievement, or family composition, the 




Graduates from high school or earns an equivalency diploma. 

Turns 19 and does not wish to volunteer for the Cal-Learn 

program. 

Turns 20. 

Is no longer a pregnant or parenting teen. 


Sends a NOA to Cal-Learn teen advising of change in his/her 

program participation from Cal-Learn to the Employment 

Services Program (ESP). 

Sends a NOA to stop supportive services. 

E-mails a CL 700 to the designated Case Manager to 

discontinue case management services. 

Refers teen to the WTW program as determined by the district 

office within 10 days. 

Pends the Welfare to Work (WTW) program. 

Journals changes. 

Transfers the imaged case through district procedures to the 

appropriate EW, if applicable. 

Note: Cal-Learn and WTW programs must never be open at the 

same time. 

Questions District Managers (DMs) or Employment Service Managers (ESMs) with 

questions regarding this IIN should contact Karem Evans, Program 

Specialist (PS) I at the Program Development Division (PDD), at 

(909) 383-9717 or kevans@hss.sbcounty.gov. 



SUBJECT: Cal-Learn 


MAY 15, 2012 

DISTRIBUTION: CalWORKs FILE: CWPHB – In Front of Chapter 4 



Overview Effective 7/1/12, Cal-Learn teens will no longer receive case management 

services from the Maternal, Child and Adolescent Health (MCAH) program 

through the Department of Public Health (DPH). Case management services 

will be provided by the Employment Services Program (ESP) Welfare-to- 

Work (WTW). 

New 

Cal-Learn 

teens 

Note: Additional information will follow regarding the transition of Cal-Learn 

teens to WTW. 

Cal-Learn cases will continue to be assigned to designated Eligibility 

Workers (EWs); however, in preparation for the transition of Cal-Learn teens 

to the WTW program, EWs will no longer complete the CL 27 and refer 

new Cal-Learn teens to the MCAH program. Effective immediately, EWs 

will: 

Step Action 

1 Open the Cal-Learn program. 

2 Not complete the CL 27 and forward the CL 27 to MCAH. 


Note: The MCAH program will return any CL 27s received after 5/21/12 to the 

EW. The returned CL 27 will be shredded. 




Current 

Cal-Learn 

teens 

The MCAH program will continue to provide services to and monitor the 

progress of current Cal-Learn teens, through 6/30/12, and notify EWs when 

the Cal-Learn teen: 

Fails to make satisfactory progress, 

Has improved his/her school performance and is now making satisfactory 

progress, 

Is not attending school, or 

Receives a high school diploma or equivalent. 

Questions District Managers (DMs) and Employment Services Managers (ESMs) may 

contact Karen Akparanta at the Program Development Division (PDD) 

regarding questions about this Interim Instruction Notice (IIN) at: 

(909) 383-9673, or 





AUGUST 22, 2011 

SUBJECT: Cal-Learn Program Policy Changes 

DISTRIBUTION: CalWORKs FILE: CWPHB In Front of Chapter 4 


OBSOLETE: September 30, 2012 

Overview The California Department of Social Services (CDSS) released All County 

Letter (ACL) 11-36 instructing counties to make changes to the CalWORKs 

program based on the passage of Senate Bill (SB) 72. This includes the 

following changes to the Cal-Learn program beginning 7/1/11 and in effect 

for one year only: 

Maternal, Child, 

and Adolescent 

Health (MCAH) 

Pregnant 

Women Only 

(PWO) Cal- 

Learn 

applicants 

Pregnant Women Only (PWO) Cal-Learn applicants must be in their third 

trimester to be eligible to CalWORKs. 

Cal-Learn penalties will no longer be imposed. The following will be 

imposed when a Cal-Learn participant has poor school performance or 

attendance: 

Welfare to Work (WTW) sanctions, and 

School attendance penalties. 

The Maternal, Child and Adolescent Health (MCAH) program hosted through 

the Department of Public Health (DPH) will continue to administer the 

Cal-Learn program. Case managers will communicate with Transitional 

Assistant Department (TAD) Eligibility Workers (EWs) to provide services to 

Cal-Learn teens. 

Beginning 7/1/11, a pregnant Cal-Learn teen with no eligible children is not 

eligible to CalWORKs until her third trimester. 

EWs will no longer approve new applications for PWO teens in the first or 

second trimester of their pregnancy, however, a PWO teen who has been 

granted aid prior to her third trimester before 7/1/11 will continue to receive 

aid if otherwise eligible. 


IIN #11-032 ERRATA (08/11) DM:SMB:cds PAGE 1 OF 6


Cal-Learn 

bonuses and 

penalties 

Grade 

evaluation 

As of 7/1/11, Cal-Learn will no longer impose $50 or $100 penalties on 

Cal-Learn teens. All Cal-Learn penalties will be replaced with either a: 

WTW sanction, or 

School attendance penalty. 

Cal-Learn bonuses will continue to be issued to teens who qualify based on 

positive school performance. 

The MCAH Case Manager will evaluate the Cal-Learn teen’s report card up 

to four times per year. The determination of a teen’s eligibility to a bonus or 

WTW sanction will be based on the overall Grade Point Average (GPA). 

WTW sanctions A WTW sanction will be imposed When a Cal-Learn teen (regardless of age) 

fails to: 

Make satisfactory progress in school, or 

Is not enrolled in school. 

Use the chart below to impose a WTW sanction: 



Provides his/her report card or to the MCAH Case Manager up to four 

times per year, or 

States that he/she is not attending school. 

2 MCAH Case Manager: 

Tracks report card information, if applicable, and 

Advises the Cal-Learn EW via the CL 700 when the teen: 

Improved his/her school performance and is now making satisfactory 

progress, 

Failed to make satisfactory progress in school, or 

Is not attending school. 


Imposes or removes (when satisfactory progress has been achieved) a 

WTW sanction on the Cal-Learn teen by: 

Updating the Non-Compliance Detail page, and 

Running Eligibility Determination and Benefit Calculation (EDBC) 

for the month that a 10 day Notice of Action (NOA) can be given, if 

applicable. 

Notifies the MCAH Case Manager via the CL 700. 

Journals all actions. 

Note: For additional information regarding teens who are 18 or older, see the 

“WTW Sanctions for teens 18 or older” block in this IIN. 




Erroneous Cal- 

Learn program 

closure 

School 

penalties 

When a Cal-Learn teen who is 18 or older and is Head of Household incurs a 

WTW sanction, the Cal-Learn program will erroneously close in C-IV. To 

reopen the Cal-Learn program, the EW must do the following: 

Step Action 

1 Click Cal-Learn on the Task Navigation bar. 

2 Click the Add Status button. 

3 Enter the following: 

Status: Active 

Begin Month: Month the Cal-Learn program closed. 

4 Click Save and Return. 

Note: Cal-Learn programs which are reopened may need to be reviewed 

anytime EDBC is run. 

Cal-Learn teens under the age of 18 are now subject to CalWORKs school 

attendance penalties. The MCAH Case Manager will discuss the attendance 

record with the Cal-Learn teen monthly to ensure the teen is attending school 

regularly. 

The Cal-Learn EW must follow the steps below for the school attendance 

process: 

Step Action 

1 Obtain the TAD 144.1 at application and Re-Evaluation (RE). 

2 Submit the completed TAD 144.1 to the school district. 

3 Accept the TAD 144 from the school attendance office when a 

teen has: 

Missed 20 or more days, or 

Attended 30 consecutive days (when in penalty status). 

4 Impose or remove the school penalty. 

Note: 16 or 17 year old Cal-Learn teens that have a school 

attendance penalty are not referred to WTW. 

5 Advise the MCAH Case Manager of the school attendance penalty 

via the CL 700. 

6 Journal all actions. 




List of cases A list of Cal-Learn teens under age 18 titled “Cal-Learn School Attendance” 

has been posted to the C-IV Resource Center. EWs must review the list and 

take the following action by 6/30/11 for each case: 

Completed 

forms 

Incomplete 

forms or failure 

to return 

Step Action 

1 Complete Section 1 and the Child’s Name (Cal-Learn teen) in 

Section 3 of the Release of Information for School 

Attendance (TAD 144.1). 

2 Generate a Verification Request List (VER 100 CIV) in the C-IV 

case and allow the customer 10 days to return the form. 

3 Mail the following to the Cal-Learn parent/caretaker relative: 

TAD 144.1, 

VER 100 CIV, and 

Postage-paid return envelope. 

When a TAD 144.1 for a Cal-Learn teen under age 18 has been returned to 

the district office, follow established policy for forwarding to the appropriate 

school district. 

When a customer fails to return the TAD 144.1 for a Cal-Learn teen under 

age 18 or submits an incomplete form, the EW will send a second TAD 144.1 

and VER 100 CIV to the customer. In the event the customer fails to 

return/complete the second request, the EW will: 

Apply a school attendance penalty in the first month that 10 day NOA can 

be given, and 

Notify the MCAH Case Manager via the CL 700 of the imposed penalty. 




Bus passes All bus passes will be picked up in the TAD district office by the Cal-Learn 

teen. The chart below describes the bus pass process: 

Cal-Learn 

bonuses 


1 Cal-Learn teen discusses transportation need with the MCAH 

Case Manager. 


Calls or faxes the Cal-Learn EW with the names of customers 

who need bus passes/tickets, or 

E-mails a list of customers via CL 700 to the Cal-Learn EW. 


Approves transportation request. 

Completes Service Agreement for each customer. 

Gives Service Agreement to the Authorized Issuance Office 

Assistant (AIOA). 

Advises Cal-Learn teen of transportation approval and when to 

pick up. 

4 AIOA: 

Orders bus passes/tickets as needed. 

Issues passes or tickets to the Cal-Learn teen in the district 

office. 

Receives/reconciles all bus passes/tickets. 


Picks up bus pass in district office. 

Signs Service Agreement. 

Signs bus pass, if required. 

Cal-Learn bonuses will continue to be issued based on school performance. 

The following describes the process for issuing a Cal-Learn bonus: 


1 Cal-Learn teen provides his/her report card to the MCAH Case 

Manager up to four times per year. 


Tracks report card information, and 

Advises the Cal-Learn EW via the CL 700 when the teen has 

made satisfactory progress in school. 


Issues the Cal-Learn bonus, and 

Notifies the MCAH Case Manager via the CL 700. 

Journals all actions. 

Note: For additional information, see Chapter 11-Cal-Learn 

Procedures, in the TAD Office Procedures Handbook (TOPHB) 




Time Limits 18 and 19 year old Cal-Learn teens will remain exempt from the CalWORKs 

48-month time clock until they turn age 20, or graduate from high school or 

its equivalent (whichever occurs first). 

Employment 


Program (ESP) 

Updating the 

Work 

Registration 

Detail page 

The 307 and 308 time limit exemption codes must be updated manually on 

the Cash Aid Time Limit Month List page in C-IV at every Time on Aid 

(TOA) review. 

At this time, San Bernardino County will continue to administer the Cal-Learn 

program through the DPH and will not be referring any participants to the 

Employment Services Program (ESP). 

The Cal-Learn EW will update the Work Registration Detail page in the 

C-IV system with the following: 

Type = WTW 

Pregnant or Parenting Teen = No (this prevents a WTW program from 

opening) 

Status = Exempt 

Status Reason = Cal-Learn Participant 

Questions Managers with questions regarding this IIN should contact Shannon Bailey, 

Program Specialist (PS) I at the Program Development Division (PDD), at 

(909) 383-9717 or shannon.bailey@hss.sbcounty.gov. 


Overview 

Children and Eligibility 

Introduction This chapter contains information regarding childhood issues, verifying a 

child’s birth, proof of age, Maximum Family Grant (MFG), immunizations, 

school attendance, minor parents, Child Protective Services (CPS) referrals, 

second parent and the Cal-Learn program. 


Topic 

See 

Page 

Age Requirements 4-3 

Proof of Child’s Age 4-4 

Verifying Child’s Age 4-6 

Eligibility Requirements: 18 Year Olds 4-7 

18 year-Olds with Disabilities 4-9 

Maximum Family Grant (MFG): Overview and Definitions 4-13 

MFG: Applying the MFG Rule and Exemptions 4-15 

MFG: Verifying Exemptions 4-17 

MFG Determinations: Examples of Family Situations 4-18 

MFG: Eligibility Requirements 4-20 

MFG Financial Eligibility and Grant Determination Rules 4-21 

MFG Child Only AU 4-22 

Immunizations 4-24 

Verification of Immunization: The First Two Months of Aid 4-26 

Verification of Immunization: On-going Cases 4-28 

Immunization Penalty 4-29 

Imposing the Immunization Penalty 4-30 

Family Member Changes During a Penalty Period 4-31 

School Attendance: Overview and Definitions 4-32 

School Attendance: Policy 4-33 

School Attendance: Rules 4-34 

School Attendance: Verification 4-36 

School Attendance: Penalty 4-38 

School Attendance: Imposing the Penalty 4-40 

School Attendance: Family Member Changes during a Penalty Period 4-41 

Minor Parents 4-42 

Minor Parents Case: Establishing the Payee 4-43 

Forms: Minor Parent in an Acceptable Living Arrangement 4-44 

Exemptions from the Acceptable Living Arrangement Requirement 4-46 


CWPHB #4605 (04/11) CHILDREN AND ELIGIBILITY 4-1

Overview, Continued 

Contents (continued) 

Topic 

See 

Page 

Minors Living Independently 4-48 

Child and Family Services (CFS) Referrals 4-50 

Summary: Examples of Required Forms 4-52 

Completing Casework after the CFS Referral 4-53 

CFS Referral Locations 4-55 

When the Second Parent of the Minor Parent Moves In 4-56 

Minor Parent Turns 18 4-57 

Teens Turning 18 Years Old – Seamless Determination of Eligibility 4-58 

The Cal-Learn Program 4-64 

Cal-Learn Referral Procedures 4-68 

Cal-Learn Registration 4-70 

Beginning Cal-Learn Participation 4-71 

Cal-Learn Supportive Services 4-74 

Cal-Learn Bonuses and Penalties 4-85 

Cal-Learn Bonuses 4-87 

Cal-Learn Penalty 4-88 

Ending Cal-Learn Participation 4-90 


Age Requirements 

Introduction This section contains information regarding age requirements. 

Reference The following reference is applicable to information in this section: 

Age 

requirements 

• EAS 42-101 

The family must include a child or an unborn child in order for any family 

member to be considered eligible for CalWORKs. 

A child is a customer who: 

• Has not yet reached his/her 18 th birthday, and 

• Is not a parent or caretaker relative. 

In addition, a child is a customer who: 

• Is 18 years old, 

• Is enrolled in high school or vocational school, and 

• Is expected to graduate from high school or complete the vocational 

program before reaching his/her 19 th birthday. 

Note: For more information about eligibility and 18 year olds, see the section 

specifically about 18 year olds in this chapter. 


Proof of Child’s Age 

Introduction This section contains information regarding proof of age, and retaining 

documents in the case file. 


• EAS 42-111 

Proof of age A child’s age must be verified when the family applies for aid or when a child 

is to be added to the AU. 

Forms of acceptable proof of a child’s age are given in the order of 

preference and include: 

• Birth certificate 

• TP screen print of the birth record from the San Bernardino County 


• Hospital, physician, or midwife record of the birth 

• Bureau of Vital Statistics or local government records of birth and 

parentage 

• Adoption decree 

• Governmental records of naturalization 

• Passport 

• Record of immigration 

• Court records of parentage when the child’s date of birth is given 

• Paternity records 

• Juvenile court records 

• Indian census records 

• U.S. government census records 

• NUMI file screen print from the Social Security Administration for people 

born on or after January 1,1978 listing the customer’s name, date of birth, 

place of birth, and parents’ names 


• Church records of birth, including statements from a priest or minister 

• Baptismal records of birth 

• Declaration on the Statement of Facts, if verification is not questionable 

and unavailable or never existed 



Proof of Child’s Age, Continued 

Retaining 

documents in 

the case record 

Birth verification must be photocopied and placed in the case record. 

An original document will only be kept in the case record when: 

• The document was obtained through the TAD 623 process, and 

• Is not requested by the family. 


Verifying a Child’s Age 

Introduction This section contains information regarding the age verification process for a 

child. 

Verification 

process 

Begin the age verification process by asking the parent/caretaker relative to 

provide a birth certificate for each child. Use the chart below when a birth 

certificate cannot be provided. 

If the parent/caretaker relative … Then… 

Does not have the birth certificate • Ask for another form of birth 

verification from the list in the Birth 

Verification section. 

• Verification must list the child’s date of 

Has no document verifying the child’s 

age and the child has received 

CalWORKs in San Bernardino County 

• Does not have proof of the child’s 

age and the child has not received 

cash aid, or 

• The closed case is not available, 

or 

• Proof of the child’s age does not 

exist or never existed 

birth to verify the child’s age. 

• Request the case be pulled from 

district or central closed files through 

the use of the HSS 38 and use the 

birth verification from that case file, or 

• Access verification from C-IV 

• Give the parent or caretaker the 

TAD 622 with the information needed 

to request a copy of birth verification 

from the vital records bureau where 

the child was born. 

• Use the TAD 623 process after 90 

days when the parent or caretaker 

states they cannot pay for the birth 

certificate or has been unsuccessful in 

acquiring the certificate. 

• Refer to the TAD 622 and TAD 623 

Forms and Procedures guides for 

complete instructions. 

• Request any closed case from Central 

Closed Files via the HSS 38. The 

parent or caretaker must still make 

reasonable efforts to verify the birth. 

• Access verification from C-IV. 

• Verification must be provided to the 

EW within 90 days. Set a Task to 

follow-up. 

• The caretaker relative’s statement on 

the Statement of Facts, non-financial 

root questions, may be used as a last 

resort and only when the facts as 

declared are not questionable. 


Eligibility Requirements: 18 Year-Olds 

Introduction This section contains information regarding policy, definitions, requirements, 

and actions related to student status of 18 year-olds. 

Reference The following reference is applicable to information in this section. 

• EAS 42-101 

Policy A child meets the CalWORKs age requirement until his/her 18 th birthday. A 

child age 18 may be eligible provided certain requirements are met. 

Definitions Charter school: A private or home school that meets specific requirements 

set by California Department of Education (CDE). The charter school is given 

proof of charter school status if approved by CDE. 

Full-time student: As defined by the school. 

Graduating by 19 th birthday: Having enough credits to graduate by the 

child’s 19 th birthday, even if the ceremony is after the child’s 19 th birthday. 

High school: 

• Traditional public, private, or charter high school 

• Independent study program that is overseen by a private, public or 

charter high school 

• GED program with classroom courses 

• Home schools that have been chartered by the local/county school 

district 

Note: High school does not include correspondence courses or home 

schools that do not have charter status. 

Vocational/technical training: A program that does not lead to a college 

degree. 

Requirements In order to be eligible for CalWORKs, an 18 year-old must: 

• Be in enrolled in high school or vocational program, and 

• Expect to graduate from high school or complete the vocational program 

before his/her 19 th birthday. 

Exception: Otherwise eligible 18 year-olds who are attending school fulltime 

and are not expected to graduate by age 19 from high school or 

vocational school because of a disability may receive cash aid beyond 

his/her 18 th birthday (see 18 Year-Olds with Disabilities section of this 

chapter). 



Eligibility Requirements: 18 Year-Olds, Continued 

When to verify 

graduation 

status 

Progress towards graduation or completion of the vocational program is 

verified using the TAD 44 at the following times: 

• When the family applies for CalWORKs for an 18 year old, and 

• When the child turns 18. 

The TAD 44 The TAD 44 is required to be sent: 

Actions related 

to student 

status of 

18-year olds 

• Month prior to the month of birth for children whose birth month falls from 

September through May. 

• In May for children whose birth month falls in June, July and August. 

Use the following chart to determine eligibility for an 18 year-old child. 

When the TAD 44… Then… 

Verifies the child is enrolled in an 

acceptable educational program and 

is expected to obtain enough credits, 

graduate or complete the vocational 

program before the his/her 19 th 

birthday 

• Verifies the child will NOT obtain 

enough credits, graduate or 

complete the vocational program 

before the child’s 19 th birthday, or 

• Verifies the child is NOT enrolled 

in school, or 

• Verifies the child is participating 

in Job Corps, or 

• Indicates that graduation before 

his/her 19 th birthday is 

questionable due to poor 

attendance, or 

• Is not returned 

The child remains eligible through 

the month of graduation or 

vocational program completion. 

• Deny the application for the child 

if there are other eligible children, 

or 

• Deny the application for the 

entire AU if the 18 year-old is the 

only eligible child, or 

• Discontinue aid for the child in an 

on-going case when there are 

other eligible children, or 

• Discontinue aid for the entire AU 

in an on-going case when the 18 

year-old is the only eligible child. 

Note: Discontinuance for age and school requirements is a County-initiated 

action and can be completed mid-quarter. 


18 Year-Olds with Disabilities 

Introduction As a provision of the Fry v. Saenz court decision the rule for determining 

CalWORKs cash aid eligibility for otherwise eligible 18 year-olds has been 

modified. Cash aid will be provided to otherwise eligible 18 year-olds who 

are attending school full-time and are not expected to graduate by age 19 

from high school or vocational school because of a disability. 

Definition Otherwise eligible: 18 year-olds are considered “otherwise eligible” if the 

only reason they are not CalWORKs eligible is because they are not 

expected to graduate before their 19 th birthday. 

Disabled 

Criteria 

The following children are considered disabled under the Fry v. Saenz court 

decision: 

• Children who currently receive or have in the past received SSI/SSP 

benefits; 

• Children who currently receive or have in the past received services 

through a Regional Center Program pursuant to the Lanterman Act; 

• Children who currently receive services at school in accordance with their 

Individual Education Plan (IEP) or receive services under/pursuant to 

Section 504 of the Rehabilitation Act or have received such services in 

the past; or 

• Children who are determined disabled through independent verification of 

a current or past disability by a health care provider or a trained, qualified 

learning disabilities evaluation professional. 

18 year-olds meeting any of the disabled criteria who attend school full-time 

shall continue to be considered an eligible child in their parent/caretaker 

relative’s Assistance Unit (AU), and aid shall continue for the otherwise 

eligible parent/caretaker relative until the child graduates, turns 19, or stops 

attending school full-time, whichever occurs first. 



18 Year-Olds with Disabilities, Continued 


disability 

The following table lists documentation required to verify the 18 year-olds 

disability. 

Disability Verification 

Receipt of SSI/SSP benefits • Current or past SSI/SSP benefit 

award letter, 

• Statement from Social Security 

Administration, or 

• Other reliable verification. 

Lanterman Act Statement from the Regional Center 

stating the child is currently 

receiving or has in the past received 

services. 

IEP/Section 504 services • Copy of the child’s IEP or 

Section 504 Accommodation 

Plan/Section 504 Plan, 

• Verification from the school that 

there is or has been in the past 

an IEP, or 

• Section 504 Accommodation 

Plan/Section 504 Plan in place 

for the student. 

Other disability When a child’s disability cannot be 

verified by the above three criteria, 

the parent/caretaker relative can 

provide independent verification of a 

current or past disability by a health 

care provider or a trained, qualified 

learning disabilities evaluation 

professional. They may also 

authorize the Transitional 

Assistance Department’s (TAD) use 

of the CW 61. 




Request for 

verification 

The TAD 44 Graduation Verification form is mailed to the parent/caretaker 

relative for completion the month prior to the child’s 18 th birthday. Use the 

chart below to determine what actions to take once the TAD 44 is returned. 

If the completed 

TAD 44 states the 

child will… 

Graduate prior to 

his/her 19 th birthday 

Not graduate prior 

to his/her 19 th 

birthday, 

And… Then… 

The school states the 

child currently has or in 

the past had an IEP or 

Section 504 

Accommodation 

Plan/Section 504 Plan in 

place, 

The parent/caretaker 

relative has answered 

YES to at least one of 

the questions in Section 

1 of the TAD 44, 

The parent/caretaker 

relative has not 

answered YES to at 

least one of the 

questions in Section 1 

and the school has not 

answered YES to the 

question in Section 2. 

Enter the Expected 

Completion Date on the 

School Attendance Detail 

page in C-IV. 

• Set the Fry v. Saenz flag 

in C-IV for the Fry child, 

and 

• On the School 

Attendance Detail page 

for the child enter 

Expected Completion 

Date = child’s 19 th birth 

date, and 

• Complete the Medical 

Condition Detail page 

for the child selecting Fry 

v. Saenz Disability as 

the Medical Condition 

Type. 

Request verification from the 

parent/caretaker relative and 

allow 10 days to provide. 

• If verification is provided, 

follow the instructions 

from the box above. 

• If verification is not 

provided, discontinue the 

child at the end of the 

current QR Payment 

Quarter. 

Discontinue the child from 

the CalWORKs AU at the 

end of the current QR 

Payment Quarter. 




Failure to 

cooperate 

Pregnant or 

parenting teens 

If the parent/caretaker relative fails to cooperate with TAD in providing 

requested verification and the disability status of the child under Fry v. Saenz 

cannot be determined, the EW will discontinue the 18 year-old at the end of 

the QR Payment Quarter after timely notice, in accordance with Quarterly 

Reporting requirements. 

Pregnant or parenting teens who are 18 or are approaching their 18 th 

birthdays and are not expected to graduate from high school or vocational 

school by age 19, continue to have the option of establishing their own AUs. 

These teens must continue to be informed of the possible continuing 

eligibility options. 


Maximum Family Grant (MFG): Overview and Definitions 

Introduction This section contains information regarding general information on 

Maximum Family Grant (MFG), and definitions. 

Reference The following references are applicable to information in this section. 

• ACL 00-78 

• EAS 44-314.5 

Overview Beginning September 1, 1997, regulations required that the Maximum Aid 

Payment (MAP) not increase for any child born into a family that has 

received cash aid continuously for 10 months prior to the birth of the baby, 

unless an exception is met. 

Definitions Law Enforcement Agency: Federal, State and local police, sheriff, 

probation and parole agencies. 

Mental Health Professional: A person who is licensed by the State of 

California to provide counseling services. 

MFG Child: Children that are not included in the AU for the purposes of 

determining the MAP. 

Nested Teens: A minor parent who is receiving aid as a child in his/her 

senior parent's AU. 

Received Cash Aid: Cash aid received for him/herself and/or on behalf of 

his/her eligible child(ren). This includes: 

• A sanctioned parent 

• A parent excluded by regulation (citizenship status) 

• Prorated months 

• Months aid received and the AU was ineligible. 

Two-Consecutive Months Break in Aid: When aid is not received due to 

discontinuance, suspense month or Zero Basic Grant (ZBG) month. 



Maximum Family Grant (MFG): Overview and Definitions, 

Continued 

General 

information 

The chart below will help you determine whether or not the MFG rules apply 

to a baby, when the baby is born to a nested teen. 

If… And… Then… 

Child is born prior 

Do NOT apply the MFG 

to July 1, 2001 

rule. 

Child is born on or MFG Informing Notice is The MFG rule applies. 

after July 1, 2001 received 10 months 

prior to baby’s birth 

Child is born on or MFG Informing Notice Do NOT apply the MFG 

after July 1, 2001 was NOT received, or 

NOT received 10 

months prior the baby’s 

birth 

rule. 

Nested teen Baby was MFG child Do NOT apply the MFG 

establishes own while teen was nested rule when the teen 

AU 

establishes own AU. 

Note: If the case record does not contain a signed MFG Informing Notice 

(or documented refusal to sign the MFG Informing Notice), or if the MFG 

Informing Notice on file is not dated 10 months prior to the baby’s birth, the 

MFG rule will not be imposed. 


MFG: Applying the MFG Rule and Exemptions 

Introduction This section contains information regarding applying the MFG rules, MFG 

exemptions, how long the MFG exemption last, and information regarding aid 

received in other states. 

Applying the 

MFG rule 

MFG 

exemptions 

How long does 

the MFG 

exemption last 

The MFG rule applies when: 

• The AU has received written notice of the MFG rules at least 10 months 

prior to the birth of the baby, AND 

• The AU has received aid 10 months prior to the birth of the baby without 

a break in aid of at least two consecutive months. 

The MFG regulation will NOT be applied when the child: 

• Was conceived as a result of rape or incest. 

• Was conceived as a result of failed contraception (IUD, Norplant, 

• Depro-Provera, or sterilization). 

• Was conceived while either parent was a non-needy, non-parent 

caretaker relative (NNC). 

• Is NOT living with either parent. 

• Was previously designated an MFG child and has not received aid for at 

least 24 consecutive months, including time as an MFG child receiving 

Zero Basic Grant (ZGB). 

• Was previously designated an MFG child when born to a minor parent 

(nested teen) who was aided as a child in their senior parents' case AND 

the minor parent establishes his/her own AU. 

• Was born on or after September 1, 1997, but the parent(s) have not 

received aid for 10 months prior to his/her birth. 

• Was born on or after September 1, 1997, and there was a break in aid of 

at least two consecutive months in the 10 months prior to the birth of the 

baby. 

• Was born on or after September 1, 1997 and the parent(s) did not 

receive the MFG notice 10 months prior to the baby's birth. 

• Was born on or after November 1, 2001 and the parent(s) did not receive 

the MFG notice 10 months prior to the baby's birth. 

• Is born to a minor parent (nested teen) who is aided as a child in his/her 

senior parent's case prior to July 1, 2001. 

• Is the first child who would have been designated as a MFG child, when 

the parent is a minor parent who receives SSI/SSP or is an 

undocumented immigrant. 

Once a child has been designated as exempt from MFG, this designation will 

be permanent unless: 

• There was an error in the designation, or 

• The MFG child has not received aid for at least 24 consecutive months, 

which includes time as an MFG child on a ZBG case. 



MFG: Applying the MFG Rule and Exemptions, Continued 

Other states 

and MFG rule 

MFG regulations apply only for families receiving CalWORKs in California. If 

the family received aid in another state, the MFG regulation will NOT be 

applied. This is because aid received in other states is not considered when 

counting the 10 consecutive months. 


MFG: Verifying Exemptions 

Introduction This section contains information regarding verifying exemptions for MFG. 

Verifying 

exemptions 

Exemptions from the MFG regulations must be verified. The following chart 

gives examples of acceptable verification. 

Exemption Reason Verification 

Rape or incest A statement from a law enforcement agency, 

licensed medical or mental health professional, or 

rape/incest victims counseling organization. The 

statement must: 

• Be made no later than three months after the 

birth of the child and 

• Include the date the incident was reported to a 

law enforcement agency 

Failed contraceptive 

or sterilization 

Note: Due to the confidential nature of this 

exemption, a copy of the verification will NOT be 

kept for the case record. Narrate in the case 

Journal that verification was witnessed and the 

child meets a permanent MFG exemption. 

Medical statement 

Unaided, non-needy 

caretaker status 

Case record or MEDS 

Not living with either 

parent 

Case record, MEDS, CA 2.1Q, CA 2.1 N&A 

Break in aid Case record or MEDS 

Born to nested teen 

prior to July 1, 2001 


Born on/after 

September 1, 1997 

and aid not received 

10 months prior to 

birth. 


MFG child born to 

nested teen who 

establishes own AU 


Did not receive MFG MFG Informing Notice is NOT in the case record 

notice 

(this will apply to children born after July 1, 2001) 

24 consecutive Case record, which may include: 

months of Zero Basic • C-IV Issuance History, or 

Grant (ZBG) 

• Other issuance documentation 


MFG Determinations – Examples of Family Situations 

Introduction This section contains information regarding examples of MFG family 

situations. 

Example 1: 

Child 

conceived 

while mom was 

a non-needy 

caretaker 

Example 2: 

MFG child 

moves into the 

home of the 

other parent 

Example 3: 

MFG child with 

no deprivation 

Example 4: 

Suspending the 

MFG 

designation, 

change in 

caretaker 

Situation: An aunt is the non-needy caretaker of her two nieces and has 

been receiving cash aid for the girls for the last year. The aunt becomes 

pregnant and gives birth. The aunt requests aid for herself and for her baby. 

MFG determination: Because the aunt was a non-needy caretaker when 

her child was conceived, her baby is not an MFG child. 

Situation: The AU consists of a mother and her two children. The youngest 

child is determined to be the MFG child. The MFG child moves in with his 

father. The father requests aid for himself and the child. 

MFG determination: The child is still an MFG child because he lives with 

one of his parents, his father. 

Situation: A mother and her child have been receiving cash aid for the past 

18 months. The mother becomes pregnant. The father of the child is living 

in the home and is full-time employed; there will be no deprivation for the 

child when it is born and will not be added to the AU at that time. 

MFG determination: Since the child was conceived while one parent was 

receiving aid, the child will be designated an MFG child. 

Situation: A non-needy grandfather applies for aid for his grandchildren. 

Both parents are absent. The children have been on aid for several months 

with their parents. The youngest child is an MFG child. 

MFG determination: The MFG child will be aided as long as he/she does 

not live with either parent. 



MFG Determinations - Examples of Family Situations, Continued 

Example 5: 

Ending the 

MFG 

designation, 

minor parent 

Example 6: 

MFG child born 

to nested teen 

Example 7: 

Child born to 

SSI/SSP minor 

parent 

Example 8: 24 

consecutive 

months ZBG 

Situation: The AU consists of the senior parent, her two children. One of 

the children has a baby that has been determined to be a MFG child. When 

the minor turns 18 years old, she applies for CalWORKs for herself and her 

baby. 

MFG determination: As of September 1, 2000, the MFG designation for the 

baby no longer applies. 

Situation: Baby is born to nested teen. 

MFG determination: The baby is an MFG child. The MFG designation 

remains until the minor parent establishes his/her own AU. 

Situation: The SSI/SSP minor parent and her baby are living in the home of 

her aided senior parent. 

MFG determination: The first designated MFG child born to the SSI/SSP 

minor parent is exempted from the MFG rule. 

Note: Any other children born to the SSI/SSP minor parent is not exempt 

from the MFG rule for this reason. 

Situation: A CalWORKs AU consists of a mother on SSI/SSP and her MFG 

child. It is a Zero Basic Grant (ZBG) AU, which has not received CalWORKs 

for 24 consecutive months. 

MFG determination: Immediately following the 24 month (beginning the 25 

month), the child is no longer MFG. 

Note: Until the 25 th month, the child remains MFG. 


MFG: Eligibility Requirements 

Introduction This section contains information regarding MFG eligibility requirements, how 

to add a MFG child to the AU, and failure to report a birth information. 

Eligibility 

requirements 

Adding the 

MFG child to 

the AU 

Failure to 

report a birth 

When the MFG child is born, the family must comply with CalWORKs 

program requirements for the child as if that child were a cash aid recipient. 

These program requirements include: 

• Reporting and verification requirements 

• Establishing and documenting deprivation, if it exists for the child 

• Cooperation with and participation in child support enforcement activities 

• Meeting immunization and school attendance requirements 

• Verification of the Social Security number 

• Verification of age and citizenship 

Follow the steps listed below when a child is born to the AU: 

Step Action 

1 Obtain the CW 8A: Statement of Facts and all corresponding 

verification as for any newborn who is to be included in the AU. 

2 Document the MFG determination by: 

• Completing and filing the MFG 473. 

• Discussing and narrating the circumstances of the child's birth 

with the parent or needy caretaker relative. 

3 Evaluate eligibility for CalFresh. 

4 Process the case in C-IV 

5 Send Notices of Action for both the CalWORKs cash aid and 

CalFresh determinations. 

If the AU fails to report the birth of a child and comply with routine additional 

person processes, the entire AU will be ineligible for cash aid. 


MFG Financial Eligibility and Grant Determination Rules 

Introduction This section contains information regarding the MFG child’s needs, and child 

support special needs. 

The MFG 

child's needs 

When a family includes an MFG child, the child's needs are included when 

determining MBSAC amount, but are not included when determining the 

Maximum Aid Payment (MAP). The chart below shows when to include or 

exclude the MFG child’s need. 

When calculating… Then the child's needs are… 

Financial eligibility Included in the MBSAC. 

The Maximum Aid Payment Not included in the MAP; see the 

(MAP) for the AU and FU "Special needs" section below. 

Homeless assistance-temporary Included in the payment. 

Homeless assistance-permanent Not included in the MAP. 

A resource transfer period of 

ineligibility 

Included in the MBSAC. 

Child support When child support for the MFG child is received, the child support payments 

are not used in the CalWORKs eligibility determination and grant 

computation. 

Special needs A pregnant woman is eligible to Pregnancy Special Needs (PSN) even if the 

child will be an MFG child. 

The MFG child is eligible for Special Need Payments described in the 

Special Needs chapter in this handbook. 

Other programs The MFG child may receive CalFresh if otherwise eligible; there is no MFG 

rule in the CalFresh. 

The MFG child is eligible to: 

• Cash based Medi-Cal and 

• Child Care assistance 


MFG Child Only AU 

Introduction This section contains information regarding Maximum Family Grant (MFG) 

child only Assistance Units (AUs). These AUs consist of an MFG child(ren) 

as the only eligible person. 

MFG child only 

– ZBG 

24 month 

exemption 

Nonreceipt of 

cash aid 

MFG/ZBG 

criteria 

Identifying 

MFG/ZBG 

cases 

Task – 

MFG/ZBG 

review 

When the MFG child is the only eligible person, the CalWORKs program 

remains open as a Zero Basic Grant (ZBG) until the family AU loses 

CalWORKs eligibility. 

After 24 consecutive months of ZBG, the MFG child meets an MFG 

exemption and is no longer MFG. For MFG purposes, a ZBG month is a 

month in which the AU did not receive cash aid. 

At the end of the 24 th consecutive month of ZBG, the MFG noncompliance 

record must be End Dated in C-IV. The AU is eligible to receive cash aid for 

that child at the beginning of the 25 th month. 

For MFG purposes, the following conditions are considered a month in which 

the AU did not receive cash aid: 

• The AU is eligible to ZBG, or 

• A reunification family does not receive a cash payment. 

A case must meet both of the following criteria to be MFG/ZBG: 

• Be an Active CalWORKs program receiving ZBG, and 

• Have at least one Active MFG child. 

MFG/ZBG cases are identified at the following times: 

• Application, both full case (Intake) and add person, 

• Re-Evaluation (RE), and 

• QR 7 review. 

To assist in deciding when the 24 th month has been reached, set a Task with 

Short Description of “MFG/ZBG review” and a Long Description including the 

name of the MFG child and the expected 24 th month of ZBG as follows: 

If the 24 th month of ZBG will be … Then set a Task for the … 

Before the next CalWORKs RE is Expected 24 

due, 

th month of ZBG. 

The month of next CalWORKs RE is RE month. 

due, 

After the next CalWORKs EW is RE month. 

due, 



MFG Child Only AU, Continued 

Reviewing MFG 

child only AUs 

MFG child only AUs must reviewed at application (both full case and add 

person), RE, and QR 7 review to determine if the AU has received ZBG for 

24 consecutive months. Review the case and CalWORKs program in the 

month the MFG/ZBG Task is due. If the CalWORKs program has reached 

the 24 th month of ZBG 

If the 24 th month has … Then 

Not been reached, Set a new Task following the 

instructions in the block above 

Been reached, Remove the MFG designation 

following the instructions in the 

block below. 

Removing MFG When the MFG child has received CalWORKs in an AU eligible to ZBG for 

24 consecutive months, the child is no longer MFG. After reviewing the case 

and the CalWORKs program to verify no cash aid has been received in any 

California county for 24 consecutive months, the EW must take the following 

actions: 

Step Action 

1 End Date the MFG non-compliance record, in C-IV, for the child 

the end of the 24 th month of ZBG. 

2 Run the CalWORKs EDBC, in C-IV, for the 25 th month to 

authorize cash aid for the child. 

Note: If the CalFresh is Active, run the CalWORKs and CalFresh 

EDBCs for the 25 th month together. Follow the instructions in the 

CalFresh Policy Handbook regarding CalWORKs grant increases 

and Mid-Quarter changes. 

3 Send appropriate notice to the customer. 

4 Notify the Local Child Support Agency/Department of Child 

Support Services (LCSA/DCSS) the child is no longer MFG. 



Immunizations 

Introduction This section contains information regarding immunization policy, definitions, 

exemption from the rule, and proof of immunizations. 


• EAS 40-105.4 

Policy In order to receive CalWORKs cash aid, most young children must be 

immunized against preventable childhood diseases. The policy is: 

Age 

appropriate 

immunizations 

Required 

vaccines 

• Parent/caretaker relatives of children in the AU under age six, including 

MFG children, must provide proof the child has received all ageappropriate 

immunizations as defined below or face a financial penalty. 

• Proof of immunization for newborns or for children less than three 

months old at application must be provided when the next Re-Evaluation 

(RE) occurs. 

• Children under age 6 who attend public or private school are not 

required to submit proof of immunization as it is assumed they have 

done so during the school enrollment process. 

• The Child Health and Disability Prevention (CHDP) program will be 

available to provide immunization to children and information to parents 

of children who need to be immunized. 

Age appropriate immunizations are immunizations recommended by the 

American Academy of Pediatrics (AAP) and the Advisory Committee on 

Immunization Practices (ACIP). 

The required immunizations depend upon the age of the child and how 

recent the last dose was received when there is a series of doses. Parents 

are considered to be complying with immunization requirements when they 

have initiated the immunization process but have not completed a series due 

to dosage spacing requirements and health of the child. 

Most commonly, the required vaccines include: 

• Polio 

• Diphtheria, tetanus, and pertussis (DTP) 

• Measles, mumps, and rubella (MMR) 

• Varicella Virus Vaccine (Chicken pox) – not available to all doctors 

• Hepatitis B 

• Hemophilus influenza type B – for meningitis 



Immunizations, Continued 

Proof of 

immunizations 


immunization 

Exemption 

from the rule 

San Bernardino County has elected to use the IMMUN 1 to verify whether or 

not the child has received age appropriate immunizations. However, if the 

parent/caretaker is unable to have the IMMUN 1 completed, the parent can 

provide other verification, such as shot records, doctor’s statement, etc., 

to verify immunizations. 

Note: A new IMMUN 1 is obtained at application and RE. 

Verification of immunization is required at initial application, when adding a 

child under the age of six to the AU, and at Re-Evaluation (RE). Verification 

of immunizations must be submitted until the child(ren) completes all 

age-appropriate immunizations or the child(ren) reaches the age of six. 

Children may be exempt from the immunization requirement when: 

• A medical professional indicates the child should not be immunized, or 

• The parent gives a written statement stating his or her belief the child 

should not be immunized. 


Verification of Immunization: The First Two Months of Aid 

Introduction This section contains information regarding informing parents/caretaker 

relatives, and proof of compliance for the verification of immunization in the 

first two months of aid. 


compliance: 

Intake 

The Eligibility Worker (EW) gives the parent the IMMUN 2 - Informing Notice, 

and the IMMUN 1 - Proof of Immunizations, during the application process. 

Informing parents/caretaker relative of the immunization requirements and 

verification of compliance with the requirements happens in the following 

sequence: 

If the IMMUN 1 or other 

verification is… 

Submitted before the 

application is processed 

• Submitted before 

processing, or 

• Not returned before 

processing 

Not submitted within 30 days 

of establishing CalWORKs 

eligibility, case processed, 

and customer has not 

expressed personal beliefs 

against immunization 

Not signed due to personal 

beliefs against immunization 

And the child… Then… 

Has the required Process the application if 

immunizations 


• Does not have the • Process the 

required 

application if 

immunizations, and otherwise eligible. 

• Is not exempt • Refer the family to 

CHDP. 

• Send the customer 

an IMMUN 1 and 2 

giving a 30-day 

deadline for return. 

• Set a Task for the 

information return 

deadline. 

• Do not apply a 

penalty. 

Is not exempt • Process if otherwise 

eligible. 

• Refer the family to 

CHDP. 

• Apply the penalty as 

directed in this 

chapter. 

Is exempt based on a Process the application if 

signed statement by the 

parent or caretaker 




Verification of Immunization: The First Two Months of Aid, 

Continued 


compliance: 

after 30 days of 

aid 

The continuing Eligibility Worker (EW) takes one of the following actions after 

the family has received aid for 30 days. 

If the IMMUN 1 or 

other verification… 

And the child is… Then… 

Returned Immunized Take no action. 

Returned Not immunized and not • Refer to CHDP, 

exempt 

• Send penalty NOA, 

Not returned Not exempt 

and 

• Apply the penalty 

Note: A penalty can be implemented mid-quarter (lowering cash aid) 

because it is a County-initiated Action. 


Verification of Immunization: Ongoing Cases 

Introduction This section contains information regarding verification of immunization after 

the first two months of aid. 

Verification 

after the first 

two months of 

aid 

The first IMMUN 1 for newborns or for children under three months old at 

application must be provided when the Re-Evaluation (RE) occurs. 

Parents must continue to submit the IMMUN 1 at each RE until any 

non-exempt child in the family completes all age appropriate immunizations 

or until the child enters public/private school or turns six years old, whichever 

is earlier. 

When there is a child subject to immunization requirements, the RE packet 

must include the IMMUN 2 and IMMUN 1. The parent or caretaker has 45 

days to return the IMMUN 1 after the re-evaluation of eligibility. 

Use the following verification guidelines when completing the RE. 

When the IMMUN 1 or 

other verification is… 

Returned at the RE 

appointment 

Not returned but the parent 

or caretaker provides: 

• A statement of 

opposition to 

immunization, or 

• Doctor’s statement 

• Returned at the RE 

appointment, or 

• Not returned 

And the child… Then… 

Has received required 

immunizations 

Is exempt 

• Has not received the 

required 

immunizations, and 

• Is not exempt 

Process the RE if the 

customer is otherwise 

eligible. 

• Process the 

application if 


• Refer the family to 

CHDP. 

• Send the customer 

another IMMUN 1 and 

2 giving a 45 day 

deadline for return. 

• Set a task for the 

return of the 

IMMUN 1. 

• A penalty is not 

applied unless the 

parent/caretaker 

misses the second 

deadline. 

Note: A penalty can be implemented mid-quarter (lowering cash aid) because it is 

a County Initiated Action. 


Immunization Penalty 

Introduction This section contains information regarding the immunization penalty, and 

when the parent is a non-Assistance Unit (AU) member or non-person to the 

AU. 

Immunization 

penalty 

When the 

parent is a non- 

AU member or 

non-person to 

the AU 

When a parent or needy caretaker relative fails to submit the IMMUN 1 or 

other verification, proving age appropriate immunizations for a child under 

age six who is not exempt or not in school, a financial penalty will be 

imposed. During the penalty period: 

The CalWORKs cash grant will not include the financial needs of the 

parent or needy caretaker. Both parents are penalized when both are in 

the home. 

The penalized parent/needy caretaker continues to be an AU member 

and their income and resources are considered when the Eligibility 

Worker (EW) determines eligibility and the grant amount for the rest of 

the AU 

The penalized parent/needy caretaker must continue to comply with all 

program requirements including: 

- Reporting and verification requirements 

- Participation in Welfare-to-Work (WTW)/CalWORKs activities 

- Cooperation with and participation in child support enforcement 

activities 

- Meeting school attendance requirements 

- Verification of Social Security numbers 

- Verification of age and citizenship 

When the family consists of a parent who receives Supplemental Security 

Income (SSI) or is otherwise excluded by regulation, and a child who is not 

immunized or exempt, send the penalty Notice of Action but do not decrease 

the CalWORKs cash grant. 


Imposing the Immunization Penalty 

Introduction This section contains information regarding the effective date of the penalty, 

when the penalty results in ZBG, and compliance after the penalty has been 

imposed. 

The effective 

date of the 

penalty 

When the 

penalty results 

in ZBG 

Compliance 

after the 

penalty has 

been imposed 

Decrease the grant due to the immunization penalty effective the first day of 

the month after which 10-day advance notice has been given. The penalty 

can begin mid quarter because it is considered a County-initiated Action. 

When the customer is already in a penalty period for another CalWORKs 

program non-compliance reason, send the 10-day advance notice of 

immunization penalty even though the grant will not be reduced further. Flag 

the case so the immunization penalty can be imposed should the customer 

clear the earlier penalty. 

When the combination of the family’s other income and the imposition of the 

immunization penalty results in a zero grant: 

• Do not discontinue the case 

• Leave the case open at the zero grant level 

• Make it clear to the customer that the months of zero grant eligibility will 

count toward time limits for CalWORKs eligibility 

The needs of the parent or needy caretaker will be met by increasing the 

CalWORKs cash grant when the Immunization requirement has been met 

and the: 

• Parent or caretaker provides the completed and signed IMMUN 1 or 

other verification of immunizations, or 

• Parent or caretaker submits a statement of exemption, or 

• Child turns six years old, or 

• Child enters public or private school. 

The beginning date of aid (BDA) when adding a parent or needy caretaker to 

the case is the first of the month following the month in which the: 

• IMMUN 1 or statement of exemption is received, or 


• Child enters public or private school. 


Family Member Changes During a Penalty Period 

Introduction This section contains information regarding change of caretaker during the 

penalty period, and when the child leaves the home. 

Change of 

caretaker 

during the 

penalty period 


leaves the 

home 

The penalty will not continue when there is a change in caretaker relative. 

When there is a change in caretaker: 

• Give the new caretaker relative the IMMUN 2 informing notice and the 

IMMUN 1. 

• Explain the regulation and verification requirements to the new caretaker. 

• Allow the new caretaker 30 or 45 days to comply with immunization 

requirements, depending upon whether the children involved are 

applicants or recipients of cash aid. 

When the child for whom the immunization requirement was not met leaves 

the home, the penalty will be lifted. 

Make a Journal entry so that the penalty can be applied if the child returns to 

the home and the immunization requirement has not been met, if still 

applicable. 


School Attendance: Overview and Definitions 

Introduction This section contains information regarding San Bernardino County’s school 

attendance policy, requirements and process. 


School 

attendance 

• EAS 40-105.5 

Regulations require that all children in an AU for whom school is compulsory 

attend school regularly and that the parent/caretaker relative cooperate in 

obtaining verification. However, regulations do not dictate how counties 

define regular/irregular attendance and the process for obtaining the 

attendance information. 

Definitions The terms and definitions as related to school attendance are: 

Compulsory school age: Children ages 6 through 17 who do not have a 

high school diploma or GED. 

Good cause: Verified prolonged illness/series of health care appointments 

or death in the family. 

Regular school attendance: Missing less than 20 days in a school year. 

SARB: School Attendance Review Board. 

School: An institution for learning. This includes: 

• Traditional public or private school 

• Independent study program overseen by a public or private high school 

• GED program with classroom courses 

• Charter school that has filed a "Private School Affidavit" with San 

Bernardino County Schools. 


School Attendance: Policy 

Introduction This section contains information regarding school attendance policy. 

Policy San Bernardino County's policy for school attendance is: 

• All applicants/recipients (parents/caretaker relatives) are to sign the 

TAD 144.1 (release of information for school attendance) at application, 

Re-Evaluation (RE) and when the child turns six (6). 

• Parents/caretaker relatives that fail/refuse to sign the TAD 144.1 for any 

school age child will have a non-cooperation penalty imposed. 

• All school age children are assumed to be attending school regularly 

unless notified by the school and/or SARB (via TAD 144) that the child is 

NOT attending school regularly. 

• Children who have missed 20 or more cumulative days of school 

(excluding school breaks and holidays) are considered to have poor 

attendance, unless there is good cause. 

• For middle, junior and high school, each period missed will count as a 

fraction of the total school day and applied towards the 20 days. 

Example: Child is to attend five periods each day. The child misses 10 

periods. This equals two days of absences. 

• Absences include being 30 or more minutes late to school. 

• Appeals will determine whether a child has good cause for not attending 

school regularly when the parent/caretaker appeals the penalty. 

• The penalty will be removed only after the child has attended school for 

30 consecutive school days and the school has verified the attendance. 


School Attendance: Rules 

Introduction This section contains information regarding rules for when to get the 

TAD 144.1, refusal to sign TAD 144.1, rules for Cal-Learn teens, general 

rules for 16 and 17-year-olds, application rule for 16 and 17-year-olds, 

Continuing case rule for 16 and 17-year-olds, and rules for 18-year-olds. 

Rules for when 

to get the 

TAD 144.1 

Refusal to sign 

TAD 144.1 

A TAD 144.1, completed and signed by the parent/caretaker, will be 

obtained: 

• At application, reapplication and restoration 

• At annual Re-Evaluation (RE) 

• By the end of the month in which a child turns six (6) 

• When adding a child age 6 through 17 to an ongoing case. 

Note: A TAD 144.1 will be obtained annually at RE, for all children, even if a 

TAD 144.1 was obtained when the child turned 6 or was added to the AU. 

Example: Child turns 6 in January and a TAD 144.1 is obtained. The RE is 

taken in June. A new TAD 144.1 will be obtained at the RE and every RE 

thereafter. 

If the customer does not want to sign the TAD 144.1 because he/she states it 

is an invasion of their privacy or they do not want the school to know that 

their child is receiving CalWORKs, the parent/caretaker relative will not be 

denied or discontinued form CalWORKs. The parent/caretaker relative will 

be allowed to provide proof of attendance by providing attendance records 

each month. The attendance records will be submitted with the QR 7. The 

customer will also provide information as to when the school year begins and 

ends. Failure to provide this information will result in school attendance 

penalty being applied. 

Note: The above procedure is done on an exception basis with approval of 

the District Manager (DM). Complete a Journal entry to indicate that the 

parent/caretaker relative is to provide school attendance monthly and not 

through the TAD 144.1 process. 



School Attendance: Rules, Continued 

Rules for Cal- 

Learn teens 

General rules 

for 16 and 

17-year olds 

Application rule 

for 16 and 

17 year olds 

Continuing 

case rule for 16 

and 17 year 

olds 

Rules for 

18-year olds 

The school attendance requirements do not apply to pregnant/parenting 

teens that are in the Cal-Learn program. 

The Cal-Learn program monitors the teen's progress. If the teen is not 

making progress, Cal-Learn penalties will be imposed. 

Note: For a pregnant teen that is school penalized, remove the penalty the 

first of the month the pregnancy is reported, but only after the pregnancy has 

been verified. 

To avoid the imposition of a penalty, children age 16 or 17 who have not 

graduated from high school or obtained a GED must: 

Enroll in school 

Meet school attendance requirements. 

Children, age 16 or 17-years old, who drop out of school, graduate from high 

school or obtain a GED, will be referred to the Welfare-to-Work (WTW) 

program. 

At application when the 16 or 17-year old is NOT enrolled in school, the child 

must register with WTW. The WTW activity for the teen will be to enroll and 

attend school. At the point the teen does not cooperate with WTW, an WTW 

sanction will be imposed upon notification. A school attendance penalty will 

not be imposed. 

For a continuing case, when a teen drops out of school, he/she is to be 

referred to WTW. At this time the school attendance penalty is imposed. 

The WTW activity for the teen will be to enroll and attend school. If the teen 

does not re-enroll in school, the penalty will turn to an WTW sanction. If the 

teen returns to school, the penalty will remain in place until the teen attends 

school for 30 consecutive school days. 

A child 18-years of age is eligible for CalWORKs only if he/she: 

Is enrolled as a full-time student (as defined by the school) in high school, 

or 

Has not completed high school, and 

Is in a vocational or technical training program which cannot result in a 

college degree, and 

Is expected to complete either program before reaching age 19. 

Note: The 18-year old will be discontinued if the school reports via the 

TAD 44 that the child will not graduate by his/her 19 th birthday. 


School Attendance: Verification 

Introduction This section contains information regarding verifying school attendance. 

Proving 

attendance 

When the AU includes a child, including an MFG child, who must attend 

school, the parent or caretaker, will sign the TAD 144.1 - Release of 

Information for School Attendance. The school will keep the release in the 

child's school record and report to TAD when the child has missed 20 days of 

school. When that happens, the school will then have the authorization from 

the parent or caretaker to communicate with TAD about the child's 

attendance record. The Eligibility Worker (EW) will then take appropriate 

action. 



School Attendance: Verification, Continued 

Process The following are steps for the school attendance process, to be taken during 

the application process, when a child reaches age six, or when a child who 

must attend school joins the AU: 


1 EW explains the school attendance requirement to the parent or 

caretaker and gives them the opportunity to initiate the school 

attendance verification process through the completion of the TAD 

144.1. 

2 TAD staff mails the TAD 144.1 to the school district’s Child 

Welfare and Attendance Administrator per TAD district procedures 

3 School Administrator notifies TAD via the TAD 144 when a child 

has missed 20 cumulative days in an academic year 

4 EW applies the penalty effective the first of the following month, in 

which timely notice can be given 

5 Parent/Caretaker notifies the EW when the child has attended 

school for at least 30 consecutive school days 

6 EW sends the TAD 144 to the school requesting proof of 

attendance 

7 School Administrator returns the TAD 144 to the EW with the 

attendance record 

8 EW determines required action: 

If the child has… Then… 

Attended school for 30 

consecutive days 

Not attended school for 30 

consecutive days 

The penalty will be lifted as 

described later in this 

section. 

The penalty will continue. 


School Attendance: Penalty 

Introduction This section contains information regarding the penalty for poor school 

attendance, when the penalty results in a Zero Basic Grant (ZBG) case, and 

when the parent is a non-Assistance Unit (AU) member or non-person to the 

AU. 

Penalty for 

poor school 

attendance 

Requirements 

during the 


When the 


in ZBG 

The school attendance penalty will be imposed on: 

A parent or needy caretaker relative who fails to sign the TAD 144.1 

A parent or needy caretaker relative when a child age 6-15 fails to attend 

school regularly 

Both parents when both are in the home 

A child age 16-17 who fails to attend school regularly 

Note: School attendance penalties are not applied to step-parents, unless 

the step-parent is receiving aid as a caretaker relative and no natural parent 

is in the home. 

During the penalty period: 

The CalWORKs cash grant will not include the financial needs of the 

penalized customer 

The penalized customer must continue to comply with all program 

requirements including: 

– Reporting and verification requirements 

– Participation in Welfare-to-Work (WTW)/CalWORKs activities 

– Cooperation with and participation in child support enforcement 

activities 

– Meeting immunization and school attendance requirements 

– Verification of Social Security number 

– Verification of age and citizenship 

When the combination of the family's other income and the imposition of the 

school attendance penalty results in a zero grant, the case is discontinued 

effective the first of the following month in which 10-day Notice is given. This 

action can be taken mid-quarter if necessary as it is considered a Countyinitiated 

Action. 



School Attendance: Penalty, Continued 

When the 

parent is a non- 

AU member or 

non-person to 

the AU 

When to apply 

a penalty if the 

customer 

reapplies 

When the family consists of a parent who receives Supplemental Security 

Income (SSI), or is otherwise excluded by regulation, including ineligibility for 

timing out, and a child who does not attend school regularly: 

• Do not impose a penalty if the child is 15 or younger because the parent 

would otherwise be penalized but does not receive CalWORKs cash aid. 

• Do not discontinue the entire case if the child is 16 or older and there are 

no other eligible children. Penalize the child and leave the case open at 

the zero grant level. 

When a case is discontinued and there is a school attendance penalty, and 

the customer reapplies for CalWORKs, use the chart below to determine 

whether or not to apply a school attendance penalty. 

If there is… Then… 

Less than a 30 day break in aid Apply the penalty. 

More than a 30 day break in aid Do not apply the penalty. 


School Attendance: Imposing the Penalty 

Introduction This section contains information regarding the effective date of the penalty, 

compliance after the penalty has been imposed, and graduation after the 

penalty has been imposed. 

Effective date 

of the penalty 

Compliance 

after the 

penalty has 

been imposed 

Graduation 

after the 

penalty has 

been imposed 

The grant will be decreased due to the school attendance penalty effective 

the first day of the month after which 10-day advance notice has been given. 

This action can be taken mid-quarter if necessary as it is considered a 

County-initiated Action. 

The penalty will continue through summer vacation and other nonattendance 

periods. 

When the customer is already in a penalty period for another CalWORKs 

program non-compliance reason, send the 10-day advance notice of school 

attendance penalty even if the grant will not be reduced further. Complete a 

Journal entry so the school attendance penalty can be imposed should the 

customer clear the earlier penalty. 

The needs of the parent, needy caretaker or 16-18 year old will be met by 

increasing the CalWORKs cash grant when: 

• The parent or caretaker initiates the attendance verification process by 

signing the TAD 144.1 when the penalty is for failure to do so, or 

• Verification is received confirming the child has attended school for at 

least 30 consecutive school days when penalized for non-attendance. 

The penalty will be lifted and the needs of the customer will be added back to 

the case effective the first of the month in which the: 

• TAD 144.1 is signed, when the penalty is for failure to do so, or 

• TAD 144 is received, verifying acceptable attendance when penalized for 

non-attendance. 

When a 16 or 17-year old has been penalized but graduates from high 

school or obtains a GED before they turn 18 years old and while the penalty 

is in force: 

• Lift the penalty effective the first of the month the student graduates or 

obtains the GED. 

• Aid the child through the month of the 18 th birthday if otherwise eligible 

and compliant with other program requirements. 


School Attendance: Family Member Changes During a 

Penalty Period 

Introduction This section contains information regarding the change of caretaker during 

the penalty period, when the child leaves the home and when a penalized 

child comes into the home. 


caretaker 

during the 



leaves the 

home 

When a 

penalized child 

comes into the 

home 

When there is a change in caretaker: 

• Explain the regulation and verification requirements to the new caretaker. 

• Do not apply the penalty if the child is age 15 and under. 

• Continue to apply the penalty to the child age 16-18. 

• If the caretaker is non-needy and the penalized child is the only child, 

leave the case open at the Zero Basic Grant level. 

When the child for whom the school attendance requirement was not met 

leaves the home, the penalty will be lifted. 

Complete a Journal entry so that the penalty can be applied if the child 

returns to the home and the school attendance requirement has not been 

met, if still applicable. 

The penalty will be reinstated if the child returns to the home within 30 days 

from being discontinued, if the child has not cured the school attendance 

penalty. 

If the child has been out of the home for more than 30 days from the 

discontinuance date, the penalty will not be imposed. A new TAD 144.1 will 

be obtained (see School Attendance Verification). 


Minor Parents 

Introduction This section contains information regarding minor parent requirements for 

receiving aid. 


• 89-201 

Definitions: The following definitions are found in this section: 

Acceptable living arrangement: Where the minor lives: 

• With a parent, legal guardian or caretaker relative, or 

• In a state licensed group or maternity home. 

Legal guardian: A relative or non-relative adult designated to care for a 

child through a court order. 

Minor parent: A person pregnant or a parent and under 18 years old. 

Nested teen: A minor parent who is receiving CalWORKs as a child in 

his/her senior parent's Assistance Unit (AU). 

Requirements In order to receive CalWORKs cash aid for themselves and/or their children, 

unmarried pregnant or parenting minors must: 

• Live in an acceptable living arrangement, and 

• Designate an adult as the payee for his or her cash assistance if living 

with an adult, or 

• Be exempt from the requirement to live with an adult, and 

• Be referred to Children's Welfare Services (CWS) for parenting and/or 

independent living services. 

Note: These rules apply to minor parents whether included in or excluded 

from the AU of their children. 


Minor Parent Case: Establishing the Payee 

Introduction This section contains information regarding determining the payee, and 

documentation. 

Determine the 

payee 

Use the following instructions to establish the payee for the minor's 

CalWORKs benefits when the minor lives in an acceptable living 

arrangement. 

If… Then… 

The minor lives with an adult, The adult must be the payee for the 

minor's CalWORKs grant. 

The minor lives with an adult and the The minor parent will be payee. 

adult refuses to be payee, 

The minor refuses or fails to 

document the adult's consent or 

refusal to be payee, 

It is not in the best interest of the 

minor for the adult to be the payee, 

The minor parent's Assistance Unit 

(AU) is ineligible for CalWORKs cash 

aid. 

• The minor may be payee, 

• The minor must provide credible 

proof of the situation, and 

• Evaluate the need for a Children 

and Family Services (CFS) 

referral. 

Documentation Use the form QR 25A: Payee Agreement for Minor Parent to document the 

selection of the payee. 

Note: Refer to the requirements section for a complete list of forms required 

for a minor parent case. 


Forms: Minor Parent in an Acceptable Living Arrangement 

Introduction This section contains information regarding the requirements for a minor 

parent in an acceptable living arrangement. 

Requirements In addition to the general application or status change procedures, use the 

following forms when a minor parent: 

• Applies for CalWORKs cash assistance, and 

• Is not exempt from the acceptable living arrangement requirement as 

described on the following pages. 

Form Purpose Requirements 

CW 23: 

Supplemental 


Facts 

CW 25: 

Supplemental 


Facts 

QR 25A: 

Payee 

Agreement for 

Minor Parent 

Lists the income of the 

senior parents. Must 

be completed by the 

minor parent. 

Lists all the people 

living in the home. 

Must be completed by 

the minor parent. 

Used at the time of 

application to obtain 

the consent of the 

senior parent, legal 

guardian or caretaker 

relative to be payee for 

the minor parent's 

CalWORKs cash grant. 

Required at: 


• Re-Evaluation (RE), or 

• When the minor moves into the 

home of the senior parent. 

Not required when: 

• The minor is living with an adult 

other than a parent. 

• The minor and parent are included in 

the same Assistance Unit (AU), or 

• The minor parent is exempt from 

minor parent rules. 

Required at: 


• RE, or 

• When the minor moves from one 

acceptable living arrangement to 

another or to an independent living 

arrangement. 

A copy of this form must be sent with the 

referral to Children and Family Services 

(CFS) when a referral is made. 

If the minor parent refuses to cooperate: 

• Deny the application for cash aid, 

• If the senior parent or other required 

adult refuses to cooperate, the minor 

may be the payee. 



Forms: Minor Parent in an Acceptable Living Arrangement, 

Continued 

Requirements (continued) 

Form Purpose Requirements 

CW 73: 

Supplemental 

Monthly 

Income Report 

MPS 25B 

Minor Parent 

Appointment 

MPS 25C 

Appointment 

Log 

Required monthly to 

verify the amount of 

the unaided senior 

parent's income. 

Used as an 

appointment letter for 

the minor parent to 

meet with CFS. 

Used as a FAX 

coversheet to track 

minor parent CFS 

appointments and 

times 

Must be submitted monthly as part of the 

QR 7 reporting process. 

Not required when: 

• The minor parent lives with an adult 

other than a parent. 

• The minor and parent are included in 

the same AU. 

• The minor parent is exempt from 

minor parent rules. 

Required at: 


• RE, or 

• When the minor moves from an 

acceptable living arrangement to an 

unknown living arrangement or to an 

independent living arrangement. 

Required whenever a minor parent 

appointment is scheduled at CFS. 


Exemptions from the Acceptable Living Arrangement 

Requirement 

Introduction This section contains information regarding exemption reasons from an 

acceptable living arrangement and referrals to the Department of Child 

Support Services (DCSS). 

Exemption 

reasons 

The minor parent may be exempt from the requirement to live in an 

acceptable arrangement. In order to be exempt from these regulations, the 

minor must be unable to live with either parent. Reasons for exemption must 

be evaluated for each of the minor's parents. 

When the minor is exempt and the reason has been verified, the minor 

parent may live independently, receive cash aid if otherwise eligible, and be 

his or her own payee. 

The minor may be exempt from the acceptable living arrangement 

requirement for the following verified reasons: 

Exemption reason Required verification 

Death of a senior parent or legal 

guardian 

The whereabouts of the senior parent or 

legal guardian are unknown 

The minor parent is not allowed to live 

with his or her parent or legal guardian 

The minor parent has lived 

independently for 12 consecutive 

months 

• Death certificate 

• Award letter from Social Security 

Administration (SSA) 

• Obituary or funeral notice 

• Newspaper account 

• CW 2.1Q for the senior parent 

• CW 2.1 NA 

• Written statement from the senior 

parent or legal guardian 

• Journal entry of the conversation 

and to whom the Eligibility Worker 

spoke, if verbal verification is 

obtained 

• Rental agreement 

• Statement from the senior parent or 

legal guardian 


Court documents 

The minor is legally emancipated from 

his or her parents 

The minor is or has been married • Marriage certificate or license 

• Divorce papers 

Unsafe to return home or the minor Children and Family Services (CFS) 

would be in imminent danger at the statement on the CW 25: Supplemental 

parent's home 

Statement of Facts 



Exemptions from the Acceptable Living Arrangement 

Requirement, Continued 

Child Support 

referrals 

A Child Support referral must be made when the minor does not live with 

either or both parents, even if the minor has been married. The minor parent 

must: 

• Provide information for the completion of the Support Questionnaire (CW 

2.1Q), and 

• Complete the CW 2.1 NA for his/her parents and his/her child's absent 

parent, and 

• Participate in the child support enforcement program. 

Note: Refer to Chapter 2 – Deprivation for details. 


Minors Living Independently 

Introduction When a minor lives independently of responsible adults, the Eligibility Worker 

(EW) must make referrals for either Minor Parent Services (MPS) or 

protection through Children and Family Services (CFS) depending on the 

situation. 

Minor Parent 


Minor Parent 


termination 

Referral 

process 

CFS provides MPS to the minor parent. MPS includes: 

• Education in the areas of infant health and development, 

• Parenting skills, and 

• Life skills. 

Minor Parent Services are terminated when the minor: 

• Turns 18 years old 

• Becomes emancipated 

• Refuses services 

• Gets married 

Use the following chart when completing a referral: 

If the minor parent… Then the EW will… 

Has been granted one of the following 

exemptions from the minor parent rules: 

• Death of the senior parent or legal 

guardian, 

• Whereabouts of senior parent or legal 

guardian are unknown, 

• Minor parent is not allowed to live in 

the senior parent or legal guardian’s 

home, or 

• Minor parent has lived independently 

for 12 consecutive months prior to 

application for cash aid or the birth of 

the youngest child, 

• Is legally emancipated from his or her 

parents or, 

• Is or has been married 

States that if he/she, and the child(ren) 

return home, they: 

• Will be unsafe or 

• Are in imminent danger from the 

responsible adult(s), 

Refer the minor parent to CFS 

for MPS. 

Note: See the “CFS Referrals” 

section for instructions and 

forms. 

Not make a CFS or MPS 

referral. 

• Not make a CFS referral. 

• Immediately complete the 

SS8572: Suspected Child 

Abuse Report, and 

• Fax a copy of the SS8572 

and a copy of the CW 25 to 

the Child Abuse Hotline at: 

(909) 512-1420. 



Minors Living Independently, Continued 

Minors in 

imminent 

danger 

During the application process, if an EW suspects abuse of the minor or the 

minor’s child(ren), the EW takes the following actions: 

Step Action 

1 Calls the Child and Adult Abuse Hotline (CAAHL) 1-800-827-8724 

immediately to make the report. 

2 Sends the CW 25 and the Suspected Child Abuse Report (SS 

8572) via fax to (909) 891-3545 within 36 hours of receiving the 

information concerning the incident. 

3 Notes the action on the Transitional Assistance Department (TAD) 

referral transmittal log. 

4 Journals case actions in C-IV. 


Children and Family Services (CFS) Referrals 

Introduction This section contains information regarding the Children and Family Services 

(CFS) referral process. 


referrals 

Referral based 

on risk 

Referral based 

on provision of 

MPS 

There are two types of referrals made to Children and Family Services 

(CFS): 

• Referrals based on risk 

• Referrals based on provision of Minor Parent Services (MPS) 

CFS will investigate the allegation if the minor indicates they (or their 

children) are at risk of abuse when living with the following people: 

• Parent(s) 

• Legal guardian 

• Other adult relative 

A referral for services and assessment is made to CFS if a minor meets any 

of the following four exemptions: 

• A CFS Social Worker (SW) determines the health or safety of the minor 

or their child(ren) is in jeopardy if they return to the residence of their: 

− Parent(s), 

− Legal guardian, or 

− Other adult relative. 

• The minor’s parent(s) or legal guardian is deceased or their whereabouts 

are unknown. 

• The parent(s) of the minor refuse to let them live in the home. 

• The minor has lived apart from their parent(s) or legal guardian for at 

least twelve months prior to the birth of the minor parent’s child or the 

application for aid. 



Children and Family Services (CFS) Referrals, Continued 

The referral 

process 

When the minor lives independently or moves from an acceptable living 

arrangement to an independent living arrangement, the independent living 

arrangement will be evaluated as follows: 



• Schedules an appointment for the minor to see a CFS worker 

when the minor completes the CW 25. Appointments are to be 

scheduled at 9 a.m. on Tuesday or Thursday only. 

• Completes and gives the MPS 25B to inform the minor parent 

of the appointment date, time, and location. 

• Faxes a copy of the CW 25 and MPS 25C Appointment Log to 

the designated CFS office (See CFS locations section in this 

chapter). 

2 CFS staff faxes a copy of the MPS 25C daily indicating whether 

the minor parent appeared for the appointment. 

3 EW journals if the minor parent appeared for the CFS 

appointment. 

4 CFS staff returns the CW 25 with the final determination once the 

assessment has been completed within the designated timeframes 

(See evaluation timeframes section in this chapter). 

5 EW determines the action to take based on: 

If the case is… And the minor … Then the EW will… 

Intake, 

Attended the Continue with the 

appointment, application process. 

Failed to attend the Deny the 

appointment, application. 

Continuing, Attended the Leave the open 

appointment, case open. 

Failed to attend the Discontinue the 

appointment, open case for failure 

to appear for an 

appointment. 

Note: The EW will follow up with CFS when the CW 25 has not been 

returned timely within 20 calendar days. 


Summary: Examples of Required Forms 

Introduction This section contains information regarding which forms to use. 

Which forms to 

use? 

The following table should help you decide which forms are required in a 

variety of situations. Use this table as a checklist; use the text of this section 

of this chapter for complete instructions. 

If the minor parent lives… Then use… 

With an aided parent, None of the minor parent forms as 

long as the minor is included in the 

senior parent’s Assistance Unit (AU). 

With an unaided senior parent, • CW 25 

• QR 25A 

• CW 23 

• CW 73 

With a legal guardian or non-parent • CW 25 

caretaker relative, 

• QR25A 

Independently, • CW 25 for the case and a copy 

to Children and Family Services 

(CFS) with the CFS referral, and 

• MPS 25B as part of the CFS 

referral. 

• MPS 25C 


Completing Casework after the CFS Referral 


• Determining eligibility during the Children and Family Services (CFS) 

evaluation, 

• Acting on the results, and 

• Examples. 

Determining 

eligibility 

during the CFS 

evaluation 

Evaluation 

timeframes 

When the minor parent requests an exemption from minor parent rules based 

on a dangerous home environment, the CFS worker will conduct an 

investigation to determine whether the exemption should be granted. The 

following rules apply: 

• The CFS worker is required to make a determination about the minor 

parent’s living arrangement within designated timeframes. 

• Immediate Need (IN) payments and/or temporary Homeless Assistance 

(HA) can be granted before the CFS determination is completed, if the 

minor parent is otherwise eligible. 

• Regular cash aid and permanent HA cannot be granted until CFS makes 

the final determination and informs the Eligibility Worker (EW). 

The following chart describes the referral response timeframes: 

Time Frame Type if Referral Social Worker (SW) 

Response 

20 calendar days Based on Risk Completes an in-person 

investigation and reports 

15 calendar days For minors who have 

received Immediate Need 

(IN) 

30 calendar days Based on the Provision of 

Minor Parent Services 

(MPS) 

the result to the EW. 

Completes an immediate 

in-person investigation and 

reports the results to the 

CWPHB #4605 (04/11) CHILDREN AND ELIGIBILITY 4-53 

EW. 

Completes an in-person 

safety assessment of: 

• Minor parent’s living 

situation. 

• Minor ability to live 

independently. 

• Services required to 

ensure the health and 

safety of the minor and 

his/her child(ren). 


Completing Casework after the CFS Referral, Continued 

Acting on the 

results 

Take the following case actions based on the reported findings of the CFS 

worker: 

If… Then… 

CFS grants exemption from 

minor parent rules based on an 

unsafe home, 

CFS does not approve the 

minor parent’s living 

arrangement, 

The minor returns to an 

acceptable living arrangement, 

The EW will: 

Continue with the application process with 

the minor as an independent payee. 

Initiate the Child Support process for the 

minor’s absent parents. 

Deny the application for cash aid unless 

the minor goes to an acceptable living 

arrangement. 

Consider aid received (such as IN 

payment), before the minor enters an 

acceptable living arrangement an 

overpayment. 

Approve the application. 

The Beginning Date of Aid (BDA) is the 

date the minor parent moved into an 

acceptable living arrangement. 

Example The minor parent applies for cash aid on July 2 and requests an IN payment. 

She claims her parents are abusive and she does not want to live with them. 

A $200 IN payment is issued on July 3. CFS determines the senior parent's 

home is safe. On July 20, the minor returns to the senior parent's home. 

The BDA is July 20. The prorated grant for July is $168. The overpayment is 

$32, the difference between the actual grant and the $200 issued as an IN. 


CFS Referral Locations 

Introduction This section contains Children and Family Services (CFS) referral locations. 

CPS locations The table below provides CFS referral locations. 

TAD District Office Served by… 

San Bernardino (01): 

265 E. 4 th St. 



2050 Massachusetts Ave 



1585 E Highland Ave 


Redlands (04): 

881 W. Redlands Blvd. 

Redlands, CA 92373 

Colton (19): 

2040 Woodpine Ave 

Colton, CA 92324 

Fontana (09): 

7977 Sierra Ave 

Fontana, CA 92336 

Ontario (15): 

1637 E. Holt Blvd. 

Ontario, CA 91761 

Rancho Cucamonga (25): 

10825 Arrow Rte. 

Rancho Cucamonga, CA 91730 

Hesperia (08): 

9655 Ninth Ave 

Hesperia, CA 92345 

Victorville (18): 

15010 Palmdale Rd. 


Adelanto (48): 

10875 Rancho Road 

Adelanto, CA 92301 

Yucca Valley (03): 

56357 Pima Trl. 

Yucca Valley, CA 92284 

Twentynine Palms (79): 

73629 Sun Valley Dr. 

Twentynine Palms, CA 92277 

Barstow (06): 

1300 E Mountain View Ave 

Barstow, CA 92311 

Needles (10): 

1300 Bailey St. 

Needles, CA 92363 

San Bernardino CFS 

128 Carousel Mall 


Phone (909) 388-1900 

Fax (909) 388-1901 or (909) 388-1902 


or 

1504 Gifford Ave 


Phone (909) 386-1100 

Fax (909) 386-1913 

Rialto CFS 

851 W. Foothill Blvd. 2 nd flr 

Rialto, CA 92374 

Phone (909) 421-7711 

Fax (909) 421-3417 

Rancho Cucamonga CFS 

9638 7 th Street 

Rancho Cucamonga, CA 91730 

Phone (909) 945-3762 

Fax (909) 945-3785 or 945-4616 

Victorville CFS 

15480 Ramona Road 


Phone (760) 243-6640 

Fax (760) 243-6656 

Yucca Valley CFS/SSG 

56311 Pima Trail 

Yucca Valley, CA 92284 

Phone (760) 228-5300 

Fax (760) 228-5321 or (760) 228-6308 

Barstow CPS/SSG 

170 N. Yucca Ave., #D 


Phone (760) 255-5400 

Fax (760) 255-1501 

Needles CPS/SSG 

1300 Bailey Street 

Needles, CA 92363 

Phone (760) 255-5400 

Fax (760) 326-9270 

All offices Child and Adult Abuse Hot Line (CAAHL) 

San Bernardino County of San Bernardino 

412 W Hospitality Ln. 


Phone (909) 384-9233 or (800) 827-8724 

Fax (909) 891-3545

When the Second Parent of the Minor Parent Moves In 

Introduction This section contains information regarding when the minor parent unit 

includes both parents, when the second parent is a minor, and special notes 

regarding the payee. 

When the minor 

parent unit 

includes both 

parents 

When the 

second parent 

is a minor 

Special notes 

regarding the 

payee 

When the second parent of the minor’s child joins the home, eligibility must 

be re-evaluated. Use the following information to help determine: 

• The number of people to include in the AU 

• The payee 

• Whether to apply the minor parent rules to the second parent 

When the senior 

parent unit… 

Receives 

CalWORKs cash 

aid 

Does not receive 

CalWORKs cash 

Then… 

• Re-evaluate deprivation for the minor’s child. 

• Add the second parent to the AU if otherwise 

eligible and the minor’s child is deprived. 

• Discontinue cash aid for the minor’s child if no 

longer deprived; the minor will remain in the senior 

parent’s AU if otherwise eligible. 

• Do not add the second parent to the AU if not 


• Treat the second parent as an excluded person for 

financial eligibility and grant computation purposes 

if ineligible to CalWORKs cash aid. 

• Reevaluate deprivation for the minor’s child. 

• Add the second parent to the AU if otherwise 

eligible and the minor’s child is deprived. 

• Discontinue cash aid for the minor’s AU if the 

minor’s child is no longer deprived. 

When the second parent of the minor’s child is a minor, apply the minor 

parent rules described in this chapter, including the rules for establishing an 

adult payee, when determining eligibility for the second parent. 

When the second parent of the minor’s child joins the family, the responsible 

adult with whom the AU lives, or the minor parent with whom the child 

normally lives when the adult will not cooperate, will be the payee because 

the minor parent payee rules must still be followed as long as one of the 

parents is a minor. 


Minor Parent Turns 18 

Introduction This section contains information regarding minor’s turning 18-years old, 

living with unaided senior parent, living with aided senior parent, and an 

example of nested teen turning 18. 

When the minor 

turns 

18-years old 

When the 

minor is living 

with unaided 

senior parent 

When the minor parent turns 18-years old, the requirement for the minor to 

live in an adult supervised living arrangement no longer applies. Additionally, 

a nested teen is no longer a mandatorily included AU member of his/her 

senior parent's AU. See Seamless Determination of Eligibility rules for teens 

turning 18. 

When the minor is living with an unaided senior parent and the senior parent 

is the payee, the minor will become his/her own payee effective the first of 

the month AFTER the minor turns 18 years old. 


Teens Turning 18 Years Old – Seamless Determination of 

Eligibility 

Introduction This section contains information regarding informing teens turning 18-years 

old, the ADM 103 CIV, what action to take when the minor turning 18 wants 

his/her own Assistance Unit (AU), items to obtain from parent/caretaker 

relative’s case, items to obtain from teen, eligibility for teens turning 18years-old, 

Transitional Assistance for Needy Families (TANF) and 

CalWORKs clocks, action to take when the nested teen applies for his/her 

own AU, and when to stop using the senior parent’s income. 

Overview All County Letter (ACL) 01-77 clarified the existing State policy requiring 

counties to review cases for continuing eligibility when any Assistance Unit 

(AU) member turns 18. The letter clarified the mandatory inclusion rules for 

pregnant and parenting 18-year olds who are eligible to establish his/her own 

AU. 

The State required the transition for a pregnant/parenting teen to his/her own 

AU to be as “seamless” as possible, so no break in aid occurs. This county 

began applying this process in May 2003. 

Informing Teens must be informed 60 days prior to their 18 th birthdays of possible 

continuing eligibility options. 18-year old pregnant and parenting teens in 

his/her parent/caretaker relative’s AUs have a choice to either remain in 

his/her parent/caretaker relatives’ AUs or to establish his/her own AU. These 

teens must be informed: 

• If he/she starts his/her own AU, his/her grant will increase in most cases, 

but his/her parent/caretaker relatives’ grant will go down or stop. 

• He/she does not have to move out of his/her parent/caretaker relatives’ 

homes to establish his/her own AU. 

• His/her 48-month CalWORKs clock will not start until he/she establishes 

his/her own AU. 

• If the Maximum Family Grant (MFG) rule was applied to his/her child(ren) 

while the teen was aided as an eligible child, the teen’s child(ren) can 

now be counted when determining the cash aid payment in the teen’s 

cases. 

The State developed the CW 2103, Notice for Teens Turning 18 Years Old, 

to meet the informing requirement as stated above. The C-IV version of the 

CW 2103, the ADM 103 CIV, is automatically generated and sent out 

60 days prior to each aided teen’s 18 th birthday. 

Note: TANF 60-month clock starts the month/year teen’s case is effective. 




Eligibility, Continued 

The completion 

of the 

ADM 103 CIV 

The ADM 103 CIV is sent to parent/caretaker relatives of aided teens, within 

60 days of their 18 th birthdays, to inform the teens of possible continuing 

eligibility options. The parent/caretaker relatives are asked to give the teen 

the ADM 103 CIV. 

Teens turning 18 who do not have children and/or are not pregnant are 

informed they can continue to get cash aid as part of their parent/caretaker 

relatives’ case after their 18 th birthdays only if they are: 

• Full-time students in high school, or in a vocational or technical training 

program, AND 

• Are expected to finish school before their 19 th birthdays. 

Teens turning 18 who have a child and/or are pregnant are informed they 

can continue to get cash aid as part of their parent/caretaker relatives’ case 

after their 18 th birthdays only if they meet the requirement above. They are 

given the additional option to start their own cases. 

Pregnant/parenting teens that choose to start their own cases are advised to 

call their Eligibility Worker (EW) right away. 

Pregnant/parenting teens that are eligible to remain in their parent/caretaker 

relatives’ cases do not have to do anything. 





Teens’ choice Pregnant/parenting teens who are aided in their parent/caretaker relatives’ 

AUs may choose to: 

• Have their own AUs established on the first of the month following the 

month they turn age 18 (or the first day of the month in which they turn 

age 18 if their birthday is on the first of the month), or 

• Remain in their parent/caretaker relatives’ AUs as dependent children 

provided they continue to meet the educational and/or training 

requirements for 18-year-olds. 

Use the table below to determine what to do if the teen either requests or 

does not request to establish his/her own AU. 

If the teen … Then … 

Requests to 

establish his/her 

own AU 

Does not request to 

establish his her 

own AU 

The Eligibility Worker (EW) will schedule an 

appointment with the teen 

If the teen … Then … 

Continues to meet the 

age/school 

requirements for an 

18-year-old 

Does not meet the 

age/school 

requirements for an 

18-year-old 

Leave the teen on 

his/her parent/caretaker 

relative’s cash aid case. 

Discontinue the teen at 

the end of the month 

he/she turns 18-yearsold. 

Note: An 18-year-old can continue to get cash aid as part of his/her 

parent/caretaker relative’s AU if the 18-year old is: 

• A full-time student in high school, or a vocational or technical training 

program, AND 

• Expected to finish school before turning 19-years old. 





Action to take 

when minor 

turning 18 

wants own AU 

Items to obtain 

from parent / 

caretaker 

relative’s case 

When a minor parent or pregnant teen turning 18 wants his/her own AU, that 

teen is required to notify his/her Eligibility Worker (EW). The EW will 

schedule an appointment for the teen to complete the application paperwork 

and send or give the necessary forms to the teen. 

The transition for the pregnant/parenting teen to his/her own AU must be as 

“seamless” as possible so no break in aid occurs. The County will not 

require the teen to furnish any documentation previously provided to the 

County. Some information needed to complete the teen’s case may be 

found in the parent/caretaker relative’s case record, but may not be released 

to the teen without a release of information from the parent/caretaker relative. 

An example would be paternity information on the minor parent if Good 

Cause were claimed. The purpose of requiring a release of information is to 

ensure the parent’s information and information provided by a third party 

remains confidential. The fact the 18-year old was previously in the senior 

parent’s case does not allow him/her access to the parent’s specific 

information. 

When all information necessary to process the teen’s case is received and 

the pregnant/parenting teen becomes eligible, the EW must process the case 

and authorize approval and payment. 

The latest SAWS 1 (or equivalent) for the family contained in the case the 

teen was aided in will be copied and used to establish the separate AU for 

the teen. 

Some documentation can be retrieved from the parent/caretaker relative’s 

case record, and does not require a release of information, such as: 

• Birth/citizenship documentation for the teen and his/her children 

• Social Security number documentation for the teen and his/her children 

• Income documentation for the teen and his/her children 

• Resource/property documentation for the teen and his/her children 

• Documentation of death deprivation if the deprivation for the teen’s child 

is death 

• Verification of teen’s pregnancy 





Items to obtain 

from teen 

Income, 

resources, and 

budgeting 

Application and 

effective dates 


Action 

Forms and documentation which must be completed by the teen are those 

which require the teen’s signature and include: 

• SAWS 2 and SAWS 2A 

• Verification of deprivation for teen’s child(ren) 

• Immunization documentation 

• School verification information for teen’s children (if necessary) 

• All other application forms not listed above. 

The EW may obtain a signed SAWS 1 from the teen, but a copy of the 

SAWS 1 from the parent/caretaker relative’s case is mandatory and must be 

filed in the teen’s case. 

For income and resource limits, disregards, etc., the teen shall be treated as 

a recipient rather than an applicant. This means the teen is not subject to the 

applicant financial eligibility test. 

The teen’s AU will be budgeted following QR PB rules beginning with the 

case effective date. 

The application and effective date for the teen’s AU will be the date the teen 

is transferred to his/her own AU. This date is the first of the month following 

the teen’s 18 th birthday, or the first day of the month in which the teen turns 

18, if his/her birthday is the first day of the month. 

A Notice of Action (NOA) must be sent to each teen who chooses to 

establish his/her own AU. 

If retroactive eligibility and benefits should be ordered by Appeals, contact 

PDD for the appropriate notices. 





Retroactivity As a rule, there will be no retroactive benefits. However, if a teen files for a 

hearing based on the issuance of retroactive benefits, Appeals staff will 

determine whether or not retroactive benefits are appropriate based on the 

requirements of the ACL. If the teen is eligible to retroactive benefits, 

Transitional Assistance Department (TAD) staff will correct the CalWORKs 

effective date to the date specified by Appeals and issue retroactive 

CalWORKs benefits as directed. 

TANF and 


Clocks 

The teen’s TANF 60-month clock starts the month and year the teen 

establishes his/her own AU. 

The teen’s 48-month CalWORKs clocks will not start until he/she establishes 

his/her own AU. 

CalFresh If the teen and his/her child(ren) were receiving CalFresh as members of the 

senior parent’s CalFresh household prior to transitioning to his/her own 

CalWORKs case, the teen and his/her child(ren) will remain members of the 

senior parent’s CalFresh household after the transition if the teen: 

• Continues to reside with the senior parent, and 

• Remains under age 22. 

If the teen remains in the senior parent’s CalFresh household, the teen’s 

income (including the CalWORKs grant), expenses, and resources will be 

used to determine eligibility and benefits for the senior parent’s CalFresh 

household. 


The Cal-Learn Program 

Introduction This section contains information regarding the Cal-Learn Program 

definitions, who must participate, Eligibility Worker (EW) responsibilities 

and confidentiality. 

References The Manual of Policies and Procedures (MPP) references for this section 

are: 40-105, 42-762, 42-763, 42-764, 42-765, 42-766, 42-767, 42-768, 

42-769, 42-763, 42-766 

Overview A parent’s lack of basic education is a major barrier to self-sufficient 

families. When teens start families before they graduate from high school 

or obtain an equivalent (General Education Development - GED), the 

likelihood the family will live in poverty and rely on public assistance is 

greater than for those families where the parents have at least a high 

school education. 

The goal of the Cal-Learn program is to guide pregnant and parenting 

teens toward achieving a high school diploma. To accomplish this goal, 

teen parents are provided: 

• Case management services through the Department of Public Health’s 

(DPH) Maternal, Child and Adolescent Health (MCAH) from registered 

nurses and social workers who provide guidance in obtaining 

educational, health, and social services. 

• Supportive services through the Transitional Assistance Department 

(TAD) such as transportation, school supplies and child care to help 

overcome obstacles to school attendance. 

• Financial bonuses or penalties through the CalWORKs EW, based on 

school performance. 




Definitions Cal-Learn criteria: All CalWORKs pregnant and parenting teen/pre-teen 

custodial parents must participate in the Cal-Learn program unless they are 

exempt, deferred, or have a high school diploma or equivalent. 

Cal-Learn teen: Any customer in the Assistance Unit (AU) who is pregnant 

and/or a parent, under the age of 19, who does not have a high school 

diploma or equivalent (General Education Development - GED). 

Case management services: MCAH provides assistance to teen/pre-teen 

parents to obtain educational services necessary to earn a high school 

diploma or equivalent. These may include health services, parenting skills or 

suitable living arrangements. 

Deferral: Cal-Learn requirements are suspended while a Cal-Learn teen 

has a condition that temporarily prevents full-time school attendance. MCAH 

case management services will continue during the deferral period. 

Exemption: A teen parent may not be registered for Cal-Learn services 

when circumstances prevent full-time school attendance for more than three 

months. MCAH case management services are not provided to teen parents 

exempt from Cal-Learn. 

MCAH: Provides case management services for Cal-Learn through the 

Department of Public Health. 

Supportive Services: Services that assist the Cal-Learn teen in attending 

school regularly, such as child care and transportation costs. 




Who must 

participate in 

Cal-Learn 

Next steps 

when a teen 

earns a 

diploma or 

turns 20 

Cal-Learn EW 


Cal-Learn is mandatory for Assistance Unit (AU) members who meet all of 

the following conditions: 

Under 19 years old, 

Pregnant or a parent residing with his/her child, 

Included in the same AU as his/her child, and 

Has not earned a high school diploma or equivalent. 

Teens who meet the Cal-Learn criteria MUST participate in the Cal-Learn 

program unless exempted or deferred by the MCAH Case Manager in 

agreement with the Cal-Learn EW. Teen parents who turn 19 years old 

while they are in the Cal-Learn program and have not graduated from high 

school or its equivalent may participate in the program until they turn 20 

years old. 

When the teen parent earns a high school diploma or equivalent or turns 20 

years old, the customer is referred to Welfare-to-Work (WTW) activities 

through Welfare-to-Work (WTW) program. Although the former 

Cal-Learn customer may become exempt from meeting ESP requirements, 

he/she is expected to continue working toward heading a financially 

self-sufficient family through employment. 

Specialized EWs manage the Cal-Learn programs. This worker is referred 

to as the Cal-Learn EW. The job responsibilities of the Cal-Learn EW 

include, but are not limited to: 

Carrying the CalWORKs program with the Cal-Learn teen’s program 

Obtaining the ABCDM 228 – Applicant’s Authorization for Release of 

Information form, in order for the Program Integrity Division (PID) to 

verify participation for WTW 

Referring eligible teens to MCAH for case management services 

Interfacing with MCAH case managers about the needs and welfare of 

the Cal-Learn teens 

Communicating with Cal-Learn teens about program eligibility and 

issuances of support services and bonuses and penalties 

Authorizing and issuing supportive services 

Administering bonuses and penalties 

Referring teens to WTW when no longer required to participate in 

Cal-Learn 




Sharing 

information 

The Cal-Learn EW and the MCAH Case Manager must share appropriate 

program information with each other on a regular basis. A release of 

information is not necessary to share information between the Cal-Learn 

EW and the MCAH Case Manager. 

Follow up It is extremely important for the Cal-Learn EW to follow up on all 

information, actions, and requests sent to the MCAH Case Manager by 

sending an e-mail within five (5) business days to the appropriate contact 

person. The same will apply to the MCAH Case Manager. This ensures 

both parties take timely action. 


Cal-Learn Referral Procedures 

Introduction The following section explains the Cal-Learn criteria, when to refer to 

Cal-Learn, voluntary participation, and Maximum Family Grant (MFG) rules. 

Cal-Learn 

criteria 

When to refer 

teen parents to 

Cal-Learn 

Voluntary 

Cal-Learn 

participation 

Cal-Learn 

Self-Appraisal 

form (CL 27) 

All pregnant (even if the teen is not receiving Pregnancy Special Needs 

(PSN)) and parenting teens who do not have their high school diploma will 

be referred (up to their 19 th birthday) to Maternal, Child and Adolescent 

Health (MCAH). 

Teens who meet the Cal-Learn criteria MUST participate in the Cal-Learn 

program unless exempted or deferred by the MCAH Case Manager, in 

agreement with the Cal-Learn Eligibility Worker (EW). 

EWs review programs for teens who meet the Cal-Learn criteria at: 

• Application, reapplication, or restoration 

• Annual Re-evaluation (RE) 

• Report of pregnancy 

• Report of the birth of a child 

• Inter-County Transfer (ICT) in 

Note: The Cal-Learn program may be created manually by the EW, or 

automatically in C-IV when EDBC is run, accepted and saved. Automation 

of the Cal-Learn program ensures all parenting and pregnant teens are 

referred to the Cal-Learn program so that their required participation and 

services are met. C-IV creates an automated Journal entry when the Cal- 

Learn program is automated. 

Current or former Cal-Learn teens who are 19 years old and attending 

school full-time may volunteer to participate until 20 years old. If the 

pregnant or parenting teen would like to volunteer for Cal-Learn, the EW 

must advise MCAH to initiate or continue participation. 

The Cal-learn Self-Appraisal form, CL 27, is completed for all pregnant and 

parenting teens receiving CalWORKs. The form is used to determine the 

teen’s eligibility to participate in the Cal-Learn program. 

The EW will e-mail the CL 27 to MCAH to refer teens who meet the Cal- 

Learn program eligibility criteria. 



Cal-Learn Referral Procedures, Continued 

Teen parent of 

a Maximum 

Family Grant 

child (MFG) 

MCAH contact 

information 

Because many families are aware of the MFG rule and that a newborn may 

not cause the grant to increase, families often do not report the pregnancy 

of a teen Assistance Unit (AU) member. 

Even though cash assistance may not increase, the newborn is still 

considered an AU member for eligibility purposes. Therefore, the pregnant 

and/or parenting teen cash aid customer must participate in the Cal-Learn 

program. 

It is important for staff to remind customers to report any pregnancy in the 

family. 

Note: For more information regarding MFG children, including the nested 

teen, see the “MFG” and “Teens Turning 18 Years Old – Seamless 

Determination of Eligibility” sections of this handbook chapter. 

EWs must include the MCAH Supervising Office Assistant (SOA) in e-mails 

when the Cal-Learn program will be opened, exempted, deferred or 

discontinued. 

The MCAH SOA can also be contacted via phone or e-mail in regards to 

case information, action requests, forms, etc. 

The name of the MCAH SOA can be obtained by calling (909) 388-5742. 

The MCAH SOA’s e-mail address is located in Outlook. 


Cal-Learn Registration 

Introduction The section contains information regarding the Cal-Learn registration 

process. 

Registration 

and Approval 

Process 

Reverse 

Referral 

The Cal-Learn registration and approval process is described in the table 

below. 


1 Intake Eligibility Worker (EW) or C-IV identifies the pregnant or 

parenting teen. 

2 Intake EW: 

• Completes the electronic CL 27 Cal-Learn self-appraisal form 

using information provided by the teen. 

• Processes the CalWORKs application. 

3 Intake EW or C-IV opens the Cal-Learn program. 

4 Intake EW assigns program to the Cal-Learn EW. 

Note: If no response is received from Maternal, Child and Adolescent 

Health (MCAH) within five (5) business days indicating forms were received 

and case is now active, the Cal-Learn EW sends an e-mail to the contact 

person to follow up. 

If a reverse referral is received from MCAH (the CL 27 is received from 

MCAH ), the Cal-Learn EW will: 

Step Action 

1 Request the open CalWORKs case from the EW. 

2 Open the Cal-learn program. 

3 Immediately review the CL 27 for Cal-Learn criteria. 

If the teen is 

determined … 

Then… 

Eligible, • E-mail the electronic CL 27 and 

CL 700 to the Department MCAH. 

• Process the Cal-Learn case and 

changes Pending status to 

Active within ten (10) business 

days. 

Ineligible, Deny the Cal-Learn case. 

4 Image the CL 27 in C-IV. 


Beginning Cal-Learn Participation 

Introduction This section contains information regarding the orientation process, 

exemptions, deferrals, and what to do when the teen fails to participate in 

the Cal-Learn program. 

Cal-Learn 

orientation 

Upon receipt of the CL 27 and the CL 700, the Maternal, Child and 

Adolescent Health (MCAH) Case Manager contacts the teen (initial contact) 

and schedules the teen to participate in orientation within five (5) business 

days. 

When the teen… Then the MCAH Case Manager… 

Completes orientation, • Sends the following forms to the 

customer: 

− CL 1, 

− CL 2, and 

− CL 8. 

• E-mails the CL 700 with the report 

card/progress report dates to the 

Eligibility Worker (EW). 

Fails to attend orientation, • Sends the following forms to the 

customer: 

− CL 1, 

− CL 2, 

− CL 3, 

− CL 4 and 

− CL 8. 

• E-mails the CL 700 advising of 

orientation status to the EW. 

Note: If no response is received from the Cal-Learn EW within five (5) 

business days indicating the CL 700 was received, MCAH sends an e-mail 

to the EW to follow up. 



Beginning Cal-Learn Participation, Continued 

Deferrals or 

exemptions 

Occasionally the teen advises the MCAH Case Manager of a problem that 

keeps the teen from attending school. The MCAH Case Manager works 

with the teen to resolve the problem or comes up with the best solution for 

the teen. In some cases the teen may need to be: 

• Exempted because of circumstances that prevent full-time school 

attendance for more than three (3) months. 

Example: Teen needs transportation and no services are available for 

a period of four (4) months. Teen is not registered for Cal-Learn 

services. 

• Deferred because of a condition that temporarily prevents full-time 

school attendance. 

Example: Teen gives birth and doctor requests post-partum recovery 

period. Cal-Learn requirements are suspended but teen is registered 

for Cal-Learn and is provided services by the MCAH Case Manager. 

Teen parents who are exempted from Cal-Learn will not receive any 

services provided by the MCAH Case Manager. Because of this, it is very 

important that exemption reasons and solutions be explored thoroughly 

prior to approval. Whenever possible, defer the teen instead. 



Beginning Cal-Learn Participation, Continued 

Deferral and 

exemption 

process 

When the 

Cal-Learn teen 

fails to 

participate 

The Cal-Learn deferral and exemption process are described in the table 

below: 


1 Cal-Learn teen tells the MCAH Case Manager of problems 

preventing full time school attendance. 


• Discusses deferral or exemption with the teen. 

• Requests verification, when appropriate. 

• E-mails CL 700 form and verification of the reason for deferral 

or exemption to the Cal-Learn EW. 


• Approves or denies deferral or exemption as appropriate. 

• Sends NA 310 - Cal-Learn Notice of Exemption/Deferral to 

the teen. 

• Immediately e-mails CL 700 to the MCAH Case Manager and 

the Department of Public Health (DPH) Supervising Office 

Assistant (SOA) (see “MCAH contact information” block in the 

“Cal-Learn Referral Procedure” section of this handbook 

chapter) advising of action. 

• Journals actions in C-IV. 

• Sets a Task for one month prior to deferral/exemption 

expiration. 

Cal-Learn teens who are not exempt must participate in the program. 

The Cal-Learn teen must: 

• Attend orientation 

• Cooperate with the MCAH Case Manager 

• Attend school or equivalent activities 

• Maintain an acceptable Grade Point Average (GPA) 

The consequence for failing to participate without good cause is a penalty 

applied each time the report card is due. No other punitive action can be 

taken. 


Cal-Learn Supportive Services 

Introduction This section contains information about supportive services. These 

services assist the Cal-Learn teen in attending school regularly. 

Supportive 

services 

Cal-Learn child 

care 

Supportive services include: 

• Child Care: Provided through Transitional Assistance Department’s 

(TAD’s) Child Care Eligibility Workers (EWs). 

• Transportation: Bus passes and tickets, parking, etc. 

• Ancillary: Vouchers issued to Cal-Learn teen to cover education 

expenses, which may include: General Education Development (GED) 

fees, gym clothes, school supplies, books, and back packs if school 

lockers are not available. 

Note: Tuition is not a covered supportive service expense. 

The following table describes the Child Care process: 


1 Cal-Learn teen discusses child care need with the Maternal, Child 

and Adolescent Health (MCAH) Case Manager. 


• Contacts the Child Care EW directly by telephone or e-mails 

CL 700 requesting child care. 

• E-mails a CL 700 each school year to have a new child care 

contract set up. 

3 Child Care EW: 

• Contacts Cal-Learn teen and Child Care provider. 

• Writes child care contract. 

• Sets up program. 

• E-mails a CL 700 to the Cal-Learn EW and MCAH Case 

Manager advising of child care contract and expiration date of 

services. 


• Journals Child Care services are provided. 

• Advises the Child Care EW of any changes to the CalWORKs 

and Cal-Learn programs that may affect the Child Care 

program. 


• Contacts the Child Care EW once child care services are 

requested by the MCAH Case Manager (if so desired). 

• Signs child care contract. 

• Complies with Child Care program requirements. 

6 Child Care EW completes Service Agreement to issue benefits. 




Cal-Learn 


Cal-Learn 

Transportation- 

Bus 

Often the Cal-Learn teen requires transportation to school and to take 

his/her child to the child care provider. The Cal-Learn EW must choose the 

least costly form of transportation to meet the needs of the Cal-Learn teen. 

Normally the issuance of a bus pass is the best choice for transportation. If 

bus transportation is not available, reimbursing mileage for the use of a 

personal vehicle may become necessary. In very infrequent occasions, 

gas scrip may be provided as a temporary solution. 

Whenever possible, bus passes or tickets are provided to the Cal-Learn 

teen. 

The following table describes the transportation process: 


1 Cal-Learn teen discusses transportation need with the MCAH 

Case Manager. 


• Calls with names of customers who need bus passes or 

tickets, or 

• E-mails a list of customers via CL 700 to the Cal-Learn EW. 


• Approves transportation request. 

• Completes Service Agreement for each customer. 

• Gives Service Agreement to Issuance Clerk. 

• Advises Cal-Learn teen or MCAH Case Manager that 

transportation was approved and when to pick up. 

4 Issuance Office Assistant (OA): 

• Orders bus passes and tickets as needed. 

• Issues passes or tickets to the Cal-Learn teen or MCAH Case 

Manager in the district office. 

• Receives/reconciles bus passes returnd by the MCAH Case 

Manager. 


• Picks up bus pass in district office. 

• Delivers bus pass to Cal-Learn teen. 

• Returns any unused bus passes to the issuing district office. 

OR 

Cal-Learn teen: 

• Picks up bus pass in district office. 

• Signs Service Agreement. 

• Signs bus pass, if required. 




Student ID 

cards for bus 


Reimbursement 

for Cal-Learn 


costs 

The Cal-Learn teen may need to show the bus driver student 

identification (ID) when using a bus pass. If the school does not issue 

student ID cards, Human Services (HS) Personnel will make a Cal-Learn 

Student ID card for the Cal-Learn teen. When referring the Cal-learn teen 

to HS Personnel to obtain a student ID card, advise the teen: 

• To call HS Personnel at (909) 386-3700 to set up an appointment. 

• Student IDs are made every Tuesday at 9 a.m. 

• The ID card will have the Cal-Learn teen’s name and “TAD Cal-Learn” 

printed on it with the teen’s picture. It does not expire. 

For districts served by Victor Valley Transit Authority: 

• The Issuance Clerk will automatically issue Victor Valley Transit 

Authority Student IDs to all Cal-Learn teens who receive a bus pass. 

• The ID card will have the Cal-Learn teen’s name, the word “Cal-Learn” 

and the effective dates. 

• The ID card is good for four (4) months. A new card must be issued 

upon expiration. 

In certain circumstances it may be necessary to reimburse the Cal-Learn 

teen for travel costs to go back and forth to school and to go to the child 

care provider. Prior approval from the MCAH Case Manager and Cal- 

Learn EW is required. Travel costs may be reimbursed for: 

• Use of a personal vehicle when bus transportation is not available. The 

reimbursement for personal vehicle use is 37.4 cents a mile. There is 

no capped amount. 

• Use of a personal vehicle when bus transportation is available. The 

Cal-Learn teen will be reimbursed the cost of a local bus pass. 

• Parking, if required for school activity. The Cal-Learn teen must provide 

verification unless metered parking. There is no capped amount. 

• Bus fare, if not supplied by the Transitional Assistance Department 

(TAD) office. The Cal-Learn teen must provide verification. Limited to 

cost of a local bus pass. 




Steps for 

reimbursing 


The following table describes the steps for reimbursing transportation costs 

to the Cal-Learn teen: 


1 Cal-Learn teen discusses need to pay for own transportation and 

requests prior approval of expense reimbursement with MCAH Case 

Manager. 


• Explains to the Cal-Learn teen how to complete and submit the 

CL 753 Cal-Learn Travel Claim form and CL 735.2 CalWORKs 

Attendance Report form. 

• E-mails CL 700 to or calls Cal-Learn EW with reimbursement request 

and reason needed. 


• Approves request (may discuss with Case Manager). 

• Sends NA 113 to Cal-Learn teen. Includes enough CL 753 and 

CL 735.2 forms for the months needed. 

4 Cal-Learn teen, on or after the last day of the month: 

• Completes CL 753 for each trip made to school or child care provider. 

• Has instructor or school attendance secretary or teacher sign 

CL 735.2 for each school day attended. 

• Turns in the above forms with any receipts required to the Cal-Learn 

EW. 


• Reviews CL 753 and reconciles trips reported against CL 735.2. 

• Totals approved expenses in “County Use Section”. 

• Calculates reimbursement. 

• Completes Service Arrangement, including amount to be reimbursed 

and circles expense code “W” for Regular Travel. 

• Has authorized supervisor approve payment by signing Service 

Arrangement. 

6 Authorized Supervisor approves payment by signing the Service 

Arrangement. 


• Gives original and one copy of Service Arrangement to Issuance 

Clerk. 

• Retains copy of Service Arrangement with CL 753, CL 735.2 and any 

receipts in physical case folder. 

8 Issuance Clerk: 

• Sends original Service Arrangement to Human Services (HS) 

Auditing. 

• Retains copy of Service Arrangement with original CL 753, CL 735.2, 

and any receipts. 

9 HS Auditing mails reimbursement check to Cal-Learn teen within five (5) 

days of receipt of complete and correct Service Arrangement. 




Costs for bus 

passes 

The table below lists the county costs for bus passes. 


Omnitrans 

909-379-7100 

Victor Valley 

Transit 

760-948-4710 

• Weekdays: 4 am – 

10:30 pm 

• Saturdays: 6 am – 

8 pm 

• Sundays: 8 am – 

Daily pass $3.60 

Monthly pass $47.00 (good for 

30 consecutive 

days of use from 

the first day used) 

6:30 pm Student pass $35.00 

• Weekdays: 6 am – Daily bus ticket $3.50 

9:00 pm 

• Saturdays 7:00 am – 

8:00 pm 

$50.00 


suburban 

Adult 


suburban 

Student 


County 

Adult 


County 

Student 

County Adult day 

pass 

County Student 

day pass 

$5.00 cash value 



$40.00 

$75.00 

$65.00 

$5.50 

$4.50 

San 

Bernardino 

Valley 

Victor Valley 

Sub area 





Morongo Basin Weekday service runs for Monthly pass $30.00 Adult Morongo Basin 

Transit Authority approximately 15½ hrs a (good for 30 monthly Sub area 

(MBTA) 

day. 

days of unlimited $20.00 Student 

1-800-794-6282 Saturday service runs for use within the monthly 

approximately 14¾ hrs. same month) 

Mojave Valley Weekdays: 6 am – Daily token $1.10 Barstow area and 

Transportation 6 pm 

Monthly bus $38.00 surrounding 

760-255-3330 Saturdays: 9 am – pass (good only 

communities 

6 pm 

in month issued) 

Needles Bus 

Pass 

$28.50 

MARTA Weekdays: 6:35 am 10-Ride Pass $8.50 San Bernardino 

909-878-5200 – 6:30 pm 

Dial a Ride $20.00 Mountains and/to 

Saturdays: 6:35 am – 

$40.00 City of San 

 

6:30 pm 

Sundays: 8:45 am – 

6:30 pm 

Adult Fixed 

Route and Offthe-Mountain 

(OTM) 

Student 

$15.00 

$7.50 

Bernardino – 

service available 

through 

Redlands 

Welfare-to-Work 

(WTW) Program 

Cal-Learn 

transportation- 

Gas Card(s) 

Note: Bus pass amounts in C-IV must match the actual bus pass amount to 

issue through C-IV. 

Gas Scrip(s) will be issued as a temporary solution only. The amount issued 

should be for about a week’s worth of transportation needs and only until the 

Cal-Learn teen can pay for her/his own gasoline. The Cal-Learn teen will 

submit a travel claim at the end of the month. The value of the gas card(s) 

will be deducted from that month’s travel reimbursement (see 

“Reimbursement for Cal-Learn transportation costs” block in this section of 

the handbook chapter). 

Note: The total value of the gas card(s) issued cannot be more than the 

cost of a local bus pass when bus transportation is available. 





issue gas scrip 

Cal-Learn 

Ancillary 

services 

Follow the steps below to issue gas scrip. 



• Discusses transportation needs and appropriateness of gas 

scrip(s) to temporarily pay for gas with Cal-Learn teen. 

• Explains to Cal-Learn teen how to complete and submit the 

CL 753 Cal-Learn Travel Claim and CL 735.2 CalWORKs 

Attendance Report. 

• E-mails CL 700 to or calls the Cal-Learn EW to request gas 

scrip(s). 


• Approves request after discussion with Case Manager. 

• Determines number of gas scrip(s) needed. 

• Completes Service Arrangement. 

• Submits Service Arrangement to Issuance Clerk. 

• Sends NA 113 with CL 753 and CL 735.2 to Cal-Learn teen. 

• Advises Cal-Learn teen or MCAH Case Manager that 

transportation was approved and when to pick up gas scrip. 

3 Issuance Clerk: 

• Completes clerical portions of Service Arrangement. 

• Issues gas scrip(s) to Cal-Learn teen or Case Manager. 

• Has Cal-Learn teen or Case Manager sign the Service 

Arrangement. 

4 Cal-Learn teen picks up gas scrip(s) in district or MCAH Case 

Manager: 

• Picks up gas scrip(s). 

• Gives gas scrip(s) to Cal-Learn teen. 

Ancillary services are offered for education related expenses. The MCAH 

Case Manager and the Cal-Learn teen determine what expenses are 

needed. Expenses must be related to getting a diploma or General 

Educational Development (GED). A request is sent to the Cal-Learn EW to 

authorize payment to the vendor in the form of a voucher. 

Example: Cal-Learn teen requests supplies totaling $37.25 to complete a 

physical science class project. The Cal-Learn EW approves the expenses 

and has a voucher made. 

If unsure about approving a specific request or if the request is other than for 

books and more than $75, contact Program Development Division (PDD) 

through appropriate channels for guidance. 





issue ancillary 

services 

Follow the steps below to issue ancillary service. 



• Discusses education needs with Cal-Learn teen. 

• E-mails CL 700 to Cal-Learn EW recommending specific 

ancillary expenses. 


• Picks out the needed items at the school or store. 

• Obtains a pre-receipt that lists the items needed, including tax 

and store name and address. 

• Turns the pre-receipt into the Cal-Learn EW (Cal-Learn teen 

may call Cal-Learn EW to make arrangements to drop off 

pre-receipt and pick up voucher). 


• Approves ancillary request. 

• Completes Service Arrangement. 

• Gives Service Arrangement to Issuance Clerk. 

4 Issuance Office Assistant (OA): 

• Per Service Arrangement and pre-receipt, prepares voucher. 

• Issues voucher to Cal-Learn teen. 

5 Cal-Learn Teen: 

• Picks up and signs for voucher in district. 

• Purchases supplies or services with voucher. 

6 Vendor: 

• Provides products or services to Cal-Learn teen. 

• Accepts and signs voucher. 

• Mails voucher back to TAD district office. 

7 Issuance OA: 

• Checks voucher and processes for payment. 

• Completes Service Arrangement including amount of purchase 

and signs. 

• Requests Authorizing Supervisor sign Service Arrangement. 

8 Authorized Supervisor authorizes payment by reviewing and 

signing Service Arrangement. 


• Sends Service Arrangement to HS Auditing for payment. 

• Retains copy of Service Arrangement returned voucher and 

receipt(s). 

• Gives EW copy of Service Arrangement. 

10 HS Auditing prints and mails a warrant to the vendor within five (5) 

days of receipt of complete and correct Service Arrangement. 




Lost vouchers If a Cal-Learn teen loses a voucher before using it to purchase goods or 

services, department procedures are available for voucher replacement. 

The Cal-Learn EW will ask the Issuance OA to replace the voucher 

following procedures in the Clerical Handbook: 

• The Issuance OA will prepare a statement for the Cal-Learn teen and 

the vendor to sign promising not to use the original voucher, if found 

• The replacement voucher will be issued at the same time the teen signs 

the statement. 

• The teen will give the statement to the vendor to sign when turning in 

the replacement voucher to complete the ancillary purchase. 

Note: If both vouchers end up being cashed by the Cal-Learn teen, the 

second voucher dollar amount will be a collectable overpayment. 




Reimbursement 

for ancillary 

expenses 

Occasionally the Cal-Learn teen or his/her parent may purchase ancillary 

services and request reimbursement. The table below lists the steps to 

reimburse ancillary expenses. 



• Discusses education needs with Cal-Learn teen. 

• E-mails CL 700 recommending specific ancillary needs and 

advising of expense reimbursement. 


• Turns the original receipt with store name and address into 

the Cal-Learn EW. 

• Advises Cal-Learn EW whose name should be on the 

reimbursement. 


• Approves ancillary request. 

• Completes the amount to be reimbursed. 

• Requests Authorizing Supervisor approve and sign Service 

Arrangement. 

4 Authorizing Supervisor authorizes reimbursement by signing the 

Service Arrangement. 


• Gives original and one copy of Service Arrangement and 

receipt to Issuance Clerk. 

• Images and/or retains copy of Service Arrangement in 

physical case folder as appropriate. 


• Sends original Service Arrangement to HS Auditing. 

• Retains copy of Service Arrangement with original receipt. 

7 HS Auditing mails reimbursement check to Cal-Learn teen or 

teen’s parent within five (5) days of receipt of complete and 

correct Service Arrangement. 




Overpayments Supportive services are generally issued in advance to assist the Cal-Learn 

teen in attending school. If the Cal-Learn teen fails to follow-through with 

school or an activity for which supportive services were issued, the MCAH 

Case Manager will inform the Cal-Learn EW of the teen’s failure to comply 

with requirements. The EW will take appropriate action on the 

overpayment. 

Example: In September, a Cal-Learn teen received school supplies and a 

bus pass. The teen failed to attend school at all during the quarter. The 

value of the school supplies and the bus pass are a collectable 

overpayment. In December, the MCAH Case Manager sent a CL 700 to 

the Cal-Learn EW advising of the overpayment. The Cal-Learn EW follows 

overpayment procedures in the Income Chapter of this Handbook. 


Cal-Learn Bonuses and Penalties 

Introduction This section explains bonuses and penalties, proof of school performance, 

and who authorizes the bonuses and penalties. 

Proof of school 

performance 

Not passing 

high school 

exit exam 

Good cause 

criteria 

The Cal-Learn teen must submit report cards to the Maternal, Child and 

Adolescent Health (MCAH) Case Manager for evaluation. The teen must 

submit up to four report cards per school year and provide proof when the 

high school diploma or equivalent is received. 

The Cal-Learn teen is eligible to bonuses for acceptable school grades and 

for earning a high school diploma or equivalent. The Cal-Learn teen is also 

subject to penalties for failure to provide report cards, earning a Grade 

Point Average (GPA) below 1.0, or otherwise not cooperating with MCAH. 

If a student did not pass the high school exit exam (even though he/she is 

receiving a certificate of completion of high school requirements) and is not 

getting a diploma, he/she is not eligible to receive the $500 bonus or exit the 

Cal-Learn program. The $500 bonus will be issued once documentation is 

received indicating graduation from high school or its equivalent. The EW 

will leave the Cal-Learn program open. 

Good cause occurs when an event is beyond the teen’s control and 

substantially deprived the teen of the ability to make adequate progress in 

school, and no home study or other special arrangements could be made 

with the school. 

The process The good cause determination process is described in the table below: 


1 Cal-Learn teen tells the MCAH Case Manager of reasons for not 

making adequate progress in school. 


• Discusses good cause with the teen. 

• Requests verification, when appropriate. 

• E-mails CL 700 form and verification of the reason for good 

cause to the Cal-Learn Eligibility Worker (EW). 


• Approves or denies good cause as appropriate. 

• Immediately e-mails CL 700 to MCAH Case Manager 

advising of good cause determination. 

• Journals actions in C-IV. 

4 MCAH Case Manger sends notice to the teen and head of the AU 

containing the good cause determination. 



Cal-Learn Bonuses and Penalties, Continued 

Bonus and 

penalty basics 

Who authorizes 

bonuses and 

penalties? 

Cal-Learn and 

attendance 

penalties 

Bonuses will be issued or financial penalties imposed based on the 

Cal-Learn teen’s progress in school. The following is an overview of the 

bonuses and penalties: 

When the teen… And it is… The Cal-Learn EW 

will authorize… 

Submits a report card • Timely, or 

$100 bonus. 

showing at least a ‘C’ or • Late with good 

2.0 GPA, 

cause, 

• Late without good 

cause, 

$50 penalty. 

Submits a report card • Timely, or 

Neither a bonus or 

showing a ‘D’ or 1.0 • Late with good penalty. 

GPA, 

cause, 

• Late without good 

cause, 

$50 penalty. 


showing an ‘F’ GPA 

(anything under 1.0), 

Either timely or late, $100 penalty. 

Fails to submit a report 

card, 

$100 penalty. 

Receives a high school 

diploma or equivalent, 

$500 bonus. 

Note: $100 penalties are applied over a two month period. 

The MCAH Case Manager tracks report card information and advises the 

Cal-Learn EW of bonuses earned and penalties to be applied. The MCAH 

Case Manager e-mails the CL 700 to notify the Cal-Learn EW to issue the 

bonus or impose the penalty. The Cal-Learn EW issues the bonuses and 

imposes the penalties. Once the bonus or penalty action is completed, the 

Cal-Learn EW must notify the MCAH Case Manager via CL 700. 

School attendance requirements do not apply to Cal-Learn teens. If a 

TAD 144 is received indicating the Cal-Learn teen has missed 20 or more 

days of school in a school year, school attendance penalties will not be 

imposed. 

If questions arise regarding attendance penalties and Cal-Learn teens, the 

Cal-Learn EW should contact the Program Development Department 

(PDD) through appropriate channels for guidance. 


Cal-Learn Bonuses 

Introduction This section describes rules about bonuses and how to issue a bonus. 

The rules about 

bonuses 

How to issue a 

bonus 

The Cal-Learn bonus: 

• Is issued for the month in which the report card was due, even if 

mid-quarter. 

• Will be issued if the Cal-Learn teen was eligible in the month the bonus 

was earned, even if since discontinued from cash assistance. 

• Is given to the Assistance Unit (AU) of which the Cal-Learn teen is a 

member when the bonus is paid. 

• Is paid to the parent or caretaker relative if it is a $100 bonus. 

• Is paid to the Cal-Learn teen if it is a $500 bonus. 

• Will be issued no later than the month following the receipt of the 

CL 700 from the Maternal, Child and Adolescent Health (MCAH) Case 

Manager. 

• Cannot be used to offset an overpayment. 

• Is exempt income in the CalFresh allotment computation. 

• Is authorized for each Cal-Learn teen in the AU. 

• Is not included in the calculation of a Homeless Assistance (HA) 

payment. 

The Cal-Learn Eligibility Worker (EW) will issue the bonus upon receipt of 

CL 700 from the MCAH Case Manager, following the steps below. 

Step Action 

1 Enter the bonus in the C-IV system. 

2 Send a Notice of Action (NOA) to notify the AU of the bonus. 

3 Journal issuance of the bonus. 

4 E-mail CL 700 to MCAH Case Manager advising the bonus was 

issued. 


Cal-Learn Penalty 

Introduction This section describes rules about penalties and how to impose a penalty. 

Rules about 

penalties 

How to impose 

a penalty 

The Cal-Learn penalty: 

• Is applied for one month when the penalty amount is $50. 

• Is applied equally over two months when the penalty amount is $100. 

• Is subtracted after the grant has been computed, prior to any 

overpayment adjustments. The Assistance Unit (AU) will receive any 

remaining grant amount, even if the amount is less than $10. 

• Will be applied even if the grant amount before the penalty is less than 

the penalty amount. 

Example: Total grant authorized: $35 

Subtract penalty amount: $50 

Resulting grant amount: $0 

Unimposed penalty amount: $15 

• Any unimposed penalty amount, as the $15 in the above example, will 

not be applied to any other month. 

• Is applied as necessary for each Cal-Learn teen in the AU. 

• Is applied to the AU in which the Cal-Learn teen is a member when the 

penalty is applied. 

• Is not included in the calculation of an overpayment adjustment and will 

be applied mid-quarter, as it is a County Initiated change. 

The Cal-Learn Eligibility Worker (EW) will impose the penalty when the 

CL 700 is received from the Maternal, Child and Adolescent Health (MCAH) 

Case Manager. The penalty is imposed when 10-day advance notice can 

be sent advising the family the grant will be decreased. 

Step Action 

1 Determine the penalty month using timely notification rules. 

2 Enter the penalty in the C-IV system. 

3 Send a Notice of Action (NOA) to notify the AU of the penalty and 

grant decrease. 

4 Journal imposition of the penalty. 

5 E-mail CL 700 to MCAH to verify the penalty was imposed. 



Cal-Learn Penalty, Continued 

Imposing and 

tracking 

penalties 

Special note 

regarding 

CalFresh 

companion 

programs 

Penalties are imposed and tracked in the C-IV system. To penalize the 

family for the correct number of months, be careful with start and stop 

dates. The MCAH Case Manager will determine the penalty reason and 

will include it on the CL 700. The Cal-Learn EW will make necessary 

entries in the C-IV system. 

Penalty 

reason 

Late report 

card, no good 

cause, 

adequate 

progress 

Report card 

shows “F” 

GPA 

No report 

card 

submitted 

Amount Start Stop Monthly 

Amount 

$50 Future month Future month $50 

$100, applied 

over a two 

month period 

$100, applied 

over a two 

month period 


after future 


after future 

Note: Future month is also known as “High Date.” 

When the teen parent reaches age 18 and is too old to remain on a 

CalWORKs program with his or her parent, the teen and his or her child will 

establish a CalWORKs program for themselves. If the teen and child still 

live in the household with the senior parent(s), they remain in the original 

CalFresh. 


$50 

$50

Ending Cal-Learn Participation 

Introduction This section explains the process when the teen is no longer required to 

participate and not eligible for Cal-Learn services. 

Discontinuance When a Cal-Learn teen moves out of San Bernardino County, is 

discontinued from cash aid, or does not meet the Cal-Learn criteria, 

notifications must be made. C-IV discontinues the Cal-Learn teen when 

CalWORKs Eligibility Determination and Benefits Calculation (EDBC) is 

run, accepted and saved, and generates a discontinuance Notice of 

Action (NOA) for the Cal-Learn program. Additionally, C-IV updates the 

Status and Status Reason of the teen when he/she no longer meets the 

program requirements. 

No longer 

required to 

participate 

The Cal-Learn Eligibility Worker (EW) will complete and send CL 700s to 

the Maternal, Child and Adolescent Health (MCAH) Case Manager and 

Child Care EW advising of the change. 

When a Cal-Learn teen is no longer required to participate in the Cal-Learn 

program due to age, scholastic achievement, or family composition, the 




Graduates from high school or earns an equivalency diploma. 

Turns 19 and does not wish to volunteer for the Cal-Learn program. 

Turns 20. 

Is no longer a pregnant or parenting teen. 


Sends a NOA to Cal-Learn teen advising of change in his/her program 

participation from Cal-Learn to the Welfare-to-Work (WTW) program. 

Sends NOA to stop supportive services. 

E-mails CL 700 to MCAH Case Manager and Supervising Office 

Assistant (SOA) (see “MCAH contact information” block in the 

“Cal-Learn Referral Procedure” section of this handbook 

chapter) to discontinue case management services. 

Refers teen to Welfare-To-Work (WTW) program as determined 

by the district office within 10 days. 

Pends the WTW program. 

Journals changes. 

Transfers the imaged case through district procedures to the 

appropriate EW, if applicable. 

Note: Cal-Learn and WTW programs must never be open at the 

same time. 

Note: Cal-Learn EW sends an e-mail to follow up, if no response is received 

from MCAH within five (5) business days indicating the case was discontinued. 




CHAPTER 5 

Residency 

Residency: Overview .....................................................................................................5-1 

Basic Residency Requirements .....................................................................................5-2 

When Families Move......................................................................................................5-4 

Absence from California.................................................................................................5-6 

New State Arrivals..........................................................................................................5-8 

Contacting Other Counties or States .............................................................................5-9 

Homeless or “No Address” Families ............................................................................5-12 

Establishing a Mailing Address ....................................................................................5-13 

Housing Search…….. ..................................................................................................5-14 

Homecall and Special Investigation Referrals..............................................................5-15 


Overview 

Residency 

Introduction This section contains information regarding residency rules for CalWORKs 

cash aid eligibility and refers to other sections of this Handbook for related 

rules and casework processes. 

California 

residency 

CalWORKs cash aid is intended to help needy California residents. 

California residents include: 

• Long-term state residents, 

• New arrivals to California, 

• Homeless California residents, and 

• Residents who are temporarily absent from the state. 

California residence must be established in order for a customer to take 

advantage of the services offered through the CalWORKs program. The 

CalWORKs program will not help customers who are transient or vacationing 

in California. 


• ACIN I-54-03, I-10-04, and I-29-04 

• ACL 03-18 

• EAS 40-187 

• EAS 42-400. 42-401, 42-403, 42-406, 42-407, 42-421, and 42-422 

In this chapter This Chapter contains the following topics: 


Basic Residency Requirements 5-2 

When Families Move 5-4 

Absence from California 5-6 

New State Arrivals 5-8 

Contacting Other Counties or States 5-9 

Homeless or “No Address” Families 5-12 

Establishing a Mailing Address 5-13 

Housing Search Requirement 5-14 

Homecall and Special Investigation Referrals 5-15 

CWPHB #4605 (04/11) RESIDENCY 5-1

Basic Residency Requirements 

Introduction This section contains information regarding basic residency requirements, 

families who do not meet the residence rule, helping a customer move, 

temporary absence, and customers whose whereabouts are unknown. 

Reference The following references are applicable to information in this section: 

Residency 

requirements 

Customers who 

do not meet the 

residency rule 

Helping a 

customer move 

• EAS 42-400, 42-401, and 42-403 

Families must live in California in order to qualify for CalWORKs cash aid. 

There is no minimum duration of residence for a customer to be considered a 

California resident for CalWORKs purposes. 

In order to meet the residency requirements, a person must: 

• Be physically present in California, and 

• Declare on the Statement of Facts he/she lives in California and intends 

to continue to live here. 

A customer who is otherwise eligible remains eligible when he/she moves 

from one California county to another. CalWORKs cases may be transferred 

between California counties. This process is called an Intercounty Transfer 

or ICT. 

Although cases can be transferred from one California county to another, 

cases cannot be transferred from one state to another. CalWORKs is 

discontinued when a customer establishes residence in another state. 

A customer does not meet the residency requirement when he/she: 

• Moves to another state, 

• Says he/she is in California temporarily, and/or 

• Receives aid from another state and will not permit the Eligibility 

Worker (EW) to ask that state to stop issuing aid payments. 

If a customer has a solid job opportunity elsewhere but cannot afford to 

move, the EW and Employment Specialist (ES) will consider issuing a 

Diversion payment to help the customer move. Refer to the Application 

Chapter of this Handbook for details. 



Basic Residency Requirements, Continued 

Temporary 

absence 

When the 

customer’s 

whereabouts 

are unknown 

When an Assistance Unit (AU) is temporarily absent from the State of 

California, see “Absence from California” section in this handbook chapter for 

instructions. 

When mail sent to the customer’s last known address is returned as 

“undeliverable” or “addressee unknown” or without any forwarding address, 

the EW must attempt to contact the customer to resolve the discrepancy. If 

the EW is unable to contact the customer, his/her whereabouts are unknown. 

Loss of contact with the customer can result in the EW’s inability to request 

information necessary to determine continued eligibility for cash assistance. 

If the customer fails to report a change of address on the QR 7, the EW will 

send a notice of incomplete QR 7. The EW will attempt a personal contact if 

the customer does not respond to the incomplete QR 7 notice. Cash aid will 

be discontinued at the end of the payment quarter if the address discrepancy 

is not resolved. 


When Families Move 

Introduction This section contains information regarding how CalWORKs eligibility is 

impacted when families move. 


• ACIN I-10-04 and I-29-04 

• EAS 40-187 

• EAS 42-421 and 42-422 



When Families Move, Continued 

How eligibility 

is impacted 

when families 

move 

The following table outlines how a move can impact a customer’s eligibility 

for cash aid. 

When a customer 

moves from… 

One location within 


County to another 

location within the 

County, 


County to another 

California county, 

Any California county 

to San Bernardino 

County, 

California to any other 

state, 

Any other state to 

California 

Then… 

• The customer remains eligible if otherwise eligible. 

• The Eligibility Worker (EW): 

− Transfers the case to another district office if the 

new address is within the boundaries of another 

Transitional Assistance Department (TAD) district 

office service area. 

− Refers to the O&R Handbook to make sure the 

case is carried in the correct district and for 

Inter-District Transfer (IDT) guidelines. 


• The EW: 

− Transfers the case to the other county. 

− Refers to the O&R Handbook for Intercounty 

Transfer (ICT) guidelines and to make sure the 

case is sent to the correct county. 


• The Intake EW: 

− Asks the customer to tell the other county he/she 

has moved, if not already done. 

− Contacts the other county to assist in initiating the 

ICT, if necessary (see “Contacting Other Counties 

or States” section of this handbook chapter). 

• The County from which the customer moved begins the 

transfer of responsibility for aid payments to San 

Bernardino County. 

• The Intake EW works with the customer to re-establish 

eligibility and to build a case to be carried in San 

Bernardino County. 

• The case is assigned to a Continuing EW when San 

Bernardino County assumes responsibility for the aid 

payments. 

• CalWORKs is discontinued in California if the customer 

establishes residence in the other state (see “Absence 

from California” section of this handbook chapter). 

• The customer must apply for aid in the new state if 

he/she is still needy. 

• The customer must apply for aid in California if he/she 

is still needy. 

• The EW must call the other state to verify the status of 

the aid payment and CalFresh in the other state (see 

“Contacting Other Counties or States” section of this 

handbook chapter). 


Absence from California 

Introduction This section contains information regarding temporary absence from the 

state, eligibility while living outside of California, and loss of California 

residence. 


Temporary 

absences from 

the state 

Eligibility while 

living outside 

of California 

• EAS 42-406 and 42-407 

When a person leaves the family, the Eligibility Worker (EW) must consider 

two eligibility factors: 

• Assistance Unit (AU) composition, and 

• Residency requirements. 

See the AU/Responsible Persons Chapter regarding how temporary absence 

impacts the composition of the AU. 

When a customer leaves the state, the EW will work with the customer to 

document continuing California residency or the need to discontinue 

CalWORKs (for the case or the individual) based on loss of California 

residence. 

A customer absent from California 30 days or longer may be eligible for 

CalWORKs cash aid when he/she: 

• Declares continued California residency, 

• Was prevented from returning by illness or emergency, 

• Maintains his/her home in California by continuing to pay rent or 

mortgage payments, or 

• Maintains employment in California (if employed). 

The CalWORKs grant will be made available to a customer who is 

temporarily in another state but remains eligible for CalWORKs. 



Absence from California, Continued 

Loss of 

California 

residence 

A customer absent from California ceases to meet the residency requirement 

for CalWORKs eligibility when he/she: 

• Fails to indicate intent to return to California or fails to respond to the 

EW’s inquiry within 30 days, 

• Applies for assistance in another state, 

• Purchases, rents, or leases a home in another state, 

• Accepts employment in another state, or 

• Obtains a driver’s license in another state. 

The EW can take mid-quarter action to discontinue cash aid if it is 

determined the customer is no longer a resident of California. 


New State Arrivals 

Introduction This section contains information regarding new state arrival policy. 


• EAS 42-421 

Policy Families who move from other states to California and declare their intent to 

remain will be given CalWORKs cash aid if they are otherwise eligible. 

The Eligibility Worker (EW) will contact the Social Services agency in the 

other state to get the customer’s recent public assistance case history. See 

“Contacting Other Counties or States” section of this handbook chapter for 

instructions. 

When a customer receives an aid payment from another state in the month 

he/she applies for cash aid in California, he/she may be eligible for an aid 

payment in California in the same month if California pays a higher aid 

amount. See Income Chapter for treatment of a Transitional Assistance for 

Needy Families (TANF) grant from another state. 

When a customer receives CalFresh from another state in the month he/she 

applies for CalFresh in California, he/she will not receive a second CalFresh 

allotment in the same month. Refer to the CalFresh Handbook for details. 


Contacting Other Counties or States 


Confidentiality 

when contacted 

by other states 

• Confidentiality when: 

− Other agencies contact the Eligibility Worker (EW), and 

− Contacting other states, 

• How to locate a worker in another state, 

• What to do when a customer arrives from another state, and 

• Contacting other counties. 

In order to pay benefits in the right amounts and at the right time, other 

Welfare departments may call to gather case information. 

There are some important points to remember when discussing a customer’s 

aid with others: 

A caller asks for 

information about a 

If… Then… 

customer in this County, 

The caller’s identity as a 

CalWORKs or TANF 

agency staff member is 

questionable, 

Be certain the caller is a CalWORKs or 

Transitional Assistance for Needy 

Families (TANF) agency staff member. 

• Ask the person for a telephone number 

and/or call directory assistance for a 

number, 

• Call the person back, 

• Cooperate fully with the caller if there is 

certainty he/she is a member of a 

CalWORKs or TANF agency. 

Note: Do not give information to any person 

whose identity is questionable. 



Contacting Other Counties or States, Continued 

How to locate a 

worker in 

another state 

Arrival from 

another state 

When a customer comes from another state and indicates he/she received 

benefits there, the EW must verify the receipt or non-receipt of CalWORKs 

and CalFresh. When the state the customer came from is known, case 

information can be located by doing the following: 

Step Action 

1 Obtain the telephone number of the Social Services Department 

in the other state by: 

• Searching the agency on the internet, or 

• Calling directory assistance for the capitol city and requesting 

the telephone number for the main office of the cash 

assistance agency. 

Note: Agencies are known by a variety of names such as Public 

Services, Public Social Services, and so forth. Usually, when 

asked for the number to the “welfare office,” directory assistance 

will give the correct number. 

2 Contact the agency and identify self as a member of Human 

Services for San Bernardino County, California. 

3 Inform the person who answers the telephone at the other agency 

that case information is needed for a particular customer. 

4 Make sure names, Social Security Numbers (SSNs), and dates of 

birth are available in order to get the information needed. 

When a customer arrives from another state and says he/she did not receive 

aid in that state but appears to have few resources and has had few in the 

recent past, the EW will call that state to verify whether or not the customer 

received any assistance there. 



Contacting Other Counties or States, Continued 

Contacting 

other counties 

Locating a specific worker in another California county should be simple. 

When an ICT packet comes into San Bernardino County, the worker’s name 

and telephone number in the sending county are found on the Notification of 

Intercounty Transfer form (CW 215). 

When an ICT has not been initiated or the CW 215 has not arrived yet, do 


Step Action 

1 Identify the county currently paying assistance to the customer. 

2 Obtain the EW’s name and phone number: 

If the other county 

Then… 

is… 

A C-IV county, Obtain the EW’s name from C-IV. 

Not a C-IV county, Identify the EW in the other county 

by: 

• Asking the customer if he/she has 

a recent letter from the other 

agency. If so, look for an EW 

name and telephone number on 

the letter, or 

• Locating the customer in the 

MEDS system, finding the worker 

number for the customer in the 

other county, and contactingt the 

ICT coordinator, 

• Calling directory assistance or 

searching the internet to obtain 

the telephone number for the 

agency office in the city in which 

customer received assistance, or 

• Contacting the ICT coordinator 

for that county. 

2 Call the agency office, identify yourself as an EW from this 

County, and request specific case information. 

Note: Be ready with names, SSNs and dates of birth to get the 

information needed. 


Homeless or “No Address” Families 

Introduction The CalWORKs program includes components to reduce the number of 

homeless families in California, such as: 

• The requirement minor parents live with a responsible adult whenever 

possible, 

• Immediate Need (IN) cash aid, 

• Homeless Assistance (HA) vouchers for temporary and permanent 

housing, and 

• Diversion payments to help families go where there is a job waiting. 

County policy When the services in the “Introduction” block fail to meet the housing needs 

of homeless families, the eligible No Address customer must: 

The procedure 

for homeless 

customers 

• Actively seek housing, and 

• Pick up Notices of Action (NOAs) and other correspondence directly from 

the Transitional Assistance Department (TAD) office. 

The table below gives a general description of the events that occur when a 

customer is homeless and does not qualify for Homeless Assistance (HA). 


1 The EW and the customer discuss the situation and attempt to 

establish an address for the customer. 

2 The EW explains: 

• The need to search for permanent shelter and gives related 

forms, and 

• Human Services (HS) mail must be picked up from the TAD 

district office (QR 7, NOAs, etc.). 

3 The customer comes to the district office to pick up 

correspondence after the initial issuance. 

4 The EW meets with the customer when he/she comes to the 

district office to: 

• Gather any needed forms or information, and 

• Review the customer’s situation with him/her. 

5 The EW updates C-IV when the customer finds permanent 

housing. 

Details for each stage are given on the following pages. 


Establishing a Mailing Address 

Introduction This section contains information regarding establishing a mailing address for 

customers. 

Exploring the 

customer’s 

situation 

Acceptable 

temporary 

mailing 

addresses 

When a customer claims to have no address, talk to the customer to try to 

establish a residence mailing address, even if it is temporary. The following 

questions to help identify an address may be used: 

• “Where did you sleep last night? Where will you sleep tonight?” 

• “Can you stay at this address for a few more days?” 

• “Where do your children go to school? What address and telephone 

number did you give the school?” 

• “Where do you receive other mail or benefits (Social Security 

Administration (SSA), Unemployment Insurance Benefits (UIB), Veterans 

Administration (VA), etc.)?” 

Acceptable temporary mailing addresses include a: 

• Motel, 

• Friend’s home, or 

• Relative’s home. 

As the Eligibility Worker (EW) talks to the customer, he/she is to make sure 

the customer understands a Fraud Investigator or Homecall staff may verify 

the temporary home address. 


Housing Search 

Introduction This section contains information regarding the customer conducting a 

search for housing. 

Housing search When the customer is homeless, the Eligibility Worker (EW) will recommend 

the customer make a diligent search for housing. The EW will: 

• Give the customer the NAR 1 - No Address Customer Responsibilities 

and the HA 45 - Permanent Shelter Search Log. 

• Explain the forms and the customer’s responsibility to work toward the 

goal of securing suitable housing. 

• Explain the customer must come to the Transitional Assistance 

Department (TAD) office to get the QR 7 and Notices of Action (NOAs). 

When the customer finds housing and reports a new address, the EW will 

change the address in C-IV. 

Note: If the customer fails to find housing or provide a completed HA 45, the 

EW will take no action against the customer. 


Homecall and Special Investigation Referrals 

Introduction This section contains information regarding the definition of a mail drop, 

Eligibility Worker (EW) responsibility for eliminating mail drop fraud, Quality 

Review Unit (QRU) Homecall and Special Investigation referral procedures, 

and suspected mail drop. 

Definition A mail drop is a false address given by a customer to obtain benefits 

fraudulently. The customer receives correspondence (QR 7s, Notices of 

Action (NOAs), etc.) at an address where the Assistance Unit (AU) does not 

reside. 

EW 


for eliminating 

"mail drop" 

fraud 

Homecall and 

Fraud referral 

procedure 

When a customer says he/she does not have an address, the EW will 

conduct an in-depth interview to determine if the customer: 

• Is truly homeless, 

• Is living in a temporary housing arrangement, or 

• May be using a mail drop. 

After the interview, if the customer’s living situation is not resolved, the EW 

will complete a QRU Homecall or Fraud Investigation referral. 

When the EW determines a Homecall or Fraud Investigation referral is 

necessary, the procedures below are followed to refer the case to QRU 

Homecall or Fraud Investigation staff: 


1 EW: 

• Chooses the correct referral method by following the chart below: 

If the application date is … Then submit a… 

Within the past 60 days, QRU Homecall Referral. 

Older than 60 days, Fraud Investigation Referral. 

• Enters: 

− Referral reason - “No address case.” 

− Address - the location the customer currently uses. 

2 Quality Review Specialist (QRS) or Fraud Investigator: 

• Interviews customer, 

• Reports findings to the EW immediately, and 

• Notifies the EW of any planned follow-up investigation. 



Homecall and Special Investigation Referrals, Continued 

Suspected mail 

drop 

When a mail drop is suspected without the customer stating he/she is 

homeless, the EW will: 

• Interview the customer, and 

• Make the appropriate QRU Homecall or Fraud Investigation referral, 

describing the reasons a mail drop is suspected on the referral. 




CHAPTER 6 

Citizens, Noncitizens and Refugees 

Chapter Overview ..........................................................................................................6-1 

Citizens ..........................................................................................................................6-2 

The U.S. Citizenship Documentation Process...............................................................6-3 

Notes about the HSS 623 (E/S) Process.......................................................................6-4 

Acceptable Citizenship Documentation .........................................................................6-5 

Federal Deficit Reduction Act ........................................................................................6-6 

Child Citizenship Act of 2000.......................................................................................6-12 

Noncitizen Eligibility .....................................................................................................6-15 

The Noncitizen Eligibility Determination Process.........................................................6-16 

Noncitizen Status Verification Requirements...............................................................6-17 

CalWORKs & CalFresh Noncitizen Expired Verification..............................................6-18 

Funding the CalWORKs Grant.....................................................................................6-19 

Exceptions to the Five-year State Funding Rule..........................................................6-20 

S/O Exception: Veterans or Active Duty Military Personnel........................................6-21 

S/O Exception: People with 40 Work Quarters...........................................................6-22 

Combining Work Quarters ...........................................................................................6-23 

Countable Work Quarters ............................................................................................6-24 

Non-countable Work Quarters .....................................................................................6-25 

Finding 40 Quarters in the IEVS System .....................................................................6-26 

How the SSA Calculates Quarters...............................................................................6-27 




S/O Exception: Cuban and Haitian Immigrants ..........................................................6-28 

S/O Exception: Amerasian Immigrants.......................................................................6-30 

S/O Exception: Withheld Deportation .........................................................................6-31 

S/O Exception: Immigrants Granted Asylum ..............................................................6-32 

Afghan and Iraqi Special Immigrants...........................................................................6-33 

Noncitizens: Aid Categories and MEDS Issues..........................................................6-37 

S/O Exception: Refugee Cash Aid..............................................................................6-38 

Identifying Refugees ....................................................................................................6-39 

RRP: The Refugee Resettlement Program.................................................................6-40 

RCA for Unaccompanied Minor Refugees...................................................................6-41 

RCA: Refugees Not Linked to CalWORKs .................................................................6-42 

Welfare to Work for RRP or RCA Recipients...............................................................6-44 

Refugee Help from Other Agencies.............................................................................6-45 

Refugee Aid through a Voluntary Agency (VOLAG)....................................................6-46 

Voluntary Agency (VOLAG) List ..................................................................................6-47 

Sponsored Noncitizens – Overview.............................................................................6-48 

Sponsored Noncitizens – Identifying ...........................................................................6-50 

Sponsored Noncitizens – Determining Eligibility..........................................................6-51 

Sponsored Noncitizens – Exemptions to Deeming......................................................6-54 

Battered Noncitizens....................................................................................................6-57 

Noncitizen Victims of Human Trafficking, Domestic Violence 

and Other Serious Crimes.....................................................................................6-59 

Noncitizen Child Victims of Human Trafficking ............................................................6-65 




Jay Treaty Indians .......................................................................................................6-66 

Ineligible Noncitizens ...................................................................................................6-67 

The California Assistance Program for Immigrants (CAPI)..........................................6-68 


Overview 

Citizens, Noncitizens, and Refugees 

Background Because public funds are used to finance the CalWORKs program, eligibility 

is based in part on whether people who seek assistance are citizens of the 

United States or live in this country legally. 

Ineligible 

noncitizens 

Current regulations allow cash aid funds to be paid only to U.S. citizens or 

those legal immigrant families who: 

• Do not face the possibility of deportation, and, 

• Were living in the U.S. before August 22,1996, or, 

• Have been in the U.S. for at least 5 years, or, 

• Meet certain exceptions to the above conditions. 

Neither the federal nor state governments will pay CalWORKs cash aid to: 

• Undocumented noncitizens: people who cannot prove their immigration 

status 

• People who claim U.S. citizenship but cannot prove citizenship and 

whose citizenship is questionable 

In this Chapter This Chapter contains the following topics: 


The U.S. Citizen Documentation Process 6-3 

Noncitizen Eligibility 6-15 

Exceptions to the Five Year State Funding Rule 6-20 

Identifying Refugees 6-39 

Sponsored Noncitizens 6-48 

Ineligible Noncitizens 6-67 

The California Assistance Program for Immigrants (CAPI) 6-68 

CWPHB #4605 (04/11) CITIZENS/NONCITIZENS/REFUGEES 6-1

Citizens 

Introduction Most recipients of CalWORKs cash aid are United States (U.S.) citizens. 

U.S. citizens are eligible for CalWORKs cash aid if otherwise eligible. 

References The following references are applicable to the information in this Chapter: 

Identifying U.S. 

citizens 

Citizenship 

verification and 

eligibility 

EAS 42-431, 42-433, 43-119 and 69-200 

AB 1542 

8CFR213 

People born in the following locations are considered U.S. citizens: 

The United States of America 

The District of Columbia 

Puerto Rico 

Guam 

The U.S. Virgin Islands 

American Samoa 

Swains Island 

The Northern Mariana Islands 

CalWORKs cash aid can be approved for those U.S. citizens who prove 

citizenship. When the applicant cannot prove citizenship, approve aid for up 

to 90 days while the family gathers documentation provided there is no 

reason to doubt citizenship. 

The following pages give the instructions for verifying U.S. citizenship. 


The U.S. Citizenship Documentation Process 

Verifying 

citizenship 

Begin the citizenship verification process by asking for a birth certificate for 

each family member. Use the chart below when a birth certificate is 

unavailable. 

If… Then… 

The parent or caretaker relative 

does not have a birth certificate, 

The parent or caretaker relative: 

Does not have proof of an 

individual’s citizenship, and 

The person has never 

received CalWORKs or the 

CalWORKs case is not 

retrievable, and 

The citizenship of the person 

is not questionable, 

The parent or caretaker relative: 

Has no document verifying 

citizenship, but 

The individual previously 

received CalWORKs or 

Medi-Cal, and 

The caretaker states he/she 

provided the verification with 

the previous application, 

Proof of citizenship does not exist 

or never existed, 

Either: 

– Request another form of birth verification (see the 

Acceptable Documents section of this Chapter), or 

– Obtain a screen print of the Medi-Cal Eligibility Data 

System (MEDS) INQE screen to verify citizenship 

documentation was previously provided. 

Give the parent or caretaker relative the HS 622 with the 

necessary information to request a copy of the birth verification 

from the Vital Records Bureau where the person was born 

when other documentation is not available. 

Use the HS 623 process when the parent or caretaker relative 

states he/she cannot pay for the birth certificate or has been 

unsuccessful in acquiring the certificate or other verification and 

the information is not available in MEDS. 

Note: Documents provided as verification of citizenship must be 

original and list the person’s place of birth. 

Either: 

– Obtain a screen print of the MEDS INQE screen to verify 

citizenship documentation was previously provided, or 

– Give the parent or caretaker relative the HS 622 with the 

information needed to request a copy of birth verification 

from the Vital Records Bureau where the person was born 

when other documentation is not available. 

Use the HS 623 process when the parent or caretaker states 

he/she cannot pay for the birth certificate or has been 

unsuccessful in acquiring the certificate or other verification and 

the information is not available in MEDS. 

Verification must be provided within 90 days from the beginning 

date of aid. 

Set a Task to follow up and send the caretaker a reminder 

notice. 

Request the physical case be pulled from closed files using the 

HS 38 to obtain the birth verification on file, 

Retrieve information from C-IV, or 

Obtain screen print of MEDS INQE screen to verify citizenship 

documentation was previously provided. 

Discontinue CalWORKs cash aid for any individual for whom 

citizenship is not proven after 90 days and after using the 

HS 623 process. 

Note: Citizenship documentation is identified by a code on the MEDS INQE screen. For example, 

Code Type 1A indicates a United States Passport was provided. Refer to the MEDS My Easy Desk 

Source for a list of codes identifying the type of citizenship document provided. 


Notes about the HS 623 (E/S) Process 

The first 90 

days of aid 

HS 623 (E/S) is 

returned with a 

“No record 

notice” 

When TAD 

receives the 

birth certificate 

The customer is responsible for doing whatever is necessary to verify 

citizenship for all U.S. citizen family members during the first 90 days of aid if 

he/she was unable to do so before the application was approved. 

Use the HS 623 (E/S) process only after the customer was unsuccessful in 

his/her efforts to obtain birth verification and the information is not available 

in MEDS. The following rules apply: 

Do not discontinue the individual while information from the County 

Recorder’s database or CDS is pending. 

Journal information has been requested and is pending. 

Follow up every 30 days to see that information from the County 

Recorder’s database has been returned. 

Seek help from a supervisor when no response to the HS 623 (E/S) has 

been received within 60 days after submission. 

When the HS 623 (E/S) is returned with a “no record notice”: 

1. Check the HS 623 (E/S) with the case record to make sure the 

HS 623 (E/S) information was correct. 

2. If the HS 623 (E/S) had incorrect information, submit another 

HS 623 (E/S) with the correct information. 

3. If the case record matches the information on the original HS 623 (E/S), 

send the customer a Notice of Action (NOA) discontinuing the person or 

the case due to failure to provide: 

– Age verification, or 

– Citizenship verification. 

Once the certified copy of the birth record is received, image the record into 

the electronic case, and mail the certified copy of the birth verification to 

the customer. 


Acceptable Citizenship Documentation 

Acceptable 

citizenship 

documents 

Any document used to verify United States (U.S.) citizenship must include 

the individual’s place of birth. U.S. citizenship is verified by using one of the 

following documents, listed in order of preference: 

Birth certificate signed by a physician, hospital administrator, or 

authorized designee 

Bureau of Vital Statistics or local government records of birth 

Medi-Cal Eligibility Data System (MEDS) INQE screen print verifying 

acceptable documentation was provided 

Vista screen print of the birth record from the San Bernardino County 


Certificate of citizenship or naturalization from the U.S. Citizenship and 

Immigration Service (USCIS) 

Passport 

Notarized statement from the County Clerk where the individual was 

naturalized 

Midwife’s record of the birth 

Adoption decree 

Indian census records 

NUMI file screen print from the Social Security Administration for people 

born on or after January 1,1978 listing the individual’s name, date of 

birth, place of birth, and parents’ names 

Church records of birth, including statements from a priest or minister 

School records 

Affidavits or declarations under penalty of perjury by persons with direct 

knowledge of the date and place of birth, the citizenship of the 

individual’s parents, and/or facts about the person which would not exist 

if they were not a citizen 

Note: Once the customer provides the acceptable documentation and it is 

imaged in C-IV, or on MEDS, the Eligibility Worker (EW) will not require the 

customer to provide the documentation again. 


Federal Deficit Reduction Act 

Introduction The Federal Deficit Reduction Act (DRA) requires documentation of 

citizenship status and identity be obtained for Medi-Cal applicants/recipients 

who claim to be U.S. citizens or nationals (unless they are exempt from the 

requirement). 

Impact to 

noncitizens 

The CalWORKs citizenship and identity documentation requirements fulfill 

the DRA requirements for current and former CalWORKs recipients; 

Medi-Cal compliance will follow current CalWORKs program rules, and no 

additional evidence or documentation is needed to determine Medi-Cal 

eligibility. 

Customers approved for CalWORKs pending citizenship documentation that 

are subsequently discontinued for failure to provide that documentation are 

not considered to have met the DRA requirement. These customers will be 

required to provide acceptable citizenship and identity documentation to be 

determined Medi-Cal eligible. 

Note: U.S. nationals include individuals born in American Samoa (including 

Swains Island) and certain inhabitants of the Commonwealth of the Northern 

Mariana Islands. 

This requirement does not change the documentation or eligibility 

determination process for noncitizen customers. 

Note: The Vital Statistics Detail page in C-IV should not be established 

for noncitizens. 

HSS 623 If a customer has difficulty obtaining evidence of citizenship, the EW can 

utilize the HSS 623 process (See the “Notes About the HS 623 E/S Process” 

section in this chapter of the handbook). 



Federal Deficit Reduction Act, Continued 

DRA 

requirements 

Verifying Vital 

Statistics Detail 

page 

Since the CalWORKs customer meets the DRA requirements by being a 

former or current CalWORKs recipient, the EW will make the following 

selections from the drop-down boxes on the Vital Statistics Detail page for 

Citizenship and Identity verification for U.S. citizens and nationals being 

approved for CalWORKs: 

If citizenship documentation… Then the document type… 

Exists on the MEDS INQE screen 

or is on C-IV Vital Statistics 

Detail page, 

Does not exist on the MEDS INQE 

screen or is not on C-IV Vital 

Statistics Detail page, 

• Must match the MEDS INQE 

screen, and/or 

• Is not changed on C-IV Vital 

Statistics Detail page. 

• Is “Exempt from verification” and 

reason is “Eligible under CalWORKs 

Cash Assistance Program” 

Note: If citizenship documentation information is available on the MEDS 

INQE screen, EWs should match that information when completing the Vital 

Statistics Detail page in C-IV. 

If identity verification… Then the document type… 

Exists on the MEDS INQE screen 

or is on C-IV Vital Statistics 

Detail page, 

Does not exist on the MEDS INQE 

screen or is not on C-IV Vital 

Statistics Detail page, 

• Must match the MEDS INQE 

screen, and/or 

• Is not changed on C-IV Vital 

Statistics Detail page. 

Exempt from verification and Reason is 

“Eligible under CalWORKs Cash 

Assistance Program” 

Note: If citizenship documentation or identity verification document type in 

C-IV is “Unable to obtain documentation” then the document must be 

obtained and appropriate selections made in C-IV. 

It is necessary for the EW to complete and verify the Vital Statistics Detail 

page for each program person who is a U.S. citizen or national in order to 

record this information in MEDS and to be able to run Eligibility 

Determination and Benefit Calculation (EDBC) in C-IV. 

The Vital Statistics Detail page should not be verified until the EW is ready 

to approve CalWORKs benefits. When the page is verified, an AP 19 MEDS 

transaction is generated and the information batches to MEDS. If the worker 

verifies the page prior to approving benefits and subsequently denies the 

application, the CalWORKs exemption requirement is reported to MEDS with 

inaccurate information. 




Vital Statistics 

page and 

pending birth 

verification 

Failure to 

provide birth 

verification 

Companion 

Medi-Cal cases 

The Vital Statistics Detail page selections listed in the “DRA requirements” 

block are also appropriate for customers who have been approved for 

CalWORKs, but are pending birth verification. This includes customers who 

have signed the HS 623 and are pending return of birth verification. It is not 

appropriate to select “U.S. Public Health Record” indicating a birth certificate 

has been provided when the document has not actually been provided. If the 

customer has provided an original birth certificate or another type of 

acceptable citizenship/identity documentation, the EW should make the 

appropriate selections indicating the type of document received. 

In the event the customer is subsequently discontinued for failure to provide 

birth verification, he/she did not meet the DRA requirement and will be 

required to provide acceptable citizenship and identity documentation to be 

determined eligible for Medi-Cal. 

Companion Medi-Cal cases with the following individuals who have never 

received CalWORKs do not meet the DRA requirement: 

• Fleeing Felons 

• Drug Felons 

• TANF timed-out customers (timed out in another state) 

These customers are required to provide acceptable citizenship and identity 

documentation before eligibility to Medi-Cal can be determined. Refer to the 

table below when completing the citizenship and identity verification types on 

the Vital Statistics Detail page in C-IV. 

If CalWORKs was… Then Citizenship 


Received, • Exempt from 

verification, and 

• Reason is “Eligible 

under CalWORKs 

cash assistance 

program”, 

Not received, The document type 

provided. 

And Identity 


• Exempt from 

verification, and 

• Reason is “Eligible 

under CalWORKs 

cash assistance 

program”. 

The document type 

provided. 

Note: The MEDS INQM screen will verify if a customer has previously 

received CalWORKs. 




DRA Social 

Security 

Number (SSN) 

validation 

Acceptable 

verification – 

citizenship and 

identity 

The Social Security Number (SSN) validation process was implemented to 

verify citizenship/identity of customers applying for or receiving Medi-Cal only 

benefits who are subject to the federal DRA citizenship and identity 

requirements. 

The SSN validation is the first step in attempting to verify a customer’s 

citizenship and identity for DRA purposes. A successful match fulfills the 

DRA’s citizenship/identity verification requirements and no further 

documentation is needed from the customer. EWs are required to assist 

non-exempt customers who claim to be United States (U.S.) citizens or 

nationals and whose SSN validation is unsuccessful (refer to the Operations 

and Reference Handbook (ORHB) for specific information regarding the DRA 

SSN validation). 

Documents acceptable as verification of both citizenship and identity are: 

• United States passport issued without limitation, current or expired. 

− Passports issued through 1980 may show more than one person. 

• Certificate of Naturalization (DHS Form N-550 or N-570). 

• Certificate of Citizenship (DHS Form N-560 or N-561). 

The documents listed above are considered Primary Documents, and are 

evidence of highest reliability. These documents establish both citizenship 

and identity, and should be obtained whenever possible. 


CWPHB #4613 (07/11) CITIZENS/NONCITIZENS/REFUGEES 6-8.1


Acceptable 

verification – 

Citizenship 

only 

If a customer does not have one of the documents listed in the “Acceptable 

verification – citizenship and identity” block, separate documents must be 

provided as evidence of citizenship and identity. Documents acceptable as 

verification of citizenship, in order of reliability from Secondary Documents to 

Fourth Level Documents (Left to right in columns in table below), are: 

Secondary Documents Third Level Documents Fourth Level Documents 

• U.S. Public Birth Record 

recorded before age 5 

• Certification of Report of 

Birth (DS-1350) 

• Certification of Birth issued 

by the Department of State 

(Form CalFresh-545 or 

DS-1350) 

• Report of Birth Abroad of a 

U.S. Citizen (CalFresh-240) 

• U.S. Citizen I.D. Card (Form 

I-197 or I-179) 

• American Indian Card 

(I-872) 

• Northern Marianas 

Identification Card (I-873) 

• Final Adoption Decree 

• Evidence of civil service 

employment by U.S. 

Government showing 

employment before 6/1/76 

• U.S. Military Record 

• Systematic alien Verification 

for Entitlements (SAVE) 

• Proof of Adoption under the 

Child Citizenship Act 

• Extract of a hospital record 

on hospital letterhead 

established at the time of 

birth 

• Life or health or other 

insurance record 

• Early School records 

• Religious Records 

recorded within three 

months of birth 

• Federal or State census 

record showing U.S. 

citizenship or a U.S. place of 

birth (Generally for persons 

born 1900-1950) 

• Seneca Indian tribal census 

record 

• Bureau of Indian Affairs 

tribal census record of the 

Navaho Indians 

• U.S. State Vital Statistics 

official notification of birth 

registration 

• Delayed U.S. public birth 

record, delayed more than 5 

years after the person’s birth 

• Statement signed by the 

physician or midwife who 

was in attendance at the 

time of birth 

• Medical (clinic, doctor or 

hospital) record (excludes 

immunization records) 

• Written Affidavit 

• Institutional admission 

papers from a nursing 

facility, skilled care facility or 

other institution 

• Roll of Alaska Natives 

maintained by the Bureau of 

Indian Affairs 




Acceptable 

verification - 

Identity 

If a document listed in the “Acceptable verification – citizenship only” block, is 

provided as evidence of citizenship, one of the following documents must be 

provided as evidence of identity: 

• Certificate of Degree of Indian Blood, or other U.S. American 

Indian/Alaska Native tribal document (acceptable if the document carries 

a photograph of the applicant or recipient, or has other personal 

identifying information relating to the individual such as age, weight, 

height, race, sex and eye color) 

• Driver’s license issued by a State or Territory either with a photograph of 

the individual or other identifying information of the individual such as 

name, age, sex, race, height, weight or eye color 

• School identification card with a photograph of the individual 

• U.S. military identification card or draft record 

• Identification card issued by the Federal, State, or local government with 

the same identifying information included on driver’s licenses 

• U.S. Military dependent’s identification card 

• Native American Tribal document 

• U.S. Coast Guard Merchant Mariner card 

• For children under 16, a school record may include nursery or daycare 

records 

• An affidavit to establish the identity of children under 18 is only 

acceptable if it is signed under penalty of perjury (but does not need to be 

notarized) by a parent or guardian stating the date and place of birth of 

the child, and cannot be used if an affidavit for citizenship was provided 

• A U.S. Passport, current or expired, even if issued with limitation 

Note: Expired documents are acceptable for proof of identity. 

• Three corroborating identity documents belonging to an individual who 

provided second or third level verification of citizenship. The three 

corroborating documents must: 

− Include the individual’s name 

− Contain consistent identifying information 

− Taken together, corroborate the identity of the individual 

− Not have been used to establish citizenship 

The types of documents that may be used in this way are marriage licenses, 

divorce decrees, high school or college diplomas including general education 

equivalency diplomas, employer identity cards and property deeds/titles. 




Acceptable 

verification - 

Identity 

(continued) 

DHCS 0005 

/DHCS 0011– 

“Proof of 

Citizenship or 

Identity 

Received” 

forms 

• An affidavit of identity for children under age 18 (DHCS 0009). This is 

acceptable as evidence of identity for a child under 18 only if all the 

following conditions are met: 

− An affidavit was not used to verify the child’s citizenship, 

− The child cannot obtain a school identity card, and 

− He/she does not have a driver’s license. 

• Affidavit of identity for disabled individuals in institutional care facilities 

(DHCS 0010) signed under penalty of perjury by a residential care facility 

director or administrator on behalf of the institutionalized individual. (It 

does not have to be notarized). 

• Clinic, doctor or hospital records for children under 16. To be acceptable, 

the verification: 

− Must be on hospital letterhead, 

− Must be signed, 

− Must reference hospital medical records, 

− Cannot be an immunization record, and 

− Cannot be a souvenir birth certificate, which usually contains prints of 

baby’s palm and/or soles. 

• School records for children under 16. This category of documents 

includes nursery or daycare records and report cards, all of which must 

be verified with the issuing school in writing or through a telephone call. (If 

verified through a telephone call, a Journal entry must be made). 

When the EW receives an original birth certificate or the original of any other 

DRA verification directly from the customer the EW will complete the DHCS 

0011. The DHCS 0011 verifies that an original document was received from 

the customer and informs the customer if the document(s) provided are 

acceptable or not acceptable for meeting DRA requirements. 

The EW will also complete the DHCS 0011 when a DHCS 0005 with copies 

of documents attached is forwarded to him/her. The EW will review the 

documents to determine it they meet the DRA requirements and then send 

the DHCS 0011 to the customer to inform the customer of whether or not the 

DRA requirements are met. 


Child Citizenship Act of 2000 

Introduction The Child Citizenship Act of 2000 became effective February 27, 2001. 

Under this Act, a child born outside of the United States automatically 

becomes a citizen of the United States when that child meets specific 

conditions. 

Conditions for 

citizenship 

When is 

citizenship 

effective? 

A child born outside the United States automatically becomes a citizen of the 

United States when all of the following conditions are met: 

• At least one parent of the child is a citizen of the United States, either by 

birth or naturalization, 

• The child is under the age of 18 years, 

• The child is residing in the United States in the legal and physical custody 

of the citizen parent, and 

• The child entered the United State pursuant to a lawful admission for 

permanent residence. 

When the child is adopted, see the Adopted Children section of this Chapter 

for additional information/requirements. 

A child, who was under the age of 18 and met all the requirements listed in 

the Conditions for Citizenship section, on or before February 27, 2001, 

acquired citizenship automatically on February 27, 2001. Otherwise, a child 

acquires citizenship on the date all requirements listed in the block above are 

met. 



Child Citizenship Act of 2000, Continued 


table 

Verifying 

citizenship 

Lawful 

admission for 

permanent 

residence 

Use the table below to determine when a child acquired citizenship, under 

the Act, based on when the conditions were met. 

If the conditions were met… Then the child acquired citizenship… 

On or before February 27, 2001 February 27, 2001. 

After February 27, 2001 On the date conditions are met. 

To verify if the child is meeting the conditions listed in the “Conditions for 

Citizenship” block of this section and is therefore a citizen, the child should 

have a Certificate of Citizenship or a United States passport. In the absence 

of the Certificate of Citizenship or passport, the child’s citizenship status can 

be determined by verifying all of the following: 

• The citizenship status of at least one parent, 

• The age of the child, 

• The child entered the United State pursuant to a lawful admission for 

permanent residence, and 

• The legal relationship of the child to the parent. 

By verifying the above requirement through either USCIS documentation or 

other information, and establishing the age of the child and the family 

relationship, the citizenship status of the child can be determined. 

When the child is adopted, see the Adopted Children section in this Chapter 

for additional information/requirements. 

Admission to the United States in any immigrant classification will satisfy the 

requirement the child be admitted to the United States as a lawful permanent 

resident. For additional information related to verifying status as a lawful 

permanent resident, see the Citizenship and Immigration Documents 

Chapter of the Operations and Reference Handbook (ORHB). 



Child Citizenship Act of 2000, Continued 

Adopted 

children 

Certificate of 

Citizenship 

Contacting the 

USCIS 

To automatically become citizens of the United States under the Child 

Citizens Act of 2000, adopted children must meet additional conditions to 

those listed in the “Conditions for citizenship” block of this section. Those 

conditions are: 

• The child must be under the age of 16 and have resided in the legal and 

physical custody of the citizen parent(s) for at least two years. 

• Siblings adopted by the same parent(s) have until the age of 18 to 

qualify. 

The above conditions, in addition to those listed in the” Verifying citizenship” 

block, must be verified in order to determine the citizenship status of adopted 

children. 

The Certificate of Citizenship is obtained through the U.S. Citizenship and 

Immigration Services (USCIS). Applications are the responsibility of the 

parent and must be accompanied by a fee. Parents are not required to 

submit any evidence already contained in the USCIS file, including 

translations of documents. 

The County is not required to pay the fee to assist the applicant in obtaining 

the Certificate of Citizenship. While the Certificate of Citizenship is the 

preferred document to use when verifying citizenship, it is not the only 

document available. The County can determine citizenship status by verifying 

the child meets the requirements in the “Verifying citizenship’ block in this 

section. These are requirements the child would need to meet to qualify for a 

Certificate of Citizenship. 

Applicant/recipients with questions related to the Child Citizenship Act of 

2000 and how to obtain a Certificate of Citizenship should be referred to the 

local USCIS office. They can also be referred to the USCIS Web site at: 

www.uscis.gov or the USCIS National Customer Service Center at 

(800) 375-5283 for information about the Child Citizenship Act application, 

procedures, and forms. 


Noncitizen Eligibility 

Identifying 

noncitizens 

Verifying 

noncitizen 

status 

Definition: 

qualified 

noncitizens 

Noncitizens are identified as follows: 

• Undocumented non-citizens are those persons who do not have proof of 

legal U.S. residence or have stayed in this country after permission to live 

here has expired. If the documentation has expired, see the Noncitizen 

Expired Verification chart in this Chapter to determine if the noncitizen 

remains eligible or not. Undocumented noncitizens are ineligible for 


• Legal permanent residents (LPR) and other qualified noncitizens are 

people who have been given the privilege to live in the United States. 

These people are eligible for CalWORKs cash aid. For some CalWORKs 

qualified noncitizens, the cash grant is paid with federal funds. For 

others, the cash grant is paid with funds from the State of California. 

These recipients are commonly referred to as “state-only noncitizens”. 

It is critical you identify those noncitizens eligible to federally funded cash aid 

and those eligible for state funded benefits because more money is available 

for CalWORKs payments from the federal government than from the state 

government. 

Before cash aid is issued to a LPR, immigration status must be: 

• Verified with an original document from USCIS, and 

• Supported by the Systematic Alien Verification for Entitlements (SAVE) 

data base report, and 

• Documented on the TAD QA 2: Noncitizen Eligibility Determination 

Worksheet. 

There is more information about noncitizen status verification later in this 

Chapter. 

A qualified noncitizen qualifies for cash aid and is someone who was: 

• Lawfully admitted for permanent residence 

• Granted asylum 

• Admitted as a refugee 

• Paroled – allowed to enter under emergency conditions or in the public 

interest – into the U.S. for at least one year 

• To be deported but deportation was withheld 

• Granted conditional entry as a refugee 

• A Cuban or Haitian entrant 

• An Amerasian entrant 

• A battered noncitizen – under specific circumstances described in this 

chapter. 


The Noncitizen Eligibility Determination Process 

The Noncitizen 

Determination 

process 

The eligibility determination process for noncitizens follows: 

Step Action 

1 Identify all non-citizen AU members. 

2 Request original USCIS noncitizen status documentation. Refer to 

the Documentation Examples section of this Chapter. 

If… Then… 

The noncitizen is not a 

legal permanent resident 

of the U.S. 

Original USCIS 

document is not 

provided 

The time limit for the 

validity of the document 

has expired 

The noncitizen lives in 

the U.S. legally 

• Photocopy the USCIS document 

provided. 

• Deny the application for cash aid. 

Deny the application for cash aid. 


provided. 

• Deny application or continue eligibility 

determination process. Refer to the 

Noncitizen Verification chart in this 

chapter. 


provided. 

• Continue with the eligibility 

determination process. 

3 Document the qualified noncitizen status determination on the 

TAD QA 2 - Noncitizen Eligibility Determination Worksheet. 

4 Determine federal or state grant funding for eligible family 

members. 

5 Submit the noncitizen registration number to the Systematic Alien 

Verification for Entitlements (SAVE) system for confirmation of the 

immigration status. Refer to the SACS Handbook for information 

about the SAVE system. 

6 Respond to the SAVE report: 

If the SAVE report… Then… 

Verifies the information 

provided on the USCIS 

document for the individual 

Says secondary verification 

is needed 

Does not ask for secondary 

verification and does not 

substantiate the verification 

provided 

Place the SAVE report in the 

case record. 

Use the G-845 – Document 

Verification Request to request 

secondary verification of the 

USCIS document provided. 

Deny or discontinue CalWORKs 

cash aid. 


Noncitizen Status Verification Requirements 

Introduction Noncitizens requesting cash aid are required to present original 

documentation of their immigration status. 

The SAVE 

system 

Noncitizens who cannot produce documentation of their immigration status 

are ineligible to receive cash aid until they can provide documentation.. 

Immigration status will be verified through the Systematic Alien Verification 

for Entitlements (SAVE) system in addition to verification through the use of 

an original USCIS document. When the person has a copy of an USCIS 

document or knows their immigration registration number, status can be 

checked through the SAVE system while the person tries to obtain original 

documentation through USCIS. 

When the SAVE system indicates that secondary verification is necessary, 

the G-845 must be completed and sent to the local USCIS office. 

An individual is ineligible to receive CalWORKs cash aid if the USCIS 

document is not substantiated through the SAVE or the G-845 - Document 

Verification Request process. See the Noncitizen Eligibility Determination 

Process section of this Chapter. 

USCIS location Mail the G-845 forms to: 

United States Citizenship and Immigration Service 

Los Angeles District Office 

300 North Los Angeles Street 

Los Angeles, California 90012 

Verification 

requirements 

Photocopy both the front and the back of immigration verification document 

for the case record. If the photocopy is difficult to read, document the 

following information in the case journal: 

• The individual’s name 

• The USCIS class code or visa symbol 

• The document issue date 

• The document expiration date 

The final pages of this Chapter contain examples of USCIS documents used 

to establish immigration status. If other documentation is presented and the 

status is unclear, the District Manager (DM) may call the Program 

Development Division (PDD) for help. 


CalWORKs & CalFresh Noncitizen Expired Verification 

Overview When an AU/HH member’s noncitizen verification has expired, the Eligibility 

Worker (EW) must determine whether or not the noncitizen remains eligible. 

Eligibility for aid will depend on the type of aid requested/received and the 

type of verification the noncitizen provides. 

Noncitizen 

Expired 

Verification 

Table 

If the noncitizen’s verification has expired, and the noncitizen would be 

eligible if the verification was current, use the table below to determine 

whether or not a noncitizen is eligible to CalWORKs and/or CalFresh. 

Noncitizen Verification 

Expired immigration card, and 

noncitizen has applied for new 

card and has receipt 


noncitizen has applied for new 

card and does not have receipt 


noncitizen has not applied for 

new card 

USCIS receipt only which 

includes the immigration number 


Acceptable 

Verification 

YES 

(See Note 1) 

MAYBE 

(See Note 3) 

CalFresh 

Acceptable 

Verification 

YES 

(See Note 2) 

YES 

(See Note 2) 

CWPHB #4605 (04/11) CITIZENS/NONCITIZENS/REFUGEES 6-18 

NO 

YES 

(See Notes 1 & 3) 

YES 

(See Note 2) 

YES 

(See Note 2) 

NOTES: 

1. Obtain copy of receipt from USCIS showing the noncitizen has applied 

for a new card. Set a Task to follow-up in three months to see if the 

noncitizen has received his/her new card. 

2. Aid the noncitizen indefinitely pending verification from SAVE or using the 

G 845- Document Verification Request confirming his/her noncitizen 

status. 

3. Send the noncitizen information through SAVE. If SAVE states: 

• The noncitizen is eligible, then aid the noncitizen and set a Task to 

follow-up in 3 months to verify if the noncitizen has received his/her 

new card. 

• “Institute Secondary Verification”, complete the G-845 and send to 

the local USCIS, discontinue the noncitizen as soon as possible with 

adequate and timely notice. Once secondary verification is received, 

if the noncitizen qualifies as an eligible noncitizen, the discontinuance 

can be rescinded and aid can be restored back to the date of 

discontinuance.

Funding the CalWORKs Grant 

Noncitizens 

and CalWORKs 

funding rules 

The basic rules for determining Federal vs. State-Only (S/O) eligibility are: 

• A qualified noncitizen that arrived in the U.S. before August 22, 1996 is 

eligible for federally funded CalWORKs cash aid. 

• The federal government will not fund a CalWORKs cash grant for a legal 

permanent resident alien (noncitizen) who arrived on or after August 22, 

1996 for five years from the date they became a qualified noncitizen. 

There are exceptions to that rule. 

• A qualified noncitizen that arrived on or after August 22, 1996 who meets 

one of the exceptions to the five-year rule is eligible for federally funded 

cash aid before they have been in the U.S. for five years. 

• A qualified noncitizen that arrived on or after August 22, 1996 is eligible 

for state funded cash aid for five years after they entered the U.S. if they 

do not meet one of the exceptions to the five-year rule. 

• Immigrants receiving state funds are eligible for those benefits for five 

years after the date they entered the U.S. 

• A person who arrived in the U.S. on or after August 22, 1996 must live in 

the U.S. legally for five years or become a citizen in order to receive 

federally funded aid without a time limit. 

In summary The following is a very brief summary of the rules given above: 

If the qualified 

noncitizen arrived… 

And… Then funding is… 

Before August 22, 1996 Federal. 

On or after August 22, Meets the exception to Federal. 

1996 

the state-only rule 

On or after August 22, Does not meet an State-only. 

1996 

exception criteria 


Exceptions to the Five-year State Funding Rule 

Exceptions Qualified Noncitizens who arrived in the U.S. on or after August 22,1996 are 

eligible for State-Only (S/O) CalWORKs cash aid for five years after they 

enter the U.S. except when the noncitizen is: 

• A veteran of a branch of the U.S. military service 

• A member of a family who has 40 qualifying quarters of work with a U.S. 

company – refer to information about figuring quarters later in this chapter 

• A Cuban or Haitian entrant 

• An Amerasian immigrant 

• One whose pending deportation has been withheld 

• An asylee – a person granted asylum from persecution in their home 

country 

• A refugee – see the information in the following block 

• A parolee – a person who would otherwise not be admitted into the U.S. 

as an LPR but is admitted under emergency conditions or when the 

noncitizen’s entry is determined to be in the public interest 

Legal permanent resident aliens (noncitizens) who meet one of the above 

exceptions to the five-year State-Only funding rules are eligible for federally 

funded cash aid. Refer to the following pages for information about each of 

the exceptions to the 5-year state-funding rule. 

Refugees Special funding is available for refugees. Refugee aid funds: 

• Come from the federal government 

• Have very short time limits 

• Are separate from – but related to – CalWORKs 

• Must be carefully accounted for through the use of certain aid codes 

Even though all the funds for these cash grants come from the federal 

government, the aid must be sorted into separate funding streams. In 

addition, eligibility rules are slightly different than for other CalWORKs 

recipients. 

When considering issuing a cash grant to a refugee, refer to the instructions 

specifically for processing refugee cases later in this Chapter. 


S/O Exception: Veterans or Active Duty Military Personnel 

Veterans of the 

U.S. military 

Verifying 

veteran or 

active duty 

status 

LPR veterans and current members of U.S. military service are eligible for 

federally funded CalWORKs cash aid whether they entered the U.S. before 

or after August 22, 1996. 

The following noncitizens are federally eligible for CalWORKs cash aid: 

• Active duty service personnel 

• Veterans who were honorably discharged 

• The spouse or unmarried dependent of an honorably discharged veteran 

• The spouse or unmarried dependent of an active duty military service 

member 

• The unremarried surviving spouse of an honorably discharged veteran 

Verify veteran or active duty military status with any of the following: 

• Form DD 214 

• CA 5 

• Current leave and earnings statement of active duty personnel 

• Other original documentation from a branch of the U.S. military 


S/O Exception: People with 40 Work Quarters 

People with 40 

qualifying work 

quarters in the 

U.S. labor force 

Whose quarters 

count 

Noncitizens and their families who arrived in the U.S. on or after August 22, 

1996 with a substantial connection to the U.S. labor force are exempt from 

the five-year state-funding rule and are eligible to receive a federally funded 

CalWORKs cash grant. 

A connection to the U.S. labor force is established when family members 

have accumulated 40 three-month periods or quarters where their earnings 

were enough to be counted toward the accumulation of Social Security 

Retirement, Survivors, or Disability benefits. The Social Security 

Administration (SSA) establishes the earnings levels used to determine 

countable quarters. Those quarterly earnings levels change over time and 

are given later in this chapter. 

Since 40 work quarters represents 10 years of work, this means that work 

quarters prior to August 22, 1996 can be considered in the total. 

Accumulate the 40 quarters for the family by counting the work history of any 

family member who: 

• Worked in the U.S. or worked in another country for a U.S. company, and 

• Paid Social Security taxes, or 

• Can verify quarters of work where the worker was prevented from paying 

into the SSA retirement system because they contributed to a different 

retirement system. 


Combining Work Quarters 

Sharing 

countable 

quarters 

Individuals can become federally eligible based on their own work history. 

One family member’s work history can make another family member eligible. 

Qualifying quarters can be combined to come up with the total of 40 needed 

quarters: 

• Spouses work histories can be combined to make each other federally 

eligible during their marriage. Work histories of former spouses can no 

longer be used to establish federal eligibility for each other when the 

marriage ends. Divorced people must establish eligibility based on their 

own work histories or that of the current spouse when they remarry. 

• An individual can become federally eligible based on their parents’ work 

histories before the individual turned 18 years old regardless of the 

parents’ marital status and regardless of how old that individual is at the 

time of application for CalWORKs cash aid. 

• Children can become federally eligible based on a stepparent’s work 

history while the stepparent is married to the natural parent. A 

stepparent’s work quarters can no longer be used to establish eligibility 

for the child if the marriage ends in divorce. 


Countable Work Quarters 

Countable 

quarters 

Use the following guidelines when determining which quarters are countable: 

• Only those work quarters linked to the Social Security system through the 

payment of FICA taxes will count toward establishing eligibility for 

federally funded cash aid unless the worker was prevented from 

contributing to the Social Security Administration (SSA) retirement system 

by their employer because they paid into a different retirement system. 

• Up to seven of the most recent work quarters may not appear on the 

Income and Earnings Verification System (IEVS) report due to lag time in 

the data compilation process. 

• If quarters too recent to show on the IEVS report are needed to establish 

eligibility, the applicant may prove the existence of countable quarters by 

providing a current employer prepared wage statement as proof of 

earnings as long as the statement shows FICA withholding or payments 

to another mandated retirement system. The W-2 or W-2D, employer 

prepared wage statements or an IRS tax return copy for the prior year 

may also be used to verify the recent work quarters not showing on the 

IEVS report. 

• Self-employed people are required to pay Social Security taxes based on 

their earnings so quarters accumulated through self-employment must be 

verified through the IEVS system. 

• Self-employed people may use the TAD QA 1: Statement of Qualified 

Employment to certify their work history too recent to appear on the IEVS 

system. 

• If eligibility is based on the use of quarters too recent to appear on the 

IEVS report and the IEVS report does not show those quarters when 

checked later, aid received as a result of the use of those quarters not 

verified through SSA is an overpayment. 


Non-countable Work Quarters 

Quarters that 

do not count 

Use the following guidelines when determining what quarters are not 

counted: 

• The current, incomplete quarter cannot be counted in the total. 

• Do not count any quarter in which the noncitizen received federally 

funded assistance including TANF or CalWORKs cash aid, SSI, 

Medi-Cal, Child Day Care assistance, or CalFresh. 

• Work history that does not appear on the IEVS report and is not too 

recent to show on the report cannot be used to help establish federal 

eligibility unless the worker can prove they were working under a 

retirement system that prohibited participation in the Social Security 

Administration (SSA) retirement system. 


Finding 40 Quarters in the IEVS System 

How to find 

work quarters 

To find those noncitizens with a connection to the labor force, request 40 

quarters information from Earnings Verification System (IEVS). The report 

will come back with any quarter where the employed person worked and paid 

into the Social Security system. 

Any wage earner not listed on the Statement of Facts but whose work history 

is to be considered must give permission for access to the SSA work history 

record by signing the SSA 3288. 

Follow these steps to determine whether the family has the 40 quarter 

connection to the U.S. labor force: 

Step Action 

1 Have any wage earner not listed on the Statement of Facts 

complete and sign the SSA 3288 to grant permission to access 

the SSA work history record via IEVS. 

2 Request 40 quarters information from the IEVS system. You 

should receive the report from the IEVS system within seven 

days. 

3 Tally the countable work quarters on the TAD QA 2A; Qualified 

Alien Worksheet Attachment. 

4. Document the 40 quarters on the TAD QA 2. 

5 Enter work quarter information in the citizenship page of C-IV. 


How the SSA Calculates Quarters 

Introduction A qualifying quarter is based on the amount of earnings reported to the SSA 

by an employer or a self-employed person in a particular year. 

Using this 

information 

Establishing 

quarters for 

years before 

1978 

• Quarters are the three-month periods of January through March, April 

through June, July through September, and October through December. 

• Credit for one quarter is granted when gross earnings reach or exceed 

the level established by the Social Security Administration (SSA) for that 

particular year. 

• Since there are only four quarters in a year, a maximum of four quarters 

can be earned by an individual in a single year. 

Rely on the Earnings Verification System (IEVS) system to establish 

countable work quarters. Use the information on this page when the IEVS 

system is not functioning or when figuring countable quarters too recent to 

appear on the IEVS report. 

The following are the rules to establish quarters before 1978: 

• A work quarter was established for each calendar quarter in which an 

individual was paid more than $50, including agricultural wages from 

1951 until 1955. 

• A work quarter was established when an agricultural worker earned at 

least $100 in a quarter from 1955 through 1977. 

• Four quarters were established for each taxable year in which an 

individual’s net earnings from self-employment were $400 or more. 

Credits are not given for quarters with earnings of less then $400. 

1978 and later For 1978 and later years, credit for work quarters is based on the total yearly 

earnings of any type. The amount of earnings needed to earn a credit 

changes annually. The earnings needed to establish a single quarter are: 

Year Amount Year Amount Year Amount 

1978 $250 1992 $570 2006 $970 

1979 $260 1993 $590 2007 $1000 

1980 $290 1994 $620 2008 $1050 

1981 $310 1995 $630 2009 $1090 

1982 $340 1996 $640 2010 $1120 

1983 $370 1997 $650 

1984 $390 1998 $700 

1985 $410 1999 $740 

1986 $440 2000 $780 

1987 $460 2001 $830 

1988 $470 2002 $870 

1989 $500 2003 $890 

1990 $520 2004 $900 

1991 $540 2005 $920 


S/O Exception: Cuban and Haitian Immigrants 

Overview Cuban and Haitian immigrants who arrived in the U.S. on or after 

August 22, 1996 are eligible to receive federally funded CalWORKs cash aid 

before they have been in the U.S. for five years if they are otherwise eligible. 

Identifying 

Cuban and 

Haitian 

immigrants 

The following persons are considered Cuban and Haitian entrants when they: 

• Are granted parole status as a Cuban/Haitian entrant (Status Pending) on 

or after April 1, 1980, or paroled into the United States on or after 

October 10, 1980. 

• Are the subject of removal, deportation or exclusion proceedings but do 

not have a final, non-appealable order of removal, deportation, or 

exclusion. 

• Have an application for asylum pending with the Department of 

Homeland Security (DHS) and do not have a final, non-appealable order 

of removal, deportation, or exclusion. 

Identify Cuban and Haitian immigrants by looking at the United States 

Citizenship and Immigration Services (USCIS) codes on the 

I-94 card, I-551, or foreign passport. The following documents/codes allow 

correct identification of a Cuban/Haitian entrant. 

USCIS document Status codes 

I-94 • CU7, 

• Paroled as “Cuban/Haitian Entrant” under 

section 212(d)(5) of the INA, or 

• Paroled as “Cuban/Haitian Entrant (Status 

Pending)”. 

I-551 CU6, CU7, or CH6 

Unexpired temporary CU6 

I-551 

Unexpired temporary 

I-551 stamp in a 

Foreign passport 

• CU7, or 

• 212(d)(5) stamp dated after October 10-1980. 

The following documentation is provided to immigrants who are the subjects 

of removal, deportation or exclusion proceedings: 

Document Code 

Department of Homeland Security 

(DHS) Form I-221 

N/A 

DHS Form I-862 N/A 

DHS Form I-220A N/A 

DHS Form I-122 N/A 

DHS Form I-221S N/A 

I-766 C10 

I-688B 274a.12(c)(10) 



S/O Exception: Cuban and Haitian Immigrants, Continued 

Identifying 

Cuban and 

Haitian 

Immigrants, 

(continued) 

Cuban medical 

professionals 

The following documentation is provided to immigrants with an application for 

asylum pending: 

Document Code 

DHS receipt for filing Form I-589 N/A 

I-766 C08 

I-688B 274a.12(c)(8) 

On August 11, 2006, the U.S. Department of Homeland Security announced 

a program that allows certain Cuban medical professionals living outside of 

Cuba to apply for parole or asylum into the U.S. They may receive federally 

funded Office of Refugee Resettlement (ORR) benefits and services when 

admitted into the U.S. if otherwise eligible. 

Spouses and minor children of Cuban medical professionals may also qualify 

for parole into the U.S. However, non-Cuban spouses and/or minor children 

of Cuban medical professionals do not meet the definition of Cuban or 

Haitian immigrant. They are not eligible to receive ORR benefits and 

services unless they qualify for assistance under another status. 


S/O Exception: Amerasian Immigrants 

Overview Amerasian people are children of a U.S. parent and a Vietnamese parent. 

Identifying 

Amerasian 

aliens 

Amerasian immigrants who arrived in the U.S. on or after August 22, 1996 

are eligible to receive federally funded CalWORKs cash aid before they have 

been in the U.S. for five years if they are otherwise eligible. 

Amerasian immigrants are also eligible for refugee cash aid for a short time 

after they arrive in the U.S. Refer to the information later in this chapter 

about refugees before issuing cash aid to an Amerasian immigrant. 

Identify Amerasian immigrants by looking at the USCIS codes on the I-94 

card, I-551, or a foreign passport. The codes allowing you to correctly 

identify these people are on the following table. 

USCIS document Status codes 

I-94 AM1, 2, or 3 

I-551 AM1, 2,3,6,7,8, or 9 

Unexpired temporary I-551 stamp in 

a Foreign passport 

AM1, 2, or 3 


S/O Exception: Withheld Deportation 

Overview Immigrants who meet the following criteria are eligible to receive federally 

funded CalWORKs cash aid before they have been in the U.S. for five years 

if they are otherwise eligible: 

• Scheduled for deportation (return to the country of origin), but 

• For whom deportation has been withheld, and 

• Who arrived in the U.S. on or after August 22, 1996. 

Identifying 

immigrants 

with withheld 

deportation 

Identify immigrants whose deportation has been withheld by looking at the 

USCIS codes or INA sections on the USCIS documents presented by the 

immigrant. The codes allowing you to correctly identify these people are on 

the following table: 

USCIS document INA sections listed 

Form I-688B: Employment Authorization Card 247a. 12(a)(10) 

Form I-766: Employment Authorization Document Status code A10 

Order from an immigration judge showing 243(h) as in effect 

deportation withheld 

Order from an immigration judge showing 

removal from the U.S. withheld 

4/1/97 

241(b)(3) 


S/O Exception: Immigrants Granted Asylum 

Overview The U.S. and other nations grant asylum to people unable or unwilling to 

return to their country of nationality because of persecution or a well-founded 

fear of persecution. People granted asylum are referred to as asylees. 

Identifying 

asylees 

Asylees who arrived in the U.S. on or after August 22, 1996 are eligible to 

receive federally funded CalWORKs cash aid before they have been in the 

U.S. for five years if they are otherwise eligible. 

Asylees are also eligible for refugee cash aid for a short time after they arrive 

in the U.S. Refer to the Refugee section of this Chapter. 

Identify immigrants to whom asylum has been granted by looking at the 

USCIS codes or INA sections on the USCIS documents presented by the 

asylee. The codes allowing you to correctly identify these people are on the 

following table. 

USCIS document INA section listed 

Form I-94 A stamp showing grant of asylum 

under Section 208 of the INA 

Form I-688B: Employment 

Authorization Card 

247SA.12(A)(5) 

Form I-766: Employment 

Authorization Document 

Status code A5 

Grant letter from the Asylum office Asylum is granted in the text of the 

of the USCIS 

Order of an immigration judge 

granting asylum 

letter 

Asylum is granted in the text of the 

order 


Afghan and Iraqi Special Immigrants 

Introduction The Consolidated Appropriations Act of 2008 signed into law on 

December 26, 2007 provided Special Immigrant status under section 

101(a)(27) of the Immigration and Nationality Act (INA) to Afghan and Iraqi 

immigrants with potential eligibility to cash assistance for a limited period of 

time. 

Eligibility 

period 

Afghan and Iraqi Special Immigrants may be eligible to receive federally 

funded Office of Refugee Resettlement (ORR) benefits and other services 

available to refugees admitted under section 207 of the INA. 

This section contains information and examples regarding the eligibility 

period and how to identify special immigrants. 

Afghan Special Immigrants may receive federally funded benefits and 

other services for either six or eight months. Afghan Special Immigrants with 

a U.S. entry or adjustment date: 

• On or prior to September 30, 2008 may receive federally funded benefits 

for six months. 

• After September 30, 2008 may receive federally funded benefits for eight 

months (the eight month eligibility period was effective March 11, 2009). 

The date of eligibility is the date the immigrant was admitted to the U.S. as 

an Afghan Special Immigrant; however, benefits and services cannot be 

received prior to December 26, 2007 or prior to the date of application for 

cash assistance, whichever is later, and cannot be received after six or eight 

months from the date of entry. The month of entry counts as month one. 

Iraqi Special Immigrants may receive federally funded benefits and other 

services for up to eight months. The date of eligibility is the date s/he was 

admitted to the U.S. as an Iraqi Special Immigrant; however, benefits and 

services cannot be received prior to December 26, 2007 or prior to the date 

of application for cash assistance, whichever is later, and cannot be received 

after eight months from their date of entry. The month of entry counts as 

month one. 

Note: The date of eligibility for federally funded benefits and other services 

for Afghan and Iraqi immigrants acquiring the Special Immigrant status while 

in the U.S. begins the date that the Special Immigrant status was granted. 



Afghan and Iraqi Special Immigrants, Continued 


eligibility 

periods 

Family 

members of 

Iraqi/Afghan 

Special 

Immigrants 

Continuing 

eligibility 

Following are examples of the eligibility periods for Special Immigrants. 

Example 1: A customer with Afghan Special Immigrant status has an 

Afghan passport showing date of entry into the U.S. as September 12, 2008. 

He applies for and is approved for cash assistance effective October 1, 2008. 

The customer has a six-month eligibility period, September 2008 through 

February 2009 as the eight-month eligibility period was not effective until 

March 11, 2009. The customer will receive cash assistance for six months 

only effective October 1, 2008 through February 28, 2009. 

Example 2: A customer with Afghan Special Immigrant status has an I-94 

document showing date of entry into the U.S. as October 1, 2008. The 

customer applies for assistance on January 3, 2008 and all eligibility 

conditions are met. The customer has an eight-month eligibility period, 

October 2008 through May 2009 as the initial six-month eligibility period ends 

after March 11, 2009 when the extension was effective. The customer is 

eligible to receive cash assistance effective 1/3/09 through 5/31/09. 

Spouses and minor children of the Afghan or Iraqi Special Immigrant must 

provide documentation showing their identity and immigration status as an 

Iraqi or Afghan Special Immigrant to be eligible for federally funded benefits 

and other services. 

Because Afghan/Iraqi special immigrants meet the definition of permanently 

residing in the U.S. under color of law (PRUCOL), they are eligible for stateonly 

benefits after their respective federal eligibility periods (eight months) 

end, if they continue to meet all other CalWORKs eligibility criteria. 




Identifying Iraqi 

Special 

Immigrants 

Newly arriving 

Iraqi refugees 

The following table lists documents that will confirm both the status and date 

of entry for Iraqi Special Immigrants. 

Applicant Documentation 

Iraqi Special Immigrant • Iraqi passport with an immigrant 

visa stamp noting the individual 

has been admitted under 

Immigrant Visa (IV) Category SI1 

or SQ1, and 

• DHS stamp or notation on 

passport or I-94 showing date of 

entry. 

Spouse of Iraqi Special Immigrant • Iraqi passport with an immigrant 


has been admitted under IV 

Category SI2 or SQ2, and 



Unmarried child under 21 years of 

age of Iraqi Special Immigrant 

Iraqi Special Immigrant adjusting 

status in the U.S. 

Spouse of Iraqi Special Immigrant 

adjusting status in U.S. 

Unmarried child under 21 years of 

age of Iraqi Special Immigrant 

adjusting status in U.S. 

entry. 

• Iraqi passport with an immigrant 


has been admitted under IV 

Category SI3 or SQ3, and 



entry. 

DHS Form I-551 showing Iraqi 

nationality (or Iraqi passport), with 

an IV code of SI6 or SQ6. 







In addition to the Iraqi special immigrant population, a group of displaced 

Iraqis are being admitted to the U.S. as refugees under INA Section 207 or 

granted asylum under INA Section 208. They may be eligible to federally 

funded refugee benefits and services if all other eligibility criteria are met. 




Identifying 

Afghan Special 

Immigrants 

The following table lists documents that will confirm both the status and date 

of entry for Afghan Special Immigrants. 

Applicant Documentation 

Afghan Special Immigrant • Afghan passport with an immigrant visa 

stamp noting the individual has been 

admitted under Immigrant Visa (IV) 

Category SI1, and 

• DHS stamp or notation on passport or 

Spouse of Afghan Special 

Immigrant 

Unmarried child under 21 

years of age of Afghan 

Special Immigrant 

Afghan Special Immigrant, 

adjusting status in the U.S. 

Spouse of Afghan Special 

Immigrant in P6 category 

Unmarried child under 21 

years of age of Afghan 

Special Immigrant in P6 

category 

I-94 showing date of entry. 

• Afghan passport with an immigrant visa 


admitted under IV Category SI2, and 



• Afghan passport with an immigrant visa 


admitted under IV Category SI3, and 



DHS Form I-551 showing Afghan nationality 

(or Afghan passport), with an IV code of SI6. 






Noncitizens: Aid Categories and MEDS Issues 

Aid categories The following chart contains the categories used to issue CalWORKs to 

families that include at least one noncitizen. These categories do not apply 

to refugee cases. For more information, refer to the Refugee section of this 

Chapter. 

If the family 

is… 

An All-Family 

A Two-Parent 

Family 

A Zero-Parent 

Family 

And… Then use aid 

code… 

All AU members are federally eligible 30 

All AU members are state-only eligible 3L 

At least one AU member is federally 

eligible and at least one is state-only 

3E 

eligible 


All AU members are state-only eligible 3M 



3U 

eligible 


All AU members are state-only eligible 3G 



eligible 

MEDS tracking Eligibility for all noncitizens, refugees, and citizen children of refugee parents 

is tracked in the MEDS system. 

MEDS coding 

for veterans 

For proper funding purposes, it is important that the following noncitizens are 

coded with the appropriate active military duty or veteran code: 

• Any noncitizen who is on active duty in a branch of the U.S. Armed Forces, 

or 

• A veteran of the U.S. Armed Forces, or 

• A spouse or dependent of an active duty service member, or 

• A spouse of a veteran. 


3H

S/O Exception: Refugee Cash Aid 

Three types of 

refugee cash 

aid 

Other aid for 

refugees 

What is refugee 

aid? 

There are three types of federally funded refugee cash aid: 

• The Refugee Resettlement Program (RRP) is cash aid for refugee 

families who are otherwise CalWORKs eligible 

• The Refugee Cash Assistance (RCA) program aids unaccompanied 

minor refugee children 

• The Refugee Cash Assistance (RCA) program aids refugees who are not 

otherwise CalWORKs eligible 

Refugees enter the U.S. with the support of a sponsor or a VOLuntary 

refugee assistance AGency known as a VOLAG. Refer to the Refugee help 

from other agencies block later in this Chapter for more information before 

you issue cash aid to a refugee. 

Special federal funding is available for refugees. Refugee aid funds: 

• Have very short time limits 

• Are separate from – but related to – CalWORKs 

• Must be carefully accounted for through the use of certain aid categories 

Although the funds for these cash grants come from the federal government, 

the aid must be sorted into separate funding streams and refugee funding 

must be tracked for discontinuance when the time limit runs out. 

Refugees otherwise eligible for CalWORKs cash aid may receive federally 

funded CalWORKs cash aid after the refugee aid time limit. 

In addition, eligibility rules are slightly different than for other CalWORKs 

recipients. Refer to the following sections for specific instructions for each of 

the three refugee aid programs. 


Identifying Refugees 

How to identify 

refugees 

People who are 

not refugees 

People admitted to the United States under the United States Citizenship and 

Immigration Services (USCIS) rules listed below are refugees according to 

the federal government and to the California Department of Social Services. 

Apply the refugee rules in this section of this handbook to these groups of 

people. Samples of the USCIS documents noted are given at the end of this 

Chapter. 

USCIS 

document 

I-94 

I-551 

ORR Letter 

dated 

10/22/96 or 

5/12/97 

Visa symbol or Admission Comments or class 

USCIS section status codes 

admission 

203(a)(7) Conditional entrant refugee 

207 RE 6,7,8,9 Conditional entrant refugee 

207(c) RE 6,7,8,9 Refugee 

208 AS 1,6,5,7 Granted asylum; considered 

a refugee 

212(d)(5) Paroled as a “refugee” or 

“asylee” reference on I-94 

AM1, 2,3,6,7, Amerasian, aided as refugee 


8,9 

CJF/HIAS • Privately funded Jewish 

refugee 

• Contact the agency 

listed on the document 

• Refer to “Refuges help 

from other agencies”, in 

this chapter 

AM 1,2,3,6,7, Amerasian, aided as refugee 

8,9 

AS6,7,8 

RE6,7,8 

IC6,7 

Refugee 

Kurdish or Iraqi asylees, 

aided as refugees 

The following people are not refugees and are aided according to general 

noncitizen eligibility rules. Look on the I-94 for the following notations: 

• Parolee • Paroled 

• Persian Gulf Evacuee • Political asylum applicant 

• Emergent reasons • Exclusionary hearing 

• Conditional entry • Entrant in the public interest 

• Humanitarian reasons

RRP: The Refugee Resettlement Program 

Introduction The Refugee Resettlement Program (RRP) is federally funded cash aid for 

refugees who would otherwise be eligible for a CalWORKs cash grant. 

The importance 

of using RRP 

funds 

Make sure to aid people eligible for RRP funds because it saves money 

available through the CalWORKs block of funds. 

The program is identical to the CalWORKs program with the exception of the 

time limit. 

The process Follow the steps below to correctly aid refugees with RRP funds. More 

information is given about each step later in this Chapter. 

Step Action 

1. Identify the RRP eligible refugee. Refer to the noncitizen 

identification information later in this chapter. 

2. Contact the sponsor or VOLAG to find out if the family receives 

another form of assistance. Refer to the Help from other agencies 

section later in this Chapter 

3. Determine eligibility and establish the AU according to CalWORKs 

rules. 

4. Determine refugee status of the children involved. The following 

children will be considered refugees: 

• Children born in the U.S. of refugee parents 

• Children born to a refugee and a U.S. citizen living with a 

refugee parent. 

5. Determine the eligibility period for RRP funds: 

• Refugees may be eligible for RRP aid for four months from the 

date they entered the U.S. 

• The month of entry is considered the first month. 


RCA for Unaccompanied Minor Refugees 

Introduction Refugee Cash Assistance (RCA) for unaccompanied minor refugees is 

federally funded cash assistance paid to a needy minor refugee child until the 

child reaches age 18. 

The program Eligibility is determined according to CalWORKs cash aid rules. 

Definition: 

unaccompanied 

minor 

refugee 

Noncitizen status is tracked in the MEDS system as for any eligible 

noncitizen. 

An unaccompanied minor refugee is a person who: 

• Is under age 18, and 

• Has no parents in the U.S., and 

• Entered the U.S. unaccompanied by and not destined to: 

− A parent, or 

− A close non-parent caretaker relative who is willing and able to care 

for the child, or 

− An adult with a clear, verifiable legal claim to custody of the minor. 

• Has been granted Special Immigrant Juvenile (SIJ) status by the 

Department of Homeland Security (DHS). 

The payee The payee for the RCA funds in an unaccompanied minor refugee case is 

normally a foster parent. 


RCA: Refugees Not Linked to CalWORKs 

The program Refugee Cash Assistance (RCA) funds are available to people not linked to 

the CalWORKs program through an eligible child. 

People not linked to the CalWORKs program cannot receive CalWORKs 

funds or RCA funds after the time limit has expired. 

Time Limits RCA funds are available for a maximum of eight (8) months, as follows: 

• Refugees may be eligible for RCA funds for 8 months from their Date of 

Entry (DOE) into the U.S. 

− The month of entry is considered the first month of potential eligibility. 

• Asylees may be eligible for RCA funds for 8 months from the date asylum 

was granted (effective 6/15/00). 

− The month asylum was granted is considered the first month of 

potential eligibility. 

Aid code The aid code for individuals eligible for RCA is 01. 



RCA: Refugees Not Linked to CalWORKs, continued 

The process Use the following instructions to issue RCA funds to a refugee not linked to 

the CalWORKs program: 

Step Action 

1 Identify the RCA eligible refugee with no deprived children. Refer 

to the noncitizen identification later in this chapter. 

2 Contact the sponsor or VOLAG to find out if the family receives 

any other form of assistance. Refer to the Help from Other 

Agencies section later in this Chapter. 

3 Establish the AU: 

• A single adult refugee is an AU of one person. 

• An emancipated minor refugee is an AU of one person. 

• A minor who is not emancipated must be aided through a 

caretaker payee. 

• Married couples are in the same AU. 

• Parents and their children under 18 years old are in the same 

AU. 

• Full time college students are ineligible. 

4 Determine eligibility according to CalWORKs rules. Refer to the 

“Welfare to Work rules” block in this section. 

5 Evaluate refugee status of the children involved. The following 

children will be considered refugees: 

• Children born in the U.S. to refugee parents 

• Children born to a refugee and a U.S. citizen living with a 

refugee parent 

6 Determine the eligibility period for RCA funds. 


Welfare to Work for RRP or RCA Recipients 

Welfare to 

Work rules 

Persons who qualify for Refugee Resettlement Program (RRP) or Refugee 

Cash Assistance (RCA) payments are subjected to the same Welfare to 

Work rules, as are people who qualify for CalWORKs. RRP and RCA 

recipients are evaluated by Employment Services for the following: 

• Initial eligibility after quitting a job 

• Good cause determinations 

• Exemption from Welfare to Work requirements 

• Registration with a work program 

Refer to the Work Requirements Chapter of this handbook for details. 


Refugee Help from Other Agencies 

Rules 

regarding help 

from other 

agencies 

Refugees enter the U.S. under the support of a sponsor or Voluntary Agency 

(VOLAG). Therefore: 

• Contact the sponsor or VOLAG before issuing cash aid. 

• Written consent from the refugee is not required to speak to the sponsor 

or VOLAG. 

• Written or verbal information about help from the VOLAG or sponsor is 

acceptable. 

• Tell the sponsor or VOLAG that the individual or family is requesting cash 

aid. 

• Find out if the individual or family is receiving any other type of 

assistance. 

• Find out if anyone in the family has declined any offer of employment with 

out good cause. 

• If information is obtained through telephone contact, document the 

contact thoroughly. 

The refugee refuses to provide 

information about the VOLAG or 

sponsor 

If… Then… 

The VOLAG or sponsor is unable or 

unwilling to meet the needs of the 

refugee 

The refugee is in an Immediate 

Need situation and the VOLAG or 

sponsor fails to respond to requests 

for information in a timely manner 

• Deny or discontinue cash 

assistance. 

• Document the refusal to provide 

information. 

Determine eligibility for RCA, RRP, 

or CalWORKs cash aid. 

Use the information provided by the 

refugee to determine eligibility for 

the appropriate aid program. 

Refer to the following pages to determine how assistance received from 

other sources will impact a refugee’s eligibility for RCA, RRP, or CalWORKs 

cash aid. 



Refugee Aid through a Voluntary Agency (VOLAG) 

Introduction A variety of humanitarian, political, religious, and ethnic organizations offer 

help to refugees voluntarily. Those organizations or agencies are referred to 

as Voluntary Agencies or VOLAGs. 

Conditional or 

unconditional 

assistance 

The impact on 

eligibility 

A VOLAG is responsible for meeting the needs for food, clothing, shelter, and 

transportation to job interviews and training during the refugee’s first 90 days 

in the United States. 

A number of refugees apply for aid during the first 90 days in the U.S. either 

because the refugee chooses not to accept VOLAG assistance or because 

VOLAG assistance does not meet all of their needs. 

When contacting a VOLAG about the assistance they provide, determine 

whether help is conditionally or unconditionally available: 

• Help is considered conditionally available when the refugee must meet 

certain conditions in order to receive the help. 

• Help is considered unconditionally available when the assistance is given 

to the refugee without limitations. 

• Money given to the refugee is usually considered unconditionally 

available. 

Help from a VOLAG can impact eligibility in the following ways: 


The refugee refuses to accept 

unconditional available income from 

the VOLAG 

The refugee refuses to accept 

conditionally available income from 

the VOLAG 

Needs are met through vendor 

payments 

Needs are met by giving the refugee 

cash 

Deny or discontinue RRP, RCA, or 


Eligibility for RRP, RCA, or 

CalWORKs cash aid is not affected. 

The assistance is not considered as 

income in the cash aid case. 

The assistance is considered 

income in the cash aid case. 


Voluntary Agency (VOLAG) List 

Names and 

addresses 

The following is a list of VOLAGs which serve as resettlement agencies for 

refugees, Cuban and Haitian entrants: 

Organization and Headquarters Local Member 

American Council of Nationalities Service 

(ACNS) 

95 Madison Avenue 

New York, NY 10016 

(212) 532-5858 

Church World Service (CWS) 

457 Riverside Drive 


(212) 870-3304 

Episcopal Migration Ministries (EMM) 

Episcopal Church Center 

815 Second Avenue 


(212)867-8400 

Hebrew Immigrant Aid Society (HIAS) 

200 Park Avenue South 


(212) 674-6800 

International Rescue Committee 

Bruce Whipple 

1833 West Eight Street – Suite 201 

Los Angeles, CA 90057 

(213) 412-2200 

Lutheran Immigration and Refugee Service 

360 Park Avenue South 


(212) 532-6350 

Tolstoy Foundation, Inc (TF) 

Michael Popov 

14553 Delano Street, Suite 211 

Van Nuys, CA 91411 

(818) 782-0420 

United States Catholic Conference (USCC) 

Catholic Charities, Mrs. Elizabeth Kirsnis 

Archdiocese Immigration and Refugee 

Division of Los Angeles 

1400 West 9 th Street 

Los Angeles, CA 90015-0095 

(213) 251-3465/ 3489 

World Relief Refugee Services (WRRS) 

P.O. Box WRC 

Nyack, NY 12096 

(914) 268-4135 

International Institute of Los Angeles 

435 South Boyle Avenue 

Los Angeles, CA 90033 

(213) 264-6210 

St. Anselm’s Immigrant and Refugee 

Community Center 

Garden Grove, CA 92644 

(714) 537-0608 

Diocese of Los Angeles 

St. Anselm’s Church 

13091 Galway Street 


(714) 537-0608 

Congregation Emanu-El 

3512 North E Street 


(909) 886-4818 

International Rescue Committee 

Alicia Cooper 

1801 West 17 th Street 

Santa Ana, CA 92706 

(714) 953-6912 

Lutheran Social Services 

Kathy Howe 

1345 South Burlington Avenue, Suite 204 

Los Angeles, CA 90006-5413 

(213) 385-2191 

None available 

Catholic Charities 

Brigitte Helmer 

1427-37 North La Cadena Drive 

Colton, CA 92324 

(909) 370-1488 / 1489 

World Relief 

Bob Chavez 

12852 Palm Street, Suite 205 


(714) 530-5474 


Sponsored Noncitizens – Overview 

Reference EAS 43-119 and 8CFR213 

Definitions Affidavit of support: An agreement to support a sponsored noncitizen. An 

affidavit of support is executed when a sponsor signs a Form I-864 (Affidavit 

of Support) and submits it to an Immigration or Consular official. 

Noncitizens 

involved 

Means-tested public benefit: Any Federal or State means-tested public 

benefits funded in whole or in part by Federal or State funds. Such benefits 

include: 

• TANF or CalWORKs 

• SSI 

• Medi-Cal 

• Child Care 

• CalFresh 

Sponsor: A person who either is eligible to execute or has executed an 

affidavit of support. 

Sponsored noncitizen: An immigrant on whose behalf a sponsor has 

executed an affidavit of support, including any spouse or child who will 

accompany or follow-to-join the sponsored noncitizen. 

The provisions of this section apply only to noncitizens: 

• Whose sponsor signed an I-864 Affidavit of Support, and 

• Who are sponsored by individuals and 

• Who do not meet one of the exemptions listed in the following block. 

Exemptions The following noncitizens are exempt from the rules of this section: 

• Refugees 

• Asylees 

• Cuban/Haitian entrants 

• Dependent children of the sponsor or the sponsor’s spouse. 



Sponsored Noncitizens - Overview, Continued 

Time limit Noncitizen sponsorship does not have a set time limit. The provisions of the 

sponsored noncitizen rules apply until the noncitizen: 

• Becomes a U.S. citizen; 

• Has worked 40 qualifying quarters or can be credited with such (for 

quarters beginning January 1, 1997 and later, if the noncitizen received 

any federal means-tested public benefit during a quarter, then that 

quarter would not qualify); 

• Leaves the United States permanently; or 

• Dies (or the sponsor dies). 

Forms The forms specific to sponsored noncitizens are listed in the table below. 

These forms are completed in addition all other required CalWORKs forms. 

See the specific Forms and Procedures Guides for more information. 

Form Title Use 

QR 22 Sponsored 

Noncitizens Applying 

For or Receiving 

Cash Aid and/or 

CalFresh 

QR 72 Sponsor’s Quarterly 

Income and 

Resources Report 

Used to obtain the sponsor’s income and 

resource information at application and 

Re-evaluation to determine the 

noncitizen’s eligibility. 

Used to obtain the sponsor’s income and 

resource information quarterly to 

determine the noncitizen’s eligibility. 


Sponsored Noncitizens – Identifying 

Reference EAS 43-119 

Identifying 

sponsored 

noncitizens 

The sponsored noncitizen rules apply when the following Visa symbols 

appear on the I-94 or I-551 cards from the United States Citizenship and 

Immigration Services (USCIS). 

A11, A12, A16, A17, A31, A32, A36, A37, A38 

B11, B12, B16, B17, B20, B21, B22, B23, B24, B25, B26, B27, B28, B29, B31, B32, B33, 

B36, B3, B38 

BX1, BX2, BX3, BX6, BX7, BX8 

C2-1, C2-2, C2-3, C4-1, C4-2, C20, C21, C22, C23, C24, C26, C27, C28, C29, C31, C32, 

C33, C36, C37, C38, C41, C42, C43, C46, C47, C48 

CF1, CF2 

CR1, CR2, CR6, CR7 

CX1, CX2, CX3, CX6, CX7, CX8 

E10, E11, E12, E13, E14, E15, E16, E17, E18, E19, E21, E22, E23, E26, E27, E28, E30, 

E31, E32, E34, E35, E36, E37, E39, E51, E52, E53, E56, E57 

ES1, ES6 

EW0, EW3, EW4, EW5, EW8, EW9, EW10 

F11, F12, F16, F17, F20, F21, F22, F23, F24, F25, F26, F27, F28, F-29 F31, F32, F33, F36, 

F37i, F38, F41, F42, F43, F46, F47, F48 

FX1, FX2, FX3, FX6, FX7, FX8 

HK1, HK2, HK3, HK6, HK7, HK8 

I51, I52, I53, I56, I57, I58 

IB1, IB2, IB3, IB6, IB7, IB8 

IF1, IF2 

IR1, IR2, IR3, IR4, IR5, IR6, IR7, IR8, IR9, IR0 

IW1, IW2, IW6, IW7 

LB1, LB2, LB6, LB7 

MR0, MR6, MR7, MR10 

NA3 

P1-1, P1-2, P2-1, P2-2, P2-3, P3-1, P3-2, P3-3, P4-1, P4-2, P4-3, P5-1, P5-2, P5-3, P6-1, 

P6-2, P6-3, P11, P12, P16, P17, P21, P22, P23, P26, P27, P28, P31, P32, P33, P36, P37, 

P38, P41, P42, P43, P46, P47, P48, P51, P52, P53, P56, P57, P58, P61, P62, P63, P66, 

P67, P68 

RN6, RN7 

SB1 

SD1, SD2, SD3, SD6, SD7 

SE-2, SE-3 

SF-2 

SG-2 

SH-2 

SJ-2 

SK1, SK2, SK-3, SK6, SK7, SK8, SK9 

SR1, SR2, SR3, SR6, SR7, SR8 

VI5 

XA, XA3 

XB 

XE3 

XF3 

XN3 

XR3 

Z2 

Note: When sponsorship is questionable, the Eligibility Worker will submit 

forms G-845S, Document Verification Request and G-845 Supplement, 

Document Verification Request Supplement, to USCIS to verify sponsorship. 


Sponsored Noncitizens – Determining Eligibility 

Reference EAS 40-181.25, 42-205.5, 43-119, and 44-133.7 

Conditions of 

Eligibility 

Whose income 

and resources 

are deemed? 

As a condition of eligibility, the sponsored noncitizen is responsible: 

• To provide information and documentation concerning his/her sponsor’s 

income and property necessary to make a determination of eligibility. 

− When a sponsored noncitizen is unwilling to provide the necessary 

information regarding his/her sponsor or when the information 

provided is not acceptable, the sponsored noncitizen is ineligible. 

• To obtain from his/her sponsor the cooperation necessary to make a 

determination of income and property eligibility. 

• To comply with reporting requirements by providing a complete QR 72 

with each QR 7. 

All the income and resources of the sponsor and the sponsor’s spouse (if 

living with the sponsor) who are not receiving CalWORKs, SSI, or other 

public cash assistance (such as General Relief) shall be deemed to be the 

income and resources of the sponsored noncitizen. 



Sponsored Noncitizens – Determining Eligibility, Continued 

Deeming 

sponsor’s 

resources 

The resources of the noncitizen’s sponsor and the resources of the sponsor’s 

spouse who lives with the sponsor shall be deemed to the sponsored 

noncitizen’s resources. Follow the chart below to determine the amount of 

resources to deem to the noncitizen. 

Step Action 

1 Determine the total value of real and personal property of the 

sponsor and the sponsor’s spouse according to CalWORKs 

resource evaluation methods (as if the sponsor and spouse were 

applying for aid). See the Resources Chapter of this handbook. 

2 Divide the amount determined in Step 1 by the number of 

sponsored noncitizens receiving CalWORKs cash aid, which is: 

• The number of sponsored noncitizens in the applicant’s or 

recipient’s AU, plus 

• The number of noncitizens receiving CalWORKs the sponsor 

sponsors in addition to those in the applicant’s or recipient’s 

AU. 

3 The amount determined in Step 2 is deemed to be the resources 

of each applicant or recipient who is a sponsored noncitizen of 

that sponsor. 

The resources determined in Step 3 shall not be considered as resources of 

other applicants or recipients in the family who are not sponsored 

noncitizens, unless such resources are actually available to the other 

persons. For example, the sponsor established a trust fund available to meet 

the current needs of the family. 



Sponsored Noncitizens – Determining Eligibility, Continued 

Deeming 

sponsor’s 

income 

When a noncitizen is sponsored by an individual who is not receiving cash 

aid, SSI, or other public cash assistance payment, the income of that 

individual and his/her spouse shall be deemed to be the sponsored 

noncitizen’s income. The income is determined as follows: 

Step Action 

1 Determine the total amount of unearned income of the sponsor 

and his/her spouse. 

2 Determine the total amount of earned income and/or net selfemployment 

received by the sponsor and his/her spouse (See 

Note 1). 

3 Determine the sponsor’s total gross income by adding the 

amounts from Step 1 and Step 2. 

4 Divide the amount from Step 3 by the total number of sponsored 

noncitizens the sponsor sponsors who are applying for or 

receiving cash aid. 

5 The amount from Step 4 shall be deemed to be the income of 

each applicant or recipient who is a sponsored noncitizen and is 

treated as unearned income (See Note 2). 

Notes: 

1. If the sponsor is either an excluded parent or stepparent, his/her income 

shall be treated in accordance with the excluded parent or stepparent 

deeming computation. 

2. When the sponsored noncitizen is not included in the AU, the portion of 

his/her income deemed from the sponsor shall not be used in 

determining his/her contribution unless such income is actually available 

to the AU. 


Sponsored Noncitizens – Exemptions to Deeming 

Introduction Sponsored noncitizens can be exempt from income and resource deeming 

due to indigence, battery or cruelty. This section explains what the 

exemptions are, how to identify them, and the time limit for each. 

Reference EAS 43-119.22 and 43-119.3 

Indigence 

exemption 

If the County determines a sponsored noncitizen will go hungry and 

homeless without aid, the sponsored noncitizen is determined to be indigent. 

See exemption below. 

Exemption The amount of income and resources of the sponsor or the sponsor’s spouse 

attributed to the sponsored noncitizen shall not exceed the amount actually 

provided by the sponsor or the sponsor’s spouse. 

Time limit This exception applies for a period beginning on the date of the indigence 

determination is made and ending 12 months from that date. This exception 

is granted once in a lifetime. 

Sponsor’s 

information not 

available 

When the sponsored noncitizen is unable to provide the necessary 

information regarding their sponsor, the County cannot establish contact with 

the sponsor, and it is determined the sponsored noncitizen would go hungry 

and homeless without aid, the sponsored noncitizen is ruled indigent. 



Sponsored Noncitizens – Exemptions to Deeming, Continued 

Battery or 

Cruelty 

Exemption 

For application of this exemption, there must be a substantial connection 

between the battery or extreme cruelty and the need for aid (see the 

“Determining substantial connection” block in this section). This exemption 

shall not apply to a noncitizen during any period in which the individual 

responsible for such battery or cruelty resides in the same household as the 

individual who was subjected to the battery or cruelty. 

Exemption The noncitizen shall be exempt from income and resource deeming in the 

following circumstances: 

If the abused 

is … 

A noncitizen 

or the parent 

of a noncitizen 

child 

A child of a 

noncitizen 

And … By … 

The noncitizen or 

parent demonstrates 

he/she has been 

battered or subjected 

to extreme cruelty in 

the United States 

The noncitizen child 

has been battered or 

subject to extreme 

cruelty in the United 

States 

• A spouse, or 

• Parent, or 

• Member of the spouse or 

parent’s family who are 

residing in the same home as 

the noncitizen, 

AND the spouse or parent 

consented to or acquiesced to the 

battery or cruelty. 

• The spouse, or 

• Parent, or 

• Family member of the 

noncitizen, 

WITHOUT the active participation 

of the noncitizen in the battery or 

cruelty. 

Time limit This exemption is for a 12-month period. The exemption can continue 

beyond the 12 months, for the batterer’s income and resources only (if the 

batterer’s income would normally be deemed to the noncitizen), if the 

noncitizen demonstrates the battery or cruelty has been recognized in: 

• An order of a judge, 

• An order of an administrative law judge, or 

• A prior determination of the USCIS. 



Sponsored Noncitizens – Exemptions to Deeming, Continued 

Determining 

substantial 

connection 

The U.S. Attorney General has issued guidance for making the determination 

of substantial connection between battery/cruelty and the need for aid. 

Below are a list of examples to assist in making the connection determination 

between battery and extreme cruelty and the need for aid. 

When aid is needed: 

• To enable the applicant, the applicant’s child, and/or (in the case of a 

noncitizen child) the applicant’s parent to become self-sufficient following 

separation from the abuser. 

• To enable the applicant, the applicant’s child, and/or (in the case of a 

noncitizen child) the applicant’s parent to escape the abuser and/or the 

community in which the abuser lives, or to ensure the safety of the 

applicant, the applicant’s child, or the applicant parent from the abuser. 

• Due to a loss of financial support resulting from the applicant’s, his/her 

child’s, and/or his/her parent’s separation from the abuser. 

• Because, as the result of battery or extreme cruelty, the applicant loses 

his/her job, earns less, or is required to leave his/her job for safety 

reasons. Results of battery/extreme cruelty include: separation from the 

abuser, work absences, low job performance resulting from the battery or 

extreme cruelty, or from legal procedures relating to it (child support, 

child custody, and divorce actions). 

• Because the applicant, applicant’s child, or parent of noncitizen child 

requires medical attention or mental health counseling, or has become 

disabled, as a result of the battery or extreme cruelty. 

• Because the loss of a dwelling or source of income or fear of the abuser 

following separation jeopardizes the applicant or parent of the noncitizen 

child to care for his or her children. 

− This includes the inability to house, feed, or clothe the children or to 

put the children into a day care for fear of being found by the abuser. 

• To alleviate nutritional risks or need resulting from the abuse or following 

separation from the abuser. 

• To provide medical care during a pregnancy resulting from the abuser’s 

sexual assault or abuse of, or relationship with the applicant, the 

applicant’s child, and/or the parent of the noncitizen child; and/or to care 

for the resulting children. 

OR 

• When medical coverage and/or health care services are needed to 

replace medical coverage or health care services the applicant had when 

living with the abuser. 


Battered Noncitizens 

Overview Certain noncitizens that would not otherwise be considered qualified 

noncitizens as defined at the beginning of this Chapter may meet the 

definition of a qualified noncitizen if the noncitizen was subjected to extreme 

cruelty by a spouse, parent, or family members of the spouse or parent. 

The eligibility 

determination 

The battered noncitizens who would otherwise not be considered a qualified 

noncitizens can receive state funded cash aid only if: 

• They meet the criteria given in the table below, and 

• They no longer live with the batterer. 

A noncitizen who is not otherwise a qualified noncitizen may be eligible to 

state funded CalWORKs cash aid on the basis of being a target of battery or 

cruelty if they meet all four of the conditions below. 

If any one of the conditions does not exist, evaluate eligibility for state-only 

CalWORKs cash based on general noncitizen eligibility rules. 

1. 

Condition 

Establish that the noncitizen has been approved or has a petition 

pending under one of the following sections of the INA: 

204(a)(1)(A)(i) 204(a)(1)(B)(i) 

204(a)(1)(A)(ii) 204(a)(1)(B)(ii) 

204(a)(1)(A)(iii) 204(a)(1)(B)(iii) 

204(a)(1)(A(iv) 

204(A)(b)(2) 

204(a)(3) before 4/1/97 

2 Determine that the noncitizen or his or her child or parent has 

been battered or subjected to extreme cruelty. A copy of a law 

enforcement report is desirable but the individual’s statement is 

acceptable. 

3 Establish that the battery is the cause of the need for benefits. 

4 Establish that the battered individuals no longer live with the 

batterer. 



Battered Noncitizens, Continued 

USCIS Case 

Status Online 

Service 

Internet 

address 

The USCIS Case Status Online Service is an online service available to 

assist Eligibility Workers (EWs) in determining CalWORKs eligibility for 

battered noncitizens. EWs can check the status of a customers USCIS case 

over the internet if the customer has an approved petition or a deferred 

action decision from the USCIS. 

The USCIS Case Status Online Service is located on the internet at 

http://www.uscis.gov. In addition to the online service, EWs can call 

(800) 375-5283 toll free for automated case status assistance. 

Online process To access a customer’s USCIS case status via the Case Status Online 

Service: 

• Locate the receipt number found on the forms provided to the customer 

by the USCIS 

• Enter this number on the Case Status Search Page. 

PDD assistance District Managers (DMs) may contact the Program Development Division 

(PDD) if assistance is required in determining battered noncitizen eligibility. 



or Other Serious Crimes 

Introduction Non-citizens who are victims of trafficking, domestic violence, and other 

serious crimes may be eligible to state-funded cash assistance and other 

services equivalent to those available to refugees including, but not limited 

to, Refugee Cash Assistance (RCA) and CalWORKs. 

The Trafficking and Crime Victims Assistance Program (TCVAP) provides 

state-funded cash assistance to non-citizen customers who are victims of 

human trafficking, domestic violence or other serious crimes but have not 

been certified by the Office of Refugee Resettlement (ORR). Cash 

assistance is paid: 

• While the customer is awaiting ORR certification or approval of his or her 

application for a T Visa or U Visa from the United States Citizenship and 

Immigration Services (USCIS), or 

• To customers who have received a U Visa. 

The customer must be determined a victim of a severe form of human 

trafficking, domestic violence or other serious crime to be eligible to cash 

assistance. Issuance of a T Visa will give these customers eligibility to 

federally-funded cash assistance. Customers obtaining a U Visa are not 

eligible to federally-funded cash assistance. 

Note: Eligibility Workers (EWs) can no longer accept U Visa Interim Relief 

applications filed after October 17, 2007 as documentation. 




or Other Serious Crimes, Continued 

Definitions The following terms and definitions are found in this section: 

Severe forms of human trafficking is defined as: 

• Sex trafficking in which a commercial sex act is induced by force, fraud, 

or coercion, or in which the person induced to perform such act has not 

attained 18 years of age, or 

• The recruitment, harboring, transportation, provision, or obtaining of a 

person for labor or services, through the use of force, fraud, or coercion 

for the purpose of subjection to involuntary servitude, peonage, debt 

bondage, or slavery. 

Non-citizen victims of serious crimes is defined as victims who: 

• Have suffered substantial physical or mental abuse as a result of having 

been victims of criminal activity involving, or similar to, violations such as, 

but not limited to: Rape, torture, trafficking, incest, domestic violence, 

being held hostage, slave trade, kidnapping, abduction, unlawful criminal 

restraint, or false imprisonment, 

• Possess information concerning criminal activity (or in the case of a noncitizen 

child under the age of 16, the parent, guardian, or adult 

representing the child), and 

• Have been helpful, are being helpful, or are likely to be helpful to a 

federal, state, or local law enforcement official, prosecutor, or judge or to 

other federal, state, or local authorities investigating or prosecuting 

criminal activities described above. 





Determination 

of trafficking 

status 

The EW may accept a sworn statement from the customer (or a 

representative if the customer is not able to competently make a sworn 

statement) declaring that s/he is a victim of human trafficking if at least one 

item of additional evidence is provided, including, but not limited to: 

• Police, government agency, or court records or files, 

• News articles, 

• Documentation from a social services, trafficking, or domestic violence 

program, or a legal, clinical, medical, or other professional from whom 

the customer has sought assistance in dealing with the crime, 

• A statement from any other individual with knowledge of the 

circumstances that provided the basis for the claim, 

• Physical evidence, 

• A copy of a completed visa application, or 

• Written notice from USCIS of receipt of the T Visa Application. 

If the customer cannot provide additional evidence, the sworn statement 

shall be sufficient if the EW makes a determination and Journals in the case 

record that the customer is credible according to current county policy. 

Once the EW determines that the customer meets the definition of a 

trafficking victim, the EW must verify that the customer: 

• Has filed an application for a T Visa with USCIS, 

• Is preparing to file an application for a T Visa, or 

• Is otherwise taking steps to meet the eligibility conditions for federal 

benefits. 

Case flags Victim of Human Trafficking or Other Serious Crime case flags must be set 

on CalWORKs cases for: 

• Noncitizen victims of human trafficking, 

• Domestic violence, or 

• Other serious crime customers. 

Note: Case flag is named Victim of Human Trafficking or Other Serious 

Crime. 





Acceptable 

documentation 

for T Visa 

applications 

Eligibility 

determination 

for victims of 

human 

trafficking 

Termination of 

state-funded 

cash 

assistance for 

victims of 

human 

trafficking 

The following documents can be used in determining whether the customer 

has filed, or is preparing to file, for a T Visa: 

• A confirmation receipt or letter from USCIS verifying an application for a 

T Visa has been filed, 

• A copy of the application for a T Visa (I-914), or 

• Statements from persons in official capacities (e.g., law enforcement 

officials or victims advocates) who have assisted or are assisting the 

customer with the T Visa Application. 

If no documentation is available, the customer’s statement that s/he has filed 

or intends to apply for a T Visa will be acceptable. 

The steps the EW will take when determining eligibility of noncitizens who 

are victims of human trafficking are summarized in the following table: 

Step Action 

1 Determine if the customer is a victim of human trafficking. 

2 Verify the customer has taken steps to meet eligibility conditions 

for federal benefits. 

If the customer has… Then… 

Taken the required steps, Approve the application for 

cash assistance, if all other 

eligibility conditions are met. 

Not taken the required steps, Deny the application for cash 

assistance. 

Once eligibility for state-funded cash assistance has been granted, it will be 

terminated if: 

• The customer’s application for a visa has been denied, 

• The customer has not applied for a T Visa within one year of applying for 

state-funded cash assistance, 

• A request by law enforcement officers on behalf of the customer for 

federal presence status has not been made within one year, or 

• The recipient is certified by the U.S. Department of Health and Human 

Services, ORR, resulting in federal eligibility. 





Domestic 

violence and 

other serious 

crime victims 

Acceptable 

documentation 

for U Visa 

Interim Relief 

or U Visa 

Non-citizen victims of domestic violence or other serious crime may be 

eligible to state-funded services when: 

• A request with USCIS for a U Visa has been filed, or 

• A U Visa has been granted. 

Note: If a U Visa is granted, the non-citizen customer may receive 

state-funded cash assistance for the duration of program time limits. 

The EW must verify that an application for a U Visa has been filed when 

determining potential eligibility for customers applying as a victim of domestic 

violence or other serious crimes. New applicants must present evidence they 

have filed for a U Visa (or have obtained one) if they do not have proof they 

filed for U Visa Interim Relief before October 17, 2007. Acceptable 

documentation of the request may include, but is not limited to: 

• A Notice of Action (Form I-797) approving U Visa Interim Relief based on 

a request filed prior to October 17, 2007; or 

• A confirmation receipt or letter from USCIS verifying that a request for U 

Visa Interim Relief was filed prior to October 17, 2007; or 

• A Form I-797 which serves as a fee receipt for an employment 

authorization request based on a request for U Visa Interim Relief filed 

prior to October 17, 2007; or 

• A confirmation receipt or letter from USCIS verifying that a Petition for U 

Nonimmigrant Status (Form I-918) has been filed (Form I-918 available 

for download at: http://www.uscis.gov/files/form/I-918.pdf); or 

• A Form I-797 approving a U Visa; or 

• A Form I-797 which serves as a fee receipt for an employment 

authorization request based on a U Visa application; or 

• A completed copy of Form I-918. If the only available evidence is the 

completed copy of the I0918, the applicant must provide, within a 

reasonable time, verification from USCIS that it was submitted; or 

• An employment Authorization Document (EAD) issued under Category 

“A19” or “A20” for an approved U Visa petitioner. 





Existing U Visa 

Interim Relief 

cases 

USCIS has indicated that petitioners who have previously been granted 

interim relief and have filed a Form I-918 for a U Visa will have their interim 

relief extended until USCIS completes its adjudication of the application. 

Therefore, cases determined eligible based on a request for U Visa Interim 

Relief prior to October 17, 2007 may remain eligible if a: 

• U Visa application has been filed, 

• U Visa has been issued, or 

• Denial of interim relief has been issued. 

When discussing elements of the new rule with recipients, EWs will not 

provide advice that may be legal in nature. EWs may suggest to recipients 

they consult: 

• An immigration attorney, 

• A legal aid representative, or 

• Other appropriate party for assistance in applying for a U Visa. 

Time limits Benefits granted to noncitizen victims of human trafficking, domestic violence 

or other serious crimes are subject to the time limits of the programs. 

Eligibility 

determination 

Termination of 

cash 

assistance 

SSN 

requirement 

Example: An eligible adult with no children will not be eligible for 

CalWORKs, but could be granted TCVAP up to the maximum eight-month 

period, consistent with the Refugee Cash Assistance (RCA) program rules. 

An adult applicant with a child eligible for CalWORKs would receive statefunded 

benefits for up to 60 months to the extent s/he is eligible, consistent 

with CalWORKs program rules. 

Once the EW has verified the customer has filed for a U Visa, or a U Visa 

has been granted, the application for cash assistance will be approved if all 

other eligibility conditions are met. 

Once eligibility for state-funded cash assistance is granted, it will be 

terminated if the customer’s application for a U Visa has been denied. 

Customers applying for state-funded cash assistance as noncitizen victims of 

human trafficking, domestic violence or other serious crimes may not 

possess Social Security Numbers (SSNs). The provision of SSNs as a 

condition of eligibility is a federally-funded Temporary Assistance for Needy 

Families (TANF) requirement. Customers are not required to provide or 

apply for SSNs as a condition of eligibility for state-funded CalWORKs. 


Noncitizen Child Victims of Human Trafficking 

Introduction This section provides information regarding the eligibility of noncitizen 

children who are victims of a severe form of trafficking to benefits and 

services under the Trafficking Victims Protection Act (TVPA) of 2000. 

Eligibility Letter The TVPA provides eligibility for federally funded cash benefits to the same 

extent as refugees to noncitizen children under 18 years of age who have 

been subjected to a severe form of trafficking. The Office of Refugee 

Resettlement (ORR) will issue an “Eligibility Letter” for the child stating that 

he/she is a victim of a severe form of trafficking. 

Validation of 

trafficking 

status 

Program 

determination 

In certain situations, an “Interim Assistance Letter” is issued by ORR to 

provide federally funded cash assistance for 90-days for a child while a 

determination is made as to whether the child is eligible for benefits and 

services as a victim of a severe form of trafficking. The table below explains 

what action to take when ORR makes an eligibility determination. 

If ORR determines the child is… Then… 

Eligible to services as a victim of a Continue federally funded cash 

severe form of trafficking, 

assistance for the child. 

Not eligible to services as a victim of a 

severe form of trafficking, 

Discontinue assistance for the child. 

Eligibility Workers (EWs) will take the following action when presented with 

an original ORR Eligibility Letter. 

Step Action 

1 Accept the original ORR Eligibility Letter. 

2 Call the ORR trafficking verification phone number (listed in the body of 

the certification letter) to: 

• Confirm the validity of the letter, and 

• Notify ORR of the benefits for which are being applied. 

3 Use the eligibility date stated in the body of the letter as the date of entry. 

4 Image the ORR Eligibility Letter into C-IV. 

Program determination for a noncitizen child with an ORR Eligibility Letter will 

be determined as follows: 

If the child is… Then… 

An unaccompanied minor, Complete a referral to Foster Care. 

With a parent or non-parent Evaluate for eligibility under the Refugee 

caretaker relative, 

Resettlement Program (RRP) or Refugee 

Cash Assistance (RCA) (see the “S/O 

Exception: Refugee Cash Aid” section of this 

handbook chapter). 


Jay Treaty Indians 

Introduction Members of the Jay tribe are North American Indians born in Canada who 

have at least 50% Indian blood. 

The Jay Treaty The Jay Treaty between Jay tribal members and the U.S. Government states 

these Indians are considered to be noncitizens with permanent U.S. 

residence status without having to apply to the USCIS for that status. 

Verification Documentation of Jay tribal membership and legal permanent resident status 

in the U.S. includes: 

• A record of birth certifying that a Canadian born person is of 50% Indian 

blood, or 

• Affidavits from tribal officials certifying the above information, or 

• Other credible proof of the above information. 

Federal vs. 

state-only 

eligibility 

As with other qualified noncitizens, eligibility for federal funds for Jay Treaty 

Indians depends upon when the person arrived in the United States and 

whether or not they meet one of the exceptions to the state-only rule. 


Ineligible Noncitizens 

Ineligibility 

based on 

noncitizen 

status 

The following people are ineligible for cash aid: 

• Noncitizens without an original document from the USCIS to prove their 

status in the United States 

• A noncitizen whose only documentation from the USCIS has expired, and 

the noncitizen is not eligible based on the chart in the “Noncitizen expired 

verification table” block in this Chapter. 

• A noncitizen whose only document is a visitor’s visa 

• A noncitizen whose only document is a foreign passport 

• A noncitizen whose passport or I-94 card is stamped “Employment 

Authorization”. If the I-94 is stamped “processed for I-551”, the 

noncitizen may be eligible if any expiration date given has not passed 

Refer to the chart below for other ineligible noncitizens. 

USCIS Class or INA 

Comments 

document 

section 

I-94 Section 242(b) Signifies “indefinite voluntary 

departure” 

I-94 with Visa Section 

These are given to visitors, 

symbols 101(a)(15)(A) temporary workers, noncitizens in 

through (M) 

Class codes: 

A-1, 2, or 3 

B-1, B-1/B-2 

C-1, 2, or 3 

D 

E-1 or 2 

G-1, 2, 3, 4, 5 

H-1, 1A, 1B, 2, 2A, 

2B, 3, or 4 

I 

J-1 or 2 

K-1 or 2 

L-1 or 2 

M-1 or 2 

N-1, 2, 8, or 9 

O-1, 2, or 3 

P-1, 2, 3, or 4 

Q-1 or 2 

R-1 or 2 

transit and to those with temporary 

residence in the U.S. 

I-181A Indicates an application for 

permanent status was submitted 

I-688 A Sections 210, 210A, 

or 245A 

These are temporary workers 

I-689 Fee receipt only 

I-688B Employment authorization only 

I-766 Employment authorization only 

I-797 USCIS Notice of Action – approval 

for voluntary departure under the 

Family Unity Program for amnesty 

aliens (noncitizens) 


The California Assistance Program for Immigrants (CAPI) 

Introduction The Cash Assistance Program for Immigrants (CAPI) is a 100% state funded 

cash aid program that may aid certain legal permanent resident noncitizens 

in California who are ineligible to federal Supplemental Security Income (SSI) 

solely due to their immigrant status. 

CAPI ineligibles The following people are not eligible for CAPI: 

CAPI 

applications 

Administering 

CAPI 

• U.S. citizens 

• Undocumented immigrants 

• Immigrants eligible for other state or federally funded cash benefits 

• Immigrants denied SSI for a reason other than immigrant status 

• Immigrants other than sponsored aliens who entered the U.S. on or after 

August 22, 1996 

When an immigrant requests a CAPI application, complete the following 

action to initiate the application process: 

If the request is received… Then the Transitional Assistance 

Department (TAD) staff will… 

• By telephone, or 

Refer the caller to the CAPI 

• In person, 

telephone line at (909) 458-9571. 

• By mail in a letter, or 

Fax the request to the CAPI fax line 

• with the QR 7, 

at (909) 458-9507. 

A specialized worker at the Ontario TAD District #75 office accepts and 

processes applications for CAPI. The same worker is assigned the 

continuing cases and determines on-going eligibility for the program. 

The Eligibility Worker’s name and telephone number can be found on the 

Ontario TAD District #75 telephone list. Please direct any questions 

regarding the CAPI program to the CAPI worker. 

CAPI aid codes Recipients of CAPI are aided on one of the following aid codes: 

If the noncitizen status is… Then the aid code is… 

Qualified noncitizen 1A 

Non-qualified noncitizen 6K 

Sponsored noncitizen 6M 

Extended CAPI 6T 




CHAPTER 7 

Work Requirements 

Overview ......................................................................................................................7-1 

The "Work First" Culture...............................................................................................7-2 

Overview of Programs..................................................................................................7-3 

Welfare-to Work (WTW) Participation ..........................................................................7-4 

Exemption from Participation .......................................................................................7-8 

Exemption Reasons .....................................................................................................7-9 

Administering the Program.........................................................................................7-14 

Introduction to the Work Participation Rate (WPR)....................................................7-15 

Initiating Participation .................................................................................................7-17 

Acting on Changes During Participation ....................................................................7-18 

Sanctions ...................................................................................................................7-19 

Sanction Procedures..................................................................................................7-21 

Sanction Appeals .......................................................................................................7-23 

Other Actions Related to Sanctions ...........................................................................7-24 

Cooperation After a Sanction .....................................................................................7-27 

California Indian Manpower Consortium, Inc. (CIMC)................................................7-29 

CIMC Registration Procedures ..................................................................................7-30 

CIMC Participating Tribes and Service Areas............................................................7-31 




MARCH 8, 2013 

SUBJECT: Young Child Exemptions (YCEs), New Welfare-to-Work (WTW) 

Regulations 

DISTRIBUTION: ESP, CalWORKs, 

QRU, Child Care, 

TAD Office 

Procedures, CSC 

FILE: ESPHB – In Front Handbook 

CWPHB – In Front of Chapter 7 

QRUHB – In Front of Chapter D 

CCPHB – In Front of Handbook 

TOPHB – In Front of Handbook 

CSCHB – In Front of Handbook 

REFERENCE: SB 1041, ACL #12-53, 

#12-53E, #12-67, #12-69, 

#12-72, #13-01, #13-02 

OBSOLETE: When Handbook Material is 

Updated 

Overview This Interim Instruction Notice (IIN) contains information regarding 

CalWORKs Welfare-to-Work (WTW) short term exemptions ending 12/31/12 

and new regulations/exemption effective 1/1/13, created by Senate Bill (SB) 

1041, including: 

Expiration of the following short-term Young Child Exemptions (YCEs): 

One child is between the ages of 12 to 23 months (last day of the 23 rd 

month). 

Two or more children are under six (6) years of age. 

Granting Good Cause – Lack of Supportive Services, which currently 

stops the CalWORKs time clock for subsequent children from age 

birth -11 months (last day of the 11 th month). 

New regulations/exemption: 

State participation hours match Federal participation hours of 

85/128/150 monthly, 20/30/35 weekly. 

County monthly hours of participation have been revised to 

85/128/150 hours per month. 

Elimination of Priority Approach 

Birth to 23 month (last day of the 23 rd month) exemption. 

WTW 24-Month Time Clock, within the CalWORKs 48-Month Time 

Limit. 

New Processes: 

YCE Reengagement Process (for expired short-term YCEs) 

New WTW 2 (within C-IV) 

Although the YCEs expire on 12/31/12, counties have two years to reengage 

customers if the exemption still applies. 


IIN #12-075 ERRATA (03/13) DM:BB:kc PAGE 1 OF 25


Effective date This policy is effective 1/1/13. These changes require information to be 

released in phases; therefore, IINs will be issued in phases. 

YCE reasons 

no longer used 

by Eligibility 

Workers (EW) 

and 

Employment 


Specialists 

(ESS) 

Beginning 1/1/13 Eligibility Workers (EWs) and Employment Services 

Specialists (ESSs) will not use the following expired exempt status reasons: 

One child is between the ages of 12 to 23 months. 

Two or more children under six years of age. 

The CalWORKs 48-Month Time Limit will remain stopped until the customer 

has been reengaged and becomes a mandatory participant. 

Beginning 1/1/13, the Good Cause – Lack of Supportive Services reason will 

still be available; however, it will not stop the CalWORKs 48-Month Time 

Limit. 

EWs and ESSs will not use the Good Cause – Lack of Supportive Service 

reason for YCE customers with a child between birth and 11 months 

beginning 1/1/13. 

Contents This IIN contains the following topics: 


Hours of Participation 3 

Young Child Exemptions (YCEs) 4 

Reengagement Requirements 7 

Young Child Exemption (YCE) Reengagement Process 11 

WTW 2 – WTW Activity Plan Assignment 14 

WTW 24-Month Time Clock 15 

Exempt Volunteers 22 

Inter-County Transfer (ICT) Process 23 

WTW 24-Month Time Clock and CalWORKs 48-Month 

Time Limit – Clock Stoppers 

24 


Hours of Participation 

State 

participation 

hours 

Participation 

hours 

Current priority 

approach 

Effective 1/1/13, new hours of participation for the state will match current 

federal hours of participation: 85/128/150 hours per month, 20/30/35 hours 

per week. 

Household Composition Monthly/Weekly Hours 

Single adult with a child under 6 years old 85 monthly/20 weekly 

Single adult with no children under 6 years old, or 128 monthly/30 weekly 

All Families 

Two-parent families 150 monthly/35 weekly 

Effective 1/1/13, the monthly hours of participation have been revised to 

85/128/150 hours per month. This still equates to 20/30/35 hours per week 

when divided by 4.33 and rounded to the nearest whole number. The 

Employment Services Specialist (ESS) will not begin the noncompliance 

process if a customer meets monthly hours of participation, either state or 

federal. 

The current priority approach no longer applies because state hours now 

mirror federal hours of participation. 

Customers now have the opportunity to be engaged in a wide array of 

activities on a case-by-case, individualized basis; based on their assessment 

results. The ESS will assist customers to utilize the new Welfare-to-Work 

(WTW) 24-Month Time Clock to best suit each customer’s current needs. 

Work Participation Rate (WPR) is the ultimate goal; however, customers 

must be allowed to participate in all available, appropriate activities that align 

with their assessment results and needs. 

Example: If a customer is meeting federal core hours of participation with 

employment and currently has no barriers to overcome, the ESS will develop 

a Welfare-to-Work (WTW) plan (WTW 2) that reflects this fact. The ESS will: 

Counsel and guide each customer to what is most beneficial for that 

particular customer. 

Review each customer’s CalWORKs Time Limit Clock to determine how 

much time is left on his/her CalWORKs 48-Month Time Limit. 

Discuss all options with the customer, including: 

New WTW regulations, 

Review exemption criteria (if they qualify), and 

Develop a WTW 2 that benefits the customer while encouraging 

him/her to meet federal WPR if it will be most beneficial; this will 

preserve time on the customer’s WTW 24-Month Time Clock that 

he/she may need at a later date to remove barriers that may arise. 

In some circumstances, customers may not meet federal WPR. 



Young Child Exemptions (YCEs) 

Introduction This section contains information on all current Young Child 

Exemptions (YCEs). 

Birth to 23 

month 

exemption 

Birth to 23 

month 

exemption and 



or rescind 


birth to 23 

month 

exemption 

The new birth to 23 month (last day of the 23 rd month, which is the month 

prior to the child turning 2 years old) exemption is effective 1/1/13. This 

request should be documented with the CW 2186A and a Journal entry. 

Customers must be informed of the following: 

This exemption stops both the Welfare-to-Work (WTW) 24-Month Time 

Clock and the CalWORKs 48-Month Time Limit. 

This is a once-in-a-lifetime, customer choice exemption. 

The aided parent or needy caretaker relative must have primary 

responsibility for personally providing care to the child. 

The Employment Services Specialist (ESS) will communicate with the 

customer by asking who has primary responsibility for personally 

providing care to the child(ren), and document the answer in a 

Journal entry. 

This exemption includes a Maximum Family Grant (MFG) or Social 

Security Income (SSI) child in the cash aid Assistance Unit (AU). 

C-IV will not have this new exemption programmed into the system by the 

effective date. ESSs will use the exemption reason of “60 years of age or 

older” for customers choosing this exemption and Journal the action taken. 

Note: No YCE customers will be placed in this exemption reason unless the 

customer chooses the new birth to 23 month exemption. Customers who are 

truly exempt for the reason of “60 years of age or older” may continue to 

be placed in this exemption reason. 

If a customer was exempt for a child birth to 23 months and his/her 

CalWORKs is discontinued, the customer will not receive this exemption 

again if he/she reapplies for aid. This is a once-in-a-lifetime exemption. 

If a customer’s case is rescinded, he/she can continue in this exemption if 

he/she chooses to do so. If the customer chooses not to continue in this 

exemption and to become a mandatory participant, the exemption will be 

considered exhausted as this is a once-in-a-lifetime exemption. 

The following is an example of the birth to 23 month exemption: 

Jane, a single custodial parent has a child who is 15 months old. The ESS 

explains to her that she only has eight months left of the birth to 23 month 

exemption, and that this is a once-in-a-lifetime, customer choice exemption. 

Jane chooses to not utilize this exemption at this time and to fully participate 

in her prescribed activities (per her WTW 2) for the required 85 hours per 

month/20 hours per week. The ESS Journals the customer’s decision to not 

use the birth to 23 month exemption. Jane can decide at a later date to use 

this birth to 23 month exemption, for instance, if she has another child. 



Young Child Exemptions (YCEs), Continued 

Two-parent 

household – 

birth to 23 

month 

exemption 

First child and 

subsequent 

child 

exemptions 

Customers 

currently in the 

FE 

One parent in a two-parent household may choose the new birth to 23 month 

exemption; however, the aided parent or needy caretaker relative must have 

primary responsibility for personally providing care to the child. The ESS will 

communicate with the customer by asking this question and documenting the 

answer in a Journal entry. 

Only one parent at a time may be granted this exemption; however, the 

parents have the option to alternate which parent uses it. The determination 

is made when the ESS asks the customers which parent has the primary 

responsibility of personally providing care for the child(ren) and there has 

been no break in the exemption. Once the ESS has determined which 

parent meets the qualification, he/she will document and complete a Journal 

entry with the customers’ statement about which parent is providing care and 

is eligible to the exemption. 

A new 2186A and CW 2186B are required each time customers choose 

to change the exemption between parents. 

If the customer verbally requests the exemption, the ESS will send the 

CW 2186A to the customer for completion. 

If the ESS does not receive the CW 2186A back from the customer, 

he/she will Journal this information and send the CW 2186B to the 

customer to confirm his/herchoice. 

The WTW 24-Month Time Clock and the CalWORKs 48-Month Time Limit 

will stop for the parent who receives this exemption. 

Note: There is no limit to the number of times the exemption may be 

alternated between parents in a two-parent household. 

The first child exemption, also known as a Full Exemption (FE), and 

subsequent child exemptions still apply and customers have the right to 

make an informed decision as to which of the three exemptions they would 

like to choose. 

See Employment Services Policy Handbook (ESPHB) pages 3-16 and 3-17, 

“Researching care of first child exemption” block, for information about 

researching and determining FE. 

Customers must be informed that these two exemptions stop the WTW 

24-Month Time Clock but do not stop the CalWORKs 48-Month Time Limit. 

The subsequent child exemption option is effective 1/1/13 and is currently 

available in C-IV. 

Note: Young child exemptions do not apply to pregnant and parenting teens 

under the age of 20 who have not earned a high school diploma or 

equivalent. 

Customers currently in the FE will be left in this exemption, unless the FE 

exemption no longer applies, or until the ESS can have the detailed 

discussion with the customer so he/she has an informed choice of which 

exemption he/she would like to choose. The ESS will document the 

customer’s choice in a Journal entry. 



Young Child Exemptions (YCEs), Continued 

Documentation 

of YCEs 

Informed 

choice for 

customers 

Current YCE 

volunteers 

Documentation for YCEs can be either in writing via the CW 2186A or 

verbally; however, the ESS should always have documentation of a YCE 

(CW 2186A, CW 2186B, and Journal entries). 

If the customer verbally requests a particular YCE, the ESS will send the 

CW 2186A to the customer for completion. If the ESS does not receive the 

CW 2186A back from the customer; he/she will Journal this information and 

send the CW 2186B to confirm the customer choice. 

If the customer does not choose one of the exemptions either verbally or in 

writing, the ESS will attempt to contact the customer by phone. If the ESS 

does not hear from the customer as to which YCE he/she chooses, the ESS 

will schedule the customer for an appointment to either provide 

documentation of the YCE choice or sign a WTW plan (WTW 2). 

If the customer fails, without good cause, to attend an appointment to sign a 

WTW plan (WTW 2), he/she will be subject to noncompliance and possible 

sanction. 

Customers need to be given an informed choice of all three young child 

exemption options on a case-by-case basis. ESSs must Journal the 

customer’s choice and any other action taken. 

The current YCEs expire effective 12/31/12; however, counties have two 

years to reengage customers. ESSs will follow the chart below for YCE 

volunteers: 

If a... Then the ESS will... 

Customer’s WTW 

plan (WTW 2) 

expires, and 

He/she does not 

qualify for another 

exemption, 

Customer comes 

into the office for 

an appointment or 

to pick up 

supportive 

services, and 

His/her volunteer 

WTW plan has not 

expired, 

Review the expired WTW plan (WTW 2) to 

determine if the customer can remain in the 

same activities, 

Make the customer a mandatory participant 

following current policy, 

Create a new WTW Plan (WTW 2), and 

Journal all action taken. 

Leave the customer in his/her exempt 

volunteer status, as long as he/she is 

meeting requirements in the current WTW 

Plan (WTW 2), 

Explain to the customer that when his/her 

WTW plan expires, he/she will be a 

mandatory participant, unless he/she 

qualifies for another exemption, 

Explain all new WTW regulations, and 

Journal all action taken. 

Note: If the customer’s WTW 2 plan expires and he/she qualifies for another 

exemption but fails to attend their reengagement appointment, without good 

cause, he/she will be subject to noncompliance and possible sanction. 


Reengagement Requirements 

Reengagement 

evaluations 

Reengagement 

flow 

Reengagement evaluations for customers being reengaged in Welfare-to- 

Work (WTW) activities will be determined on a case-by-case basis, based on 

an individual’s status and needs. The Employment Services Specialist (ESS) 

will include the following when reviewing a customer’s case: 

Determine whether the customer qualifies for another exemption or has 

good cause for not participating in WTW. 

Inform the customer of the number of months left on his/her CalWORKs 

48-Month Time Limit. 

Located in C-IV under Eligibility/Customer Information/Time 

Limits/Time Limit Summary page. 

Determine which stage in the WTW flow is appropriate to begin 

reengaging the customer. 

Identify possible barriers to participation. 

Evaluate Self-Initiated Program (SIP) eligibility (if applicable). 

Provide a general description of program requirements. 

Provide a description of supportive services available to customers and 

advance payment options. 

Provide information regarding program changes that have occurred since 

the customer became exempt including, but not limited to, the new WTW 

24-Month Time Clock and the customer’s participation requirements after 

the 24 months have expired. 

Customers are required to meet federal core hours of participation 

when their WTW 24-MonthTime Clock expires or their cash aid will 

decrease. 

Journal all actions taken and items discussed with the customer. 

Each individual reengagement evaluation will be unique; however, the 

following provisions apply to customers whose case is being reviewed to 

determine what activity(ies) to place a customer in, and where to place 

him/her in the WTW flow process: 

Customers who have never attended a WTW appraisal prior to 

reengagement shall be able to qualify for a SIP if they meet all other SIP 

requirements. 

Individuals who were in SIPs prior to becoming exempt may remain in 

their programs, provided they continued to make satisfactory progress 

through the exemption period or had their program interrupted for a 

reason that meets good cause criteria. 

Customers who are notified by the ESS that they are beginning the 

reengagement process and who have an active volunteer WTW plan will 

be allowed to continue in their plan as a mandatory participant if the 

WTW plan meets new participation requirements. 

Reengagement is structured to minimize the disruption of any 

employment or training program in which an individual is enrolled. 

A new WTW plan must be signed to reflect the change in status from 

a volunteer to a mandatory participant. 

Volunteers are not considered engaged until a new WTW Plan (WTW 2) 

is signed and the provision of supportive services is met. 



Reengagement Requirements, Continued 

CW 2206 

Reengagement 

Informing 

Notice – first 

notice 

Second notice 

ADM 102 C-IV 

Appointment 

Letter 

Participation 

requirement 

after the 

second notice 

On 1/17/13, WTW customers (excluding Good Cause – Lack of Supportive 

Services) were mailed the CW 2206 Reengagement Informing Notice 

(English and Spanish) notifying them that their exemption had ended and, 

although their time on aid will not start until reengaged, they are required to 

participate in reengagement activities when contacted by the county. 

The CW 2206 must be sent 30 days before the second notice, the ADM 102 

C-IV Appointment Letter. 

A second notice, the ADM 102 C-IV Appointment Letter, will be sent to 

customers who have not been reengaged (i.e., customers whose volunteer 

contract has ended or child has aged out of their exemption), to schedule an 

appointment at the next Reevaluation (RE) date. The appointment may be 

conducted in person, by mail, or by phone, depending on the customer’s 

specific circumstances. 

When the ESS mails the ADM 102 C-IV Appointment Letter to YCE 

customers who are scheduled for an RE appointment, the following items will 

be included: 

CW 2206 Reengagement Informing Notice 

CW 2186A CalWORKs Exemption Request form 

Note: Both forms are available in English and Spanish in the online 

Transitional Assistance Department (TAD) Forms Catalog, under 

Employment Services. 

Customers are considered required to participate once the second notice 

informing them of the requirement to take an action has been sent. 

The customer’s WTW 24-Month Time Clock will not begin until he/she signs 

a WTW plan (WTW 2) and is provided necessary supportive services. 

If the customer fails, without good cause, to attend an appointment or 

otherwise participate in reengagement he/she will be subject to 

non-compliance and possible sanction. 

Note: The ESS is not required to send another CW 2186A because, in this 

instance, the form was included in the second notice. 




Required 

language for 

the ADM 102 

C-IV 

Appointment 

Letter – YCE 

customers at 

RE 

The ADM 102 C-IV Appointment Letter will contain the following language for 

YCE customers who are scheduled for an RE appointment: 

“You have been scheduled for an appointment to go over the new WTW 

rules and develop/sign a new WTW plan (WTW 2). If you cannot make this 

appointment, please call your Employment Services Specialist (ESS) right 

away to reschedule. If you do not call, or do not attend the appointment, 

your cash aid may be lowered. If you are in a two-parent family and want to 

share hours to meet your participation requirements, both parents must 

attend the appointment. Your WTW 24-Month Time Clock and CalWORKs 

48-Month Time Limit will start when you sign a WTW plan (WTW 2). 

If you think you qualify for another exemption, please complete the attached 

CW 2186A form and return it to your worker. If you qualify for another 

exemption you may still participate in WTW activities as a volunteer.” 

Third contact A subsequent contact must be initiated to ensure the customer is able to 

attend his/her appointment to discuss new WTW regulations or submit 

necessary verification. The third contact must occur after the ADM 102 

Appointment Letter is sent, and prior to the scheduled appointment. This 

contact may be verbal or written. The ESS will set a Task or Reminder in 

their Outlook calendar to make this third contact between the ADM 102 

Appointment Letter being sent and prior to the scheduled appointment. 

Some reengagement customers may not be required to attend an in-person 

appointment, such as those who qualify for another exemption; for example, 

a person who is caring for an ill family member (and provides verification/ 

documentation). 

The third contact will include a comprehensive discussion that covers the 

following: 

WTW 24-Month Time Clock, 

Conditions that allow a month not to count toward the WTW 24-Month 

Time Clock, 

Post WTW 24-Month Time Clock participation requirements (must meet 

federal Work Participation Rate (WPR) or his/her cash aid may be 

lowered), 

Monthly/weekly hours of participation 85/128/150 monthly, 20/30/35 

weekly, and 

Criteria for WTW exemptions. 

A Journal entry must be made, including all aspects of this contact. 




Revised 

CW 2186A and 

CW 2186B 

forms 

The following forms have been revised to include new regulations, effective 

1/1/13: 

CW 2186A – CalWORKs 48-Month Time Limit, WTW Participation, and 

WTW 24-Month Time Clock Exemption Request Form 

CW 2186B – CalWORKs 48-Month Time Limit, WTW 24-Month Time 

Clock 

ESSs will use the revised forms available in the online TAD Forms Catalog, 

under Employment Services, and not the forms located within C-IV. Staff will 

be notified when C-IV provides the revised forms within the system. 

These forms include important information regarding the new WTW 

24-Month Time Clock and the new birth to 23 month YCE. 

These forms are currently available in English and Spanish. Customers who 

have elected to receive materials in languages other than English or Spanish 

should be sent the English version of the form along with the GEN 1365 – 

Notice of Language Services. 

Note: C-IV will program in the new CW 2186A and CW 2186B forms on 

5/20/13, with the 13.05 Release. A C-IV announcement will be issued when 

the revised forms are available in the C-IV system. 


Young Child Exemption (YCE) Reengagement Process 

Introduction This section contains information regarding the Young Child 

Exemption (YCE) Reengagement process. Expired YCE customers will be 

reengaged at their scheduled Re-evaluation (RE) appointments. 

Employment 


Manager (ESM) 


SESS I 


The Employment Services Manager (ESM) will designate a Supervising 

Employment Services Specialist I (SESS I) to pull the “Young Child 

Exemption Cases-CW RE in (month/year)” list, located on the C-IV Resource 

Center, beginning with the April 2013 RE list. The April 2013 RE list is 

currently posted. The Legislation and Research Unit (LRU) will continue to 

post this list on the last week of each month for the following RE month. 

Example: The list posted the week of 2/25/13 will be the April 2013 RE list. 

The designated SESS I in each district office will: 

Step Action 

1 Filter the “Young Child Exemption Cases-CW RE (month/year)” 

list for their district office, and 

Determine equitable assignment to Employment Service 

Specialists (ESSs). 

2 Request the designated Office Assistant (OA) reassign these cases 

to ESSs so appointments can be scheduled by the 10 th calendar 

day of each month, prior to the RE. 

3 Have each appointment reported back to the SESS I so that the 

appointment time can be added to the “YCE appt” column on the 

“Young Child Exemption Cases-CW RE (month/year)” spread sheet 

for their district office. 

4 Scan the completed district spreadsheet with “YCE appt” column 

completed and email the list to the district Process Approach to 

Case Excellence (PACE) supervisor/scheduler by the next 

business day. 

Note: ESSs will schedule the Welfare-to-Work (WTW) reengagement 

appointment for the April 2013 YYCE RE appointments by 3/15/13. 

Thereafter, the ESS will schedule YCE RE appointments by the 10 th 

calendar day of each month, prior to the RE month. 



Young Child Exemption (YCE) Reengagement Process, 

Continued 

ESS 


PACE 

supervisor/ 

scheduler 

Once the SESS I equitably distributes the filtered “Young Child Exemption 

Cases-CW RE (month/year)” list to assigned ESSs, and the cases are 

reassigned to the ESS by the designated OA, the ESS will: 

Step Action 

1 Block off one hour time in his/her Outlook Calendars between the 

hours of 12:00 pm and 1:00 pm, and/or 2:00 pm and 3:00 pm for YCE 

RE appointments. 

All YCE WTW RE appointments will be scheduled at 12 pm and 

2 pm only. 

Note: ESSs must review the CalWORKs RE appointment and location 

once the CalWORKs RE appointment is scheduled to ensure that the 

customer is allowed time to attend the CalWORKs RE appointment 

when it is at a different office than the WTW appointment. 

2 Schedule each customer on the list for one of the YCE RE blocked 

off time slots. 

Do not schedule these appointments on the first two working days 

of the month. 

All appointments must be scheduled before 10-day Notice of 

Action (NOA) cutoff. 

3 Complete the second and third contacts as described in the blocks 

titled “Second notice – ADM 102 C-IV Appointment Letter” and “Third 

contact” in this Interim Instruction Notice (IIN). 

4 Send the following to each customer: 

CW 2206, 

CW 2186A, and the 

Appointment Letter (ADM 102 CIV). 

5 Use the Excel YCE spreadsheet provided by his/her SESS I to 

complete the “YCE Appt.” column (last column in the Excel 

spreadsheet) with the scheduled appointment date and time. 

6 Return the completed list to his/her SESS I by the 10 th calendar day of 

each month. 


The PACE supervisor/scheduler in each district office will: 

Step Action 

1 Review the completed “Young Child Exemption Cases-CW RE 

(month/year)” list received by the SESS I. 

2 Schedule the RE appointments to coincide with the YCE appointment 

scheduled by the ESS. 

These appointments are given priority for the last two RE 

appointments slots of the day, at 1 pm and 3 pm. 

Example: If a YCE case is set to meet with the ESS from 12-1 pm, the 

PACE supervisor will schedule the RE appointment for the 1 pm time 

slot. 

3 Follow other current protocol for scheduling appointments. 




Young Child Exemption (YCE) Reengagement Process, 

Continued 

Customer 

Service Center 

(CSC) 

ESS 


if RE is 

rescheduled 

If the Customer Service Center (CSC) receives a call from a customer who 

requests to reschedule his/her RE appointment, the CSC Eligibility 

Worker (EW) will review the case to see if a WTW YCE appointment has also 

been scheduled for the customer. If the customer has a WTW YCE 

appointment scheduled, the CSC EW will ask the customer if he/she plans to 

attend the scheduled WTW YCE appointment, and: 

If the customer states he/she 

will... 

Attend the WTW YCE 

appointment, 

Not be able to keep the WTW 

YCE appointment, 

Then the CSC EW will... 

Journal this information. 

Inform the customer to contact 

his/her ESS, 

Provide the customer with the ESS 

phone number, 

E-mail the ESS stating the 

customer will not be able to attend 

the scheduled appointment, 

Provide the customer’s current 

phone number to the ESS, and 


Note: The CSC EW will not cancel the 

WTW YCE appointment. 

If the ESS is notified that the RE appointment has been rescheduled and the 

customer will also need to reschedule his/her WTW YCE appointment, the 

ESS will: 

Step Action 

1 Contact the customer to reschedule the WTW YCE appointment 

following current protocol. 

2 Send out another: 

CW 2206, 

CW 2186A, and 

Appointment Letter (ADM 102 CIV). 



WTW 2 – WTW Plan Activity Assignment 

Introduction This section contains information on the WTW 2 – WTW Plan Activity 

Assignment. 

New WTW 2 – 

WTW Plan 

activity 

assignment 

(12/12) within 

C-IV 

Employed 

customers – 

WTW 2 

WTW 2 plans 

for existing 

customers 

The new WTW 2 – WTW Plan Activity Assignment will be available within the 

C-IV system on 3/25/13. Employment Services Specialists (ESSs) will use 

this form beginning 3/25/13. A Forms and Procedures (F&P) guide, and 

sample WTW 2 plans will be available in the on-line Transitional Assistance 

Department (TAD) Forms Catalog, under Employment Services. 

If the customer has a current WTW 2 for employment and he/she is currently 

meeting participation requirements, the ESS will: 

Talk to the customer at the next scheduled appointment or phone 

contact. 

Explain all the new WTW regulations. 

Journal actions taken (i.e., New regulations explained). 

During the next regularly scheduled contact between the ESS and the 

customer, the ESS must have a comprehensive discussion regarding new 

Welfare-to-Work (WTW) regulations. 

The ESS will develop new plans with customers who want to have their plans 

reviewed and/or modified considering the new participation requirements that 

are consistent with the customers’ assessments and needs. 


WTW 24-Month Time Clock 

Introduction This section contains information regarding the new Welfare-to-Work (WTW) 

24-Month Time Clock and monthly hours of participation. 

Noncompliance 

on a 

case-by-case 

basis 

WTW 24-Month 

Time Clock 

Effective 1/1/13, the monthly hours of participation have been revised to 

85/128/150 hours per month. This still equates to 20/30/35 hours per week 

when divided by 4.33 and rounded to the nearest whole number. The 

Employment Services Specialist (ESS) will not begin the noncompliance 

process if a customer meets monthly hours of participation, either state or 

federal. 

The ESS will review each customer’s situation on a case-by-case basis to 

identify any barriers or case specifics, i.e., customer had an excused 

absence, a good cause reason, etc., that may help him/her meet the Work 

Participation Rate (WPR) for the month, before initiating the noncompliance 

process. 

If a customer is meeting state hours of participation, the ESS will not initiate 

noncompliance. 

In some circumstances, customers may not meet federal WPR. 

The WTW 24-Month Time Clock, within the CalWORKs 48-Month Time Limit, 

will be automated within C-IV. The WTW 24-Month Time Clock: 

Applies to all customers who are required to participate in the WTW 

program. 

Is cumulative, not consecutive. 

Is intended to support customers’ opportunities to reach self-sufficiency. 

Any month in which the customer meets any one of the following conditions 

does not count toward the WTW 24-Month Time Clock: 

Assessment 

Cal-Learn customer 

Exempt (including those exempt under previous Young Child Exemptions 

(YCEs) who have not been reengaged) 

Good Cause 

In the process of developing a WTW plan 

Job Search 

Meets Federal WPR 

Orientation/Appraisal 

Sanctioned 

ESSs will inform customers that this new WTW clock was created to provide 

a wide variety of appropriate activities, consistent with the customer’s 

assessments, which the county currently provides. 



WTW 24-Month Time Clock, Continued 

Customers who 

do not have a 

WTW 24-Month 

Time Clock 

What ticks the 

WTW 24-Month 

Time Clock 

Exemption 

documentation 

for WTW 

24-Month Time 

Clock 

WTW 24-Month 

Time Clock 

begin date 

Customers 

NOA for the 

WTW 24-Month 

Time Clock 

Customers whose WTW 24-Month Time Clock will not tick include the 

following: 

Safety Net (customers who have exceeded their CalWORKs 48-Month 

Time Limit), 

Drug and fleeing felons, 

Ineligible non-citizens, 


Social Security Disability Insurance (SSDI) recipients, and 

Supplemental Security Income (SSI) recipients. 

If an active WTW customer has a WTW Plan (WTW 2) that meets state 

(non-core) hours of participation, the WTW 24-Month Time Clock will tick. 

The WTW Time Clock will begin the first of the month following the WTW 

Plan (WTW 2) sign date. 

When documentation of an exemption is received and approved, the 

customer will be considered exempt from WTW under the new criteria 

beginning the first of the month following the month that verification is 

received for WTW 24-Month Time Clock purposes; however, if the exemption 

is due to a medical disability, it will be effective from the onset date. 

The ESS will place customers in the appropriate exemption status and C-IV 

will automate when the WTW 24-Month time clock begins. 

C-IV will automate Phase 1 of the WTW 24-Month Time Clock functionality 

on 3/25/13. The WTW 24-Month Time Clock will begin to tick in the month 

after the sign date of the first signed activity agreement where the “Post 

Assessment” indicator is set to “Yes”. The WTW clock will begin to tick 

regardless of the county in which the activity agreement was signed. All 

months prior to this signature will display as “N/A” in C-IV. More information 

will follow as it becomes available. 

Customers will receive a Notice of Action (NOA) regarding the status of their 

WTW 24-Month Time Clock at the following times: 

Application for CalWORKs aid for new applicants, 

Recipients’ annual Re-evaluation (RE), 

At least once between WTW 24-Month Time Clock months 18 and 21, 

This function will be automated in C-IV, and 

When the WTW 24-Month Time Clock has been exhausted. 

An Interim Instruction Notice (IIN) will be issued regarding implementation 

instructions and NOAs for noticing requirements. Until then, all customers 

will have 24 months left on their WTW 24-Month Time Clocks. 




Post WTW 

24 -Month Time 

Clock 

requirements 

New 


recipients and 

the WTW 

24-Month Time 

Clock 

Once the customer has used all of his/her WTW 24-Months, unless 

otherwise exempt or he/she has received an extension, aided adults must 

meet federal work requirements or cash aid will be decreased. Additional 

information will follow as it becomes available. 

Customers approved for CalWORKs cash aid on or after 1/1/13 will have no 

months counted towards the WTW 24-Month Time Clock until they have a 

signed WTW Plan (WTW 2), listing mutually agreed upon WTW activities and 

supportive services. The WTW 24-Month Time Clock begins the first of the 

month following the date the new WTW Plan is signed. Additional 

information will follow as it becomes available. 




Two-WEI 

Parent 

households 

Each parent in a two-Work Eligible Individuals (WEI) parent household will 

have an individual WTW 24-Month Time Clock. An individual parent’s clock 

will stop in any month that parent meets one of the conditions that stops the 

WTW 24-Month Time Clock (e.g., is exempt, good cause, sanction, 

non-compliance, meets federal work participation requirements, etc.). 

Both parents’ WTW 24-Month Time Clocks stop when the family meets federal 

participation requirements for two-WEI parent families (just applies to the 

two-parent rate). Federal rules require two-WEI parent families to participate 

a total of 150 hours per month/35 hours per week, of which 128 hours per 

month/30 hours per week must be in core activities. 

The monthly/hourly requirement can be met by one adult or through a 

combination of both adults’ participation hours (core hours can be shared), 

including an exempt parent who volunteers for a portion of the hours. 

In situations where one parent is participating and not meeting federal 

participation requirements and the other parent meets criteria for a clock 

stopping condition in the month (other than meeting federal participation 

requirements), the WTW 24-Month Clock ticks for the parent who is 

participating and does not tick for the other parent. 

Once both parents have exhausted the WTW 24-Month Time Clock, and any 

extension which may be available, the parents must meet new state standards 

based on federal work participation requirements for two-parent families (just 

the two-parent rate). 

In situations where only one parent has exhausted the WTW 24-Month Time 

Clock, the parent that reached the limit must modify his/her participation to 

bring the family into compliance with the federal work participation 

requirements to avoid being removed from the Assistance Unit (AU), unless 

the other parent changes his/her participation to meet those requirements for 

a two-parent household. 

If the family meets federal work participation requirements for a two-WEI 

parent household, the other parent’s WTW 24-Month Time Clock will stop. If 

the family does not meet federal work participation requirements, in order to 

remain in compliance with WTW participation requirements the other parent 

would need to participate a total of 150 hours per month, 35 hours per week 

in WTW activities. Any parent who has time remaining on the WTW 

24-Month Time Clock may continue in WTW activities until his/her clock runs 

out, regardless of another parent’s status. 

Implementation instructions for the post WTW 24-Month Time Clock period 

will be issued when information becomes available. 

Note: C-IV will be automating this functionality; however, ESSs need to 

understand the process to explain to customers what ticks the WTW 24-Month 

Clock. 




Customers with 

24 months or 

less on their 


48-Month Time 

Limit 

Voc Ed 

activities 

Customers with 24 months or less left of their CalWORKs 48-Month Time 

Limit will likely exhaust their time on aid prior to becoming subject to the post 

WTW 24-Month Time Clock federal work participation requirements. 

Therefore, after 1/1/13, all months on cash aid will count towards the WTW 

24-Month Time Clock, unless one of the conditions for not counting a month 

applies (e.g., a WTW exemption applies). C-IV will be automating this 

functionality and will provide a list of customers who fall into this category at 

a later date. 

Vocational Education (Voc Ed) can fulfill WTW adults’ allowable 

participation for up to three years. Voc Ed can count as a federal core 

activity for a lifetime maximum of 12 months, which would stop the WTW 

24-Month Time Clock for up to a year. 

After 12 months, customers may continue their educational programs, 

utilizing the WTW 24-Month Time Clock for CalWORKs service flexibility, 

as an Education Directly Related to Employment (no High School diploma or 

equivalent) or Job Skills Training activity. 

Once the 12 months of federally countable Voc Ed and the WTW 24-Month 

Time Clock are exhausted, education programs may continue as the 

federal non-core job skills training activity or as education directly related to 

employment activity, but must be combined with one or more core activities 

to meet federal work participation requirements. 

Customers who already have months counted toward the maximum of 12 

federal months in their lifetime do not receive a new 12 month period for 

Voc Ed beginning 1/1/13. 




Example of Voc 

Ed, employed 

customer 

Alert and 

required 

noticing form 

The example in this section provides information regarding a Voc Ed 

customer who is also employed. 

Jane is a single mother with a 30-hour per week participation requirement. 

Jane is employed as a receptionist for 25 hours per week/108 hours per 

month in a hair salon and participates in Voc Ed at a community college to 

become a hair stylist for 10 hours per week/43 hours per month. Because 

Jane’s Voc Ed program meets the definition of job skills training directly 

related to employment, the ESS is counting her education as a non-core 

activity that meets federal standards to preserve her federal 12-month 

lifetime limit of Voc Ed. 

Current policy states that if a customer meets 20 or 30 (depending on the 

household composition) federal core hours, he/she can use the job skills 

training directly related to employment or the education direction related to 

employment activities to save the customer’s time in his/her limited 12-month 

lifetime Voc Ed activity. 

In this situation, Jane met her 20 federal core hours with her work activity of 

25 hours per week/108 hours per month. Since Jane met her core 

requirement with her employment in this situation, the job skills training 

directly related to employment can be added, for 10 hours/43 hours per 

month. This makes Jane meet federal Work Participation Rate (WPR). 

An Alert flyer (Flyer #12-260) regarding the new WTW 24-Month Time Clock 

and required hours of participation, effective 1/1/13, was sent to all 

Transitional Assistance Department (TAD) staff on 11/13/12. 

The CW 2205 – New Rules for CalWORKs WTW Activities was sent to all 

non-excluded WTW eligible adults, both English and Spanish speaking, who 

receive cash aid on behalf of or with a child, including sanctioned adults and 

customers with a current YCE on 11/9/12. 




ESS 


regarding the 

WTW 24-Month 

Time Clock 

When an ESS has contact with a customer, he/she will: 

Inform customers of the: 

New WTW 24-Month Time Clock (include information that the new 

WTW 24-Month Time Clock is within the CalWORKs 48-Month Time 

Limit). 

Post WTW 24-Month Time Clock requirements. 

After the WTW 24-Month Time Clock is exhausted, the customer 

must meet federal WPR or his/her cash aid will decrease. 

CalWORKs 48-Month Time Limit is continuous (does not start over). 

New birth to 23 month exemption (if applicable). 

Provide customers with the information needed to make an informed 

choice of all three YCEs (Full Exemption (FE), subsequent child, and birth 

to 23 month) effective 1/1/13. 

Assist customers to maximize the time left on the CalWORKs 48-Month 

Time Limit to become self-sufficient. 

Counsel customers to utilize their clock in the most beneficial way in 

conjunction with their assessment results. 

Journal the discussion and the choice of the exemption (if applicable). 


Exempt Volunteers 

Introduction This section contains information regarding the exempt volunteer process. 

Exempt 

volunteer 

information 

Exempt 

volunteers who 

fail to meet 

requirements 

NA 100 – blank 

NOA for 

volunteers 

There are no monthly/weekly participation requirements for exempt 

volunteers. Exempt Welfare-to-Work (WTW) eligible adults are allowed to 

volunteer to participate in activities established in their WTW plan, which 

must include identification of necessary supportive services. 

Allow volunteers to participate on a first-come, first-serve basis with priority to 

existing customers over new applicants, consistent with the legislative intent 

regarding these changes, to the extent that funds are available to serve all of 

their needs. 

A customer may choose to use any Young Child Exemption (YCE) applicable 

to his/her situation and volunteer, as long as the Employment Services 

Specialist (ESS) is providing the customer with an informed choice. 

The ESS will review each customer’s case, assessment results, time left on 

aid, etc., on a case-by-case basis, to determine the activities in which the 

customer should be enrolled. If a customer has three months left on his/her 

exemption and four months left on the CalWORKs 48-Month Time Clock, 

going to school for two hours a week in a Vocational Education program that 

will take two years to complete may not be the best option for him/her. 

The ESS’s job is to counsel and guide customers utilizing all available 

resources to assist them in becoming self-sufficient. 

Note: A customer who is exempt for the birth to 23 month exemption may 

choose to be an exempt volunteer, and may return back to his/her exempt 

status if he/she chooses to no longer volunteer. 

An exempt volunteer who fails to fulfill his/her WTW plan requirements will 

not be allowed to volunteer again until the exemption ends. The ESS will first 

call the customer to determine if he/she had a good cause reason for not 

participating, and will Journal all actions taken. The ESS will use the Notice 

of Action (NA 100 CIV) form to notify the customer he/she has failed to meet 

his/her volunteer requirements. 

The ESS will enter the following information on the NA 100 – Blank NOA 

under “Here’s why” for volunteers who do not participate in their assigned 

WTW activity: 

You did not: 

Provide verification between the 1 st and 5 th day of the month as 

required in your WTW 2 Plan, and/or 

Meet requirements in your WTW 2 Plan. 

We will not pay transportation, or work-or training-related expenses while 

you are out of Welfare-to-Work (WTW). 

If you are employed, you may receive Child Care benefits. 

You will not be able to volunteer in WTW again until your current 

exemption ends and you no longer qualify for an exemption. 

“EAS 42-721” will be entered in the “Rules” section of the notice. 


Inter-County Transfer Process 

Introduction This section contains information regarding expired short term Young Child 

Exemption (YCE) Inter-County Transfer (ICT) customers. 

YCE ICTs On 3/25/13, C-IV will have an ICT indicator on the Work Registration Detail 

page that will default to “No”. If a customer is an ICT who currently has an 

expired short term YCE in another county, the Employment Services 

Specialist (ESS) will select “Yes” in the drop down menu and reengage the 

customer at his/her next scheduled RE. This follows the expired YCE 

Reengagement process. 

YCE identified 

by Time Limits 

at ICT review 

If an ICT case is received in the county and the Time Limit reviewer identifies 

the customer has an existing 316 exemption in the Welfare Data Tracking 

Implementation Tracking Project (WDTIP) system, the Time Limit reviewer 

will send an e-mail to the Employment Services Program (ESP) Regional 

Manager (RM) informing him/her of the identified YCE ICT. The RM will then 

inform the appropriate office so necessary action can be taken to identify the 

YCE ICT in C-IV. 

Questions Managers may contact Brenda Bovee, Program Specialist (PS) II, Program 

Development Division (PDD) at (909) 383-9727 or via county e-mail at 

bbovee@hss.sbcounty.gov with questions regarding this Interim Instruction 

Notice (IIN). 


Exemption 

Welfare-To-Work (WTW) 24-Month Time Clock and 

CalWORKs 48-Month Time Limit 

Exemptions/Good Cause Clock Stoppers 

The chart below provides information regarding WTW 24-Month Time Clock exemptions and good cause for not participating, 

and shows what affect each have on the CalWORKs 48-Month Time Limit. 

Description 

IIN #12-075 ERRATA (03/13) DM:BB:kc PAGE 24 OF 25 

WTW 24-Month 

Time Clock 

Stopper? 


48-Month Time 

Limit Stopper? 

Under 16 Years of Age Customer is under 16 years of age. N/A 1 N/A 1 

Child Attending School 

Customer is 16, 17, or 18 years of age and is attending a school in grade twelve or 

below, or vocational, or technical school on a full-time basis. 

Cal-Learn Non-Head of Household Customer is receiving aid in their parent’s Assistance Unit (AU), and is eligible for, 

participating in, or exempt from the Cal-Learn program. 

Cal-Learn Head of Household 

Customer is receiving aid in their own AU, and is eligible for, participating, or exempt from the 

Cal-Learn program. 

N/A 1 N/A 1 

Yes Yes 

Yes Yes 

60 Years of Age or Older Customer who reaches age 60 or older. Yes Yes 

Customer Disability 

Needy Non-Parent Caretaker 

Relative 

Caring for Ill or Incapacitated 

Member of Household 

Pregnant and Cannot Work or 

Participate in WTW Activities 

CW 61 documentation/verification 

required 

Customer has medical verification of a physical and/or mental disability expected to last at 

least 30 days and it significantly impairs the individual’s ability to be employed or participate 

In WTW activities. 2 

Customer is a Non-Parent caretaker relative who has primary responsibility for caring for a 

child who is either a dependent, ward of the court, receiving Kin-GAP benefits or at risk for 

placement in foster care. These caretaking responsibilities must impair his/her ability to be 

employed or to participate in WTW activities. 

Customer is caring for an ill or incapacitated person residing in the home, has medical 

verification that the illness or incapacity is expected to last at least 30 days, and caretaking 

responsibility impairs the customers ability to be regularly employed or to participate in 

WTW activities. 

Customer is a woman who is pregnant with medical verification that the pregnancy impairs 

her ability to be regularly employed or participate in WTW activities, or the county 

determines that participation will not readily lead to employment or that a training activity is 

not appropriate. 

1 The CalWORKs 48-Month Time Limit and the WTW 24-Month Time Clock do not apply to this population. 

2 This may include pregnancy if the ‘Customer Disability’ criteria are found to apply. 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

No

Exemption 

Child Birth-23 Months of Age 

Exemption for Child First Child (FE) 

Subsequent Exemption for Young 

Child 

Short-Term Young Child 

Exemption 3 

Welfare-To-Work (WTW) 24-Month Time Clock and 

CalWORKs 48-Month Time Limit 

Exemptions/Good Cause Clock Stoppers 

The chart below provides information regarding WTW 24-Month Time Clock exemptions 

and shows what affect each of these exemptions has on the CalWORKs 48-Month Time Limit. 

Description 

Customer has primary responsibility for personally providing care to a child from birth to 

23 months, inclusive. This exemption shall be available in addition to any other child 

related exemption outlined below. An individual may be exempt only once in a lifetime 

under this exemption. 

Customer is caring for his/her first child, (FE). 

Subsequent Exemption: Customer is caring for a subsequent young child. 

Customer has responsibility for personally providing care for one child between 12-23 

months of age or two or more children less than six years of age. 3 

IIN #12-075 ERRATA (02/13) DM:BB:ts PAGE 25 OF 25 

WTW 24-Month 

Time Clock 

Stopper? 

Yes 

Yes 


48-Month Time 

Limit Stopper? 

Yes 

No 

Yes No 

Yes Yes 

VISTA Volunteer Customer is a full-time volunteer in the Volunteers in Services to America (VISTA) Program Yes No 

Good Cause Customer has good cause for not participating in WTW. Yes No 

3 This exemption will no longer be available for customer to use as of 01/01/2013. Customers who are taking this exemption as of 12/31/2012 will no longer have the exemption 

as of 01/01/2013, but will not be required to participate in WTW activities and their WTW 24-Month Time Clock and CalWORKs 48-Month Time Limit will remain stopped until they are 

reengaged by the county. The counties must reengage this population by 01/01/2015.

Overview 

Work Requirements 

Introduction This section contains information regarding work requirements for 

CalWORKs Welfare-to-Work (WTW) customers and other work registration 

requirements. 


• ACL 09-07 

• EAS 42-711 

• EAS 42-763 



Overview 7-1 

The "Work First" Culture 7-3 

Overview of Programs 7-4 

Welfare-to-Work (WTW) Participation 7-5 

Exemption from Participation 7-9 

Exemption Reasons 7-10 

Administering the Program 7-15 

Introduction to the Work Participation Rate (WPR) 7-16 

Initiating Participation 7-18 

Acting on Changes During Participation 7-19 

Sanctions 7-20 

Sanction Procedures 7-22 

Sanction Appeals 7-24 

Other Actions Related to Sanctions 7-25 

Cooperation After a Sanction 7-27 

California Indian Manpower Consortium, Inc. (CIMC) 7-28 

CIMC Registration Procedures 7-29 

CIMC Participating Tribes and Service Areas 7-30 

CWPHB #4605 (04/11) WORK REQUIREMENTS 7-1

The "Work First" Culture 

Introduction This section contains information regarding San Bernardino County’s “work 

first” philosophy. 

The "work first" 

philosophy 

San Bernardino is a “work first” County and is committed to actively 

promoting clear messages to our customers about joining or re-joining the 

workforce and maintaining employment. CalWORKs Eligibility and Welfareto-Work 

(WTW) program staff collaborate to facilitate self-sufficient families 

through employment and personal responsibility for improving one’s 

situation. 

ESP Objective The objective of WTW is to help customers become self-sufficient through 

employment. Recipients of CalWORKs face time limits for receiving aid and 

need to be able to support themselves once they reach those limits. WTW 

activities are designed to help customers remove barriers to employment, 

develop job skills, enhance self-esteem, and prepare to find and retain 

employment, thereby moving toward self-sufficiency and a better future for 

their families. 


program goals 

The goal for most of our adult customers and many of our teens is to actively 

participate in the WTW program and to become employed as soon as 

possible after applying for assistance. Once the customer becomes 

employed, the customer’s goal should be to plan, act, and commit to 

eliminate their family’s need for cash assistance. 

Eligibility Worker (EW) and Employment Services Specialist (ESS) goals are 

to: 

Divert customers from cash assistance when appropriate during the 

intake process. 

Thoroughly educate customers about their role in becoming self-sufficient 

from the very beginning of the application process. 

Reduce the amount of time customers receive public assistance. 

Reduce assistance payments through increased earnings. 

Facilitate job retention. 

Build cooperative relationships and open communication between EW 

and ESS staff. 

Create a sense of urgency for staff and customers about achieving the 

goal of self-sufficiency. 


Overview of Programs 

Introduction This section contains information regarding when a customer is assigned to 

a work registration program. Continuing eligibility to cash assistance 

depends on successful participation in that program. 

Work 

programs 

Registration, 

pending 

basics 

There are three programs available to help cash aid customers achieve selfsufficiency. 

The chart below describes the program and who should 

participate in the program. 

Program name Description Who must participate 

California Indian 

Manpower 

Consortium (CIMC) 

Job seeking and self- 

sufficiency services for Native 

American tribal members 

Cal-Learn Educational requirements and 

supportive services for teen 

parent cash aid customers 

through the CalWORKs 

program and with Public 

Health 


(WTW) program 

Comprehensive job-readiness 

services offered through WTW 

for CalWORKs customers 

Any aided parent who is a member 

of certain Native American tribes 

Any Assistance Unit (AU) member 

who: 

Is under 19 years old, and 

Is pregnant or a custodial 

parent, and 

Does not have a high school 

diploma or GED 

All Work-Eligible Individuals (WEI). 

The EW will use the steps below to determine which program an individual 

must participate in and how to register or pend him/her for that program. 

Step Action 

1 Identify Native American tribal members and register by mail with the 

California Indian Manpower Consortium (CIMC). See CIMC 

Registration Procedures, this chapter. 

2 Identify teen parents and pend a Cal-Learn program in C-IV. See Cal- 

Learn Registration procedures in the Children and Eligibility Chapter of 

this handbook. 

3 Identify parents and AU members who are not eligible to participate or 

are exempt from the WTW program and record the exemption in C-IV. 

4 Pend all WEIs to the ESP WTW program. 

If a customer comes into the office and completes a CalWORKs 

application, the Office Assistant (O/A) screens customers for WTW 

using the TAD WTW CKLST 101 (E/S). If the customer meets 

requirements, the OA pends the WTW program. See TAD Office 

Procedures Handbook for additional information. 


Welfare-to-Work (WTW) Participation 

Introduction This section introduces the Welfare-to-Work (WTW) program which is the 

employment program included in CalWORKs. 

Communicating 

participation 

benefits 

Marketing 

tools 

It is critical that at all points of contact with the customer, the Eligibility 

Worker (EW) communicates and emphasizes the benefits of participation, 

including but not limited to: 

Ancillary payments for transportation, books, and other work or training 

related expenses. 

Benefits of employment; earnings, tax credits, positive role model, 

vacation, 401K, retirement, elimination of reporting requirements, 

Transitional CalFresh, Medi-Cal eligibility, etc. 

Child Care for CalWORKs recipient parents and for those parents who 

have not been discontinued from CalWORKs for more than 24 months 

through KidsNCare; this timeframe is based on the parent’s 

discontinuance date from CalWORKs. For additional information, see 

the Child Care Policy Handbook. 

Incentives available. 

Current job and training opportunities. 

The EW and Employment Services Specialist (ESS) will routinely provide 

information on the WTW program and services available to customers that 

will help increase engagement to meet Work Participation Rates (WPR), and 

the benefits of employment to achieve family self-sufficiency. Marketing tools 

include: 

• Engagement motivational flyers [WTW 812 (E/S) and WTW 813 (E/S)]. 

• “How Can We Help?” card (TAD 20 E/S) with EW/ESS contact information. 

• Open House and Job Fair flyers (available as events are scheduled). 

• Think of the Possibilities brochure (WTW 411EE). 

• Work Pays informational flyer (TAD 730 E/S). 



Welfare-to-Work (WTW) Participation, Continued 

Work-Eligible 

Individual (WEI) 

Customers not 

being served 

due to funding 

limitations 

For the WTW program, a Work-Eligible Individual (WEI) is defined as a 

parent or adult (or minor head-of-household) receiving CalWORKs 

assistance, or a non-recipient parent (sanction, safety-net, drug/fleeing felon) 

living with a child receiving assistance unless the parent is a: 

• Minor parent and not the head-of-household. 

• Non-citizen who is ineligible to receive assistance due to his/her 

immigration status. 

• Recipient of Supplemental Security Income (SSI) benefits or Aid to the 

Aged, Blind or Disabled. 

• Parent who is a recipient of Social Security Disability Insurance (SSDI) 

benefits; and 

• Parent providing care for a disabled family member living in the home, 

provided there is medical documentation to support the need for the 

parent to remain in the home to care for the disabled family member. 

All WEIs are included in the Work Participation Rate (WPR) calculation and 

must be evaluated by the EW for participation in the WTW program. 

The EW will pend the following customers to an WTW program, however, 

these customers are not currently being served due to funding limitations: 

• CalWORKs penalized customers who are not included in the AU 

• Safety Net (TANF and/or CalWORKs timed-out) customers 

• Sanctioned customers 

• Persons who violate a condition of their probation or parole 

• Persons who are fleeing to avoid prosecution, custody or confinement 

after being convicted of a crime that is a felony 

• Persons convicted of a drug-related felony after 12/31/97 for the 

possession, use or distribution of a controlled substance. 

• Persons who fail to assign child support rights 

These customers are WEIs and count toward WPR. This population is 

required to be included in the WPR and must be encouraged to become selfsufficient; 

however there is no risk to the non-recipient customer of further 

sanction or penalty for not participating in the WTW program, even when 

services are available. 




EW review 

requirements 

Coding 

registration/ 

exemption in 

C-IV 

Participation 

requirements 

The Eligibility Worker (EW) will determine if the customer must participate in 

the WTW program at: 

• Application/rescind/restoration 

• Additional persons application 

• Customer requests to volunteer in WTW 

• Inter-County Transfer (ICT) in 

• Expiration of an exemption 

• Graduation/GED completion of Cal-Learn teen, or teen turns 19 years old 

• Re-Evaluation (RE) 

• Reported changes in family composition, employment or new reason for 

exemption 

• Quarterly Report (QR 7) submission 

The EW will enter appropriate work registration and exemption coding in 

C-IV. There are only three Work Registration codes: Mandatory, Voluntary, 

or Exempt. 

If the customer is a Work-Eligible Individual (WEI), the EW will: 

• Pend the WTW Program, or 

• Enter exemption information (if appropriate). 

After the customer is pended to the WTW program, the continuing EW may 

assume the customer is participating as required unless notified to the 

contrary by the ESS. When the customer meets WTW participation 

requirements or becomes exempt from participation, they remain eligible to 

cash aid. 

When the customer fails to meet program requirements, a financial sanction 

is imposed through the discontinuance of cash aid for that individual. 

The ESS will notify the EW via a Task and an e-mail when a sanction is to be 

applied. 




WTW 

activities 

County WPR 

penalties and 

sanction 

The customer must complete activities assigned by the WTW Employment 

Services Specialist (ESS) in order to remain eligible for cash aid. 

Some of the activities WTW customers are assigned to are: 

• Orientation to the program 

• Appraisal of the customer's skills, history and current situation 

• Job search and job readiness activities 

• Employment (Subsidized or unsubsidized) 

• Unpaid Work Experience (WEX) 

• Subsidized employment 

• Self-initiated Programs of Education (SIP) 

• Volunteer (Community) Service 

• Training 

WTW may also provide Job Retention services to help working customers 

maintain employment and remain self-sufficient when cash aid stops, if 

funding permits. 

If TAD cannot engage WEI to participate the required number of hours per 

week, the county will face substantial financial State and Federal penalties 

and sanctions. 

To avoid WPR penalties and sanctions, it is the responsibility of all staff to 

inform customers of the advantages of working and becoming self-sufficient. 

We all must think about how we do business and perform our jobs in terms of 

promoting employment, work experience, volunteer (community) service, 

training opportunities, education, counseling and other services, which will 

benefit customers and increase our WPR. 


Exemption from Participation 

Introduction This section contains information regarding exemption from participation. All 

Assistance Unit (AU) members who receive federally funded cash aid are 

expected to fully participate in job-seeking activities. Some customers have 

barriers to participation in work programs and will be exempt from 

participation in the Welfare-to-Work (WTW) program. 

Except for children attending school, the goal for the exempt AU member is 

to overcome barriers to successfully completing WTW activities whenever 

possible. 

Reference The reference for this section is 42-712. 

Review 

requirements 

Exemption 

procedures 

Exemptions are determined during the application process; however 

continued use of a reason for exemption is reviewed: 

Before the exemption is due to expire, 

During the annual Re-evaluation (RE) of eligibility, or 

When needed as changes occur in the program. 

The exemption chart on the following pages will give exemption requirements 

for each exemption code. 

To exempt a cash aid customer from WTW participation, follow the 

step/action table below: 

Step Action 

1 Identify the exemption reason. 

2 Obtain and image the proof needed to support the exemption. 

3 Record the exemption in the C-IV system Work Registration page 

with the appropriate reason. See C-IV User Guide titled, 

“Exemption WTW/FSET”. 

4 Notify the Employment Services Specialist (ESS) setting a Task 

and sending an e-mail. 

Note: The ESS will update the WTW program Status page. 

5 Complete a Journal entry. 


Exemption Reasons 

Introduction This section contains information regarding exemption reasons, who can use 

documentation and when to review. 

Exemption 

table 

Use the following table when determining Welfare-to-Work (WtW) 

exemptions: 

Exemption Who can use Documentation Review 

Child under 16 

years old 

Child enrolled in 

school full time 

NOTE: The 16- 

17 year old who 

graduated high 

school, 

vocational/ 

technical school 

or obtained a 

GED would work 

register with 

WTW 

Any child under 16 years old 

unless a Cal-Learn teen 

16-18 year old children: 

In high school and/or 

vocational/technical school 

full time, and 

Have not completed 12 th 

grade, GED, or graduated, 

and 

Will graduate by 19 th 

birthday, and 

Not attending school as an 

WTW activity 

Frye children 18-19 year old children: 

In high school and/or 

vocational/technical school 

full time 

Have not completed 12 th 

grade, GED, or graduated 

Not attending school as an 

WTW activity 

Proof of the child’s age Set a Task for 30 

days before the 

child’s 16 th birthday 

to obtain school 

attendance 

verification 

If proof of school 

attendance is not 

provided, when the 

child reaches 

his/her 16 th 

birthday, pend a 

WTW program in 

C-IV 

Proof of the child’s 

age 

TAD 144.1 

TAD 44 for 18 year 

olds 

Proof of the child’s age, 

and 

TAD 44 

IEP, or 

Doctor’s statement, 

or 

CW 61, or 

SSI verification 

Set a Task for 30 

days before the 

child’s 18 th birthday 

to determine if a 

WTW case needs 

to be pended, or 

Set a Task for 

month of 

graduation/GED 

completion, and 

Pend a WTW 

program in C-IV 

Set a task for 30 days 

before the child’s 19 th 

birthday to determine if 

the EW needs to pend 

a WTW program in 

C-IV, or another 

exemption applies 

Note: These exemptions cannot be applied to teens meeting Cal-Learn criteria. They must be referred 

to and participate in the Cal-Learn program. 



Exemption Reasons, Continued 

Exemption table (continued) 


Age 60 or older Any Assistance Unit (AU) 

member age 60 or older 

Proof of age N/A 

Physically/ Any AU member who: 

• CW 61, or 

• Set a Task 30 days 

mentally 

incapacitated 

• Will be incapacitated for at 

least 30 days from the date 

proof of the incapacity is 

provided, and 

• Copies of disability 

benefit checks 

(CW 61 is the 

preferred verification) 

• 

prior to the date the 

condition is 

expected to end. 

In the end month, 

• Is actively seeking medical 

treatment to overcome the 

incapacity, 

In the absence of the 

CW 61, verification may 

be a statement from a 

send the customer 

a CW 61 and 

request the 

or 

physician or licensed / customer provide 

• Is a woman whose doctor 

prescribes a postpartum 

recovery period of more 

than six months. 

Customers who are expected 

to be incapacitated for more 

than 90 days (except in the 

certified psychologist. A 

written statement is 

preferred. Verbal 

verification must be 

narrated thoroughly in 

the C-IV Journal and 

followed up with a 

request for written 

verification. A written or 

• 

proof that the 

incapacity is 

expected to 

continue. 

Re-verify at RE if 

the condition is 

acute, permanent 

or expected to last 

case of postpartum 

complications) must be referred 

to the Department of 

Rehabilitation via the 

TAD 282 D. 

narrated doctor’s 

statement must include 

the: 

• Reason the customer 

cannot work or attend 

training 

• Duration of the 

disability 

• Description of 

postpartum 

• 

• 

more than one year 

Re-verify any time 

there is reason to 

believe that there 

has been a change 

in the condition 

and/or ability to 

work 

If proof of 

complications and continuing disability 

the baby's DOB 

is not provided, 

• Doctor’s name, 

address and 

telephone number 

pend a WTW 







Parent caring 

for household 

member who is 

Mentally or 

Physically 

impaired 

Care of First 

Child (a child 

under 12months 

of age); 

commonly 

referred to as 

the Full 

Exemption (FE) 

(See 

“Determining 

eligibility to the 


Child under 12 

months 

of age 

exemption - FE” 

block for 

additional 

information) 

A parent needed in the home to care for 

another household member who has a 

mental or physical impairment, 

Note: Customers who are exempt for 

caring for a disabled family member 

living in the home are excluded from 

WTW participation by federal 

regulations. 

Parent or caretaker relative who: 

Is personally responsible for the 

care of a child under 12 months old. 

Has not been exempt for this 

reason for more than 12 months in 

the parent’s lifetime. 

This exemption: 

Is based on care for the youngest 

child in the home. 

Ends when the child turns one (1) 

year old. 

Can be used when another child is 

born until the 12 month time limit is 

reached. 

May be switched from the mother to 

the father and vice versa in two 

parent Assistance Units (AUs). 

Note: Parenting or pregnant teens 

without a high school diploma/GED 

cannot use this exemption. 

CW 61, or 

A written 

statement from a 

licensed or 

certified doctor, 

psychologist or 

member of the 

doctor’s staff. 

Verbal verification 

must be narrated 

thoroughly in the 

C-IV Journal and 

followed up with a 

request for written 

verification. 

The written or 

narrated doctor’s 

statement must 

include: 

The nature of the 

impairment 

The need for care 

in the home 

The doctor’s 

name, address, 

and telephone 

number 

Proof of the age of the 

child on which the 

exemption is based 

If the condition 

is expected to 

last less than a 

year: 

Set a Task for 

30 days prior to 

the date the 

condition is 

expected to 

end, and 

Send the 

customer a CW 

61 and request 

the customer 

provide medical 

proof they are 

still needed in 

the home 

If proof of 

continuing need 

is not provided, 

pend a WTW 


(if the customer 

does not have 

an open WTW 

case) 

Set a Task for the 

last month the 

parent/ caretaker 

relative is eligible to 

use the exemption 

based on: 

Youngest child’s 

first birthday, or 

Parent’s 12 

month lifetime 

limit for using 

this exemption 

is reached, and 

Pend a WTW 







Care of 

Subsequent 

Child under six 

(6) months of 

age; commonly 

referred to as the 

limited 

exemption 

Note: See 

IIN #11-041, this 

exemption will 

not be used until 

7/1/2012. 

Pregnant and 

doctor states 

unable to work 

VISTA Volunteer 

(Volunteer in 

Service to 

America) 

A parent or caretaker relative 

who has already used the entire 

12 month lifetime limit of the Care 

of First Child exemption – FE. 

This exemption may be used 

when subsequent children are 

born or adopted. 

This exemption begins the month 

after the birth or adoption of the 

child. 

This is a six (6) month exemption. 

Note: Parenting or pregnant 

teens without a high school 

diploma or GED cannot use this 

exemption. 

Any AU member who: 

Is pregnant, and 

Cannot work, or attend 

training due to verified 

complications with the 

pregnancy, and 

Is not a Cal-Learn teen. 

Any AU member who is a fulltime 

VISTA Volunteer. 

A birth certificate or 

other credible document 

verifying the birth or 

adoption of the child. 

CW 61 or statement 

from a physician. A 

written statement is 

preferred. Verbal 

verification must be 

narrated thoroughly in 

the C-IV Journal and 

follow up with a request 

for written verification. 

Written or verbal proof 

must have: 

The expected date 

of birth 

The reason the 

person cannot work 

or participate in 

training 

Duration of the 

incapacity 

The doctor’s name, 

address, and 

telephone number 

Copy of VISTA 

earning statement 

Written statement 

from VISTA or 

Federal Region IX 

Set a Task for the 

last month of this 

exemption. 

In the final month, 

determine if the 

customer is 

exempt for another 

reason or pend a 


C-IV. 

At the time a 

pregnancy is 

reported. 

Set a Task to flag 

the birth month. 

Following the birth 

of the child, 

determine if the 

customer is 

exempt for another 

reason, such as 

care of a child 

under 6 or 12 

months or pend a 


C-IV. 

Quarterly with the 

QR 7. 





Child under 

12 months of 

age exemption - 

FE 

The Eligibility Worker (EW) will refer CalWORKs eligible customers with a 

child under one to the ESS to determine a Care of First Child - FE 

exemption. The EW will follow the chart below. 


An applicant, Refer the customer to WTW 

Orientation. 

A recipient, Set a Task for the ESS to review the 

customer for a Care of First Child – 

FE exemption. 

Note: Pregnant or parenting teens without a high school diploma are not 

eligible for Care of First Child - FE exemption. Cal-Learn teens are referred 

to a Cal-Learn EW. 


Administering the Program 

Introduction This section contains information regarding administering the Welfare-to- 

Work (WTW) program. 

EW duties Eligibility Worker (EW) responsibilities for referring customer to the WTW 

program include: 

Pend a WTW program when the customer qualifies for the Welfare-to- 

Work (WTW) program. 

Notify the ESS by setting a Task and sending an e-mail when an 

exemption ends. 

Notify the Employment Services Specialist (ESS) within 24-hours by email 

when a customer reports any change in employment (increase, 

decrease in wages, termination or change of employment). 

Apply financial sanctions for non-participation within seven (7) calendar 

days of notification of non-compliance. 

Notify the ESS by Task and an e-mail when a sanction has been initiated. 

Take actions as directed by the Appeals Unit. 

End financial sanctions when the customer fulfills requirements prior to 

the sanction effective date. 

Review ESS Journal entries for pertinent case information. 

Openly communicate with the ESS. 

Serve as liaison between the customer and ESS as necessary. 

ESS duties ESS responsibilities for administering the WTW program include: 

Assign customers to appropriate activities and monitor progress based 

on customer needs and situations. 

Notify the EW by setting a Task and sending an e-mail when a sanction 

needs to be applied and the effective date of the sanction, or when a 

sanction can be ended. 

Notify the EW by email when new employment is reported where income 

is anticipated to exceed the Income Reporting Threshold (IRT). 

Review Journal entries for pertinent case information. 

Openly communicate with Eligibility staff. 

Serve as liaison between the customer and Eligibility as necessary. 


Introduction to the Work Participation Rate (WPR) 

Introduction This section provides an introduction to the Work Participation Rate (WPR). 

WPR The Work Participation Rate (WPR) is used to measure the percentage of 

All-family and Two-parent family cases that have verifiable documentation in 

their case record which supports meeting Welfare-to-Work (WTW) program 

requirements for the minimum required hours per week. 

WPR team 

communication 

Federal WPR 

not met 

Documentation 

for paid 

activities 

Single parent families (also called all-families) must participate 32 hours 

per week, and 

Two-parent families must participate 35 hours per week (both parents 

can contribute toward meeting the 35 hour requirement). 

The Eligibility Worker (EW) and the Employment Services Specialist (ESS) 

can help increase WPR in the following ways: 

Promoting WTW, 

Informing customers of the benefits of WTW, and 

Encouraging participation in WTW. 

Note: EWs will communicate to the ESS via email within 24 hours when a 

customer reports any change in employment (new job, increase/decrease in 

wages or hours of employment, termination, etc.). 

If California does not meet Federal work participation requirements, counties 

that fail to meet these requirements will have to share any penalty imposed 

on the state for failure to achieve the outcomes required by Federal law. 

One of the most important factors in ensuring funding for the Transitional 

Assistance Department (TAD) WTW program is customer participation in 

WTW activities. Meeting the standards for participation coincides with TAD 

ESP’s objective of self-sufficiency for the customer. 

Documentation must be obtained for paid WTW activities to count toward 

WPR. Verification must include: 

Pay stubs with QR7, 

Other employer-produced documents, and/or 

The Work Number. 



Introduction to the Work Participation Rate (WPR), Continued 

Documentation 

for unpaid 

activities 

Documentation must be obtained for unpaid WTW activities to count toward 

WPR. Verification must include signed documents: 

• Verifying actual hours of scheduled participation, 

• Name of work site supervisor, education provider, or other service 

provider, and 

• Name and phone number of the person verifying hours. 


Initiating Participation 

Introduction This section contains information regarding the application process. 

Getting started: 

Intake 

Getting started: 

Continuing 

The chart below gives the basic steps for the Intake process. 


1 Office Assistance (OA) pends a WTW program for all CalWORKs 

adults based on information on the TAD WTW Chklst 101 and 

TAD 278 ID. 

2 Eligibility Worker (EW) identifies other AU members who are not 

exempt from work participation or applicants who volunteer to 

participate prior to approval, and pends a WTW program. 

3 EW approves CalWORKs and the WTW pending program is autoassigned 

to a special “new active” caseload. 

4 OA assigns new active WTW programs to an ESS and schedules 

customers for a group Orientation. 

5 ESS takes action based on customer’s attendance at the group 

Orientation or failure to appear. 

The continuing EW will follow the steps below to initiate participation when a 

recipient customer becomes eligible to participate in Welfare-to-Work (WTW) 

activities: 

Step Action 

1 Determine customers who are eligible to begin participation in 

WTW activities. 

2 Change the status to Mandatory in the C-IV system on the Work 

Registration Detail page. 

3 Send a Task and e-mail to the ESS informing them of the status 

change and effective date. 

4 Journal the change in WTW status. 


Acting on Changes During Participation 

Introduction This section contains information regarding acting on changes during 

participation. 

Partial list of 

changes 

The Eligibility Worker (EW) will use the chart below to help decide what 

actions to take related to Welfare-to-Work (WTW) participation in a variety of 

common situations. 

When the EW… Then the EW… 

Determines a WTW customer 

becomes exempt, 

Determines an exempt 

customer is eligible and 

required to participate in the 

WTW program, 

Determines a new mandatory 

customer, 

Conducts an annual Reevaluation 

(RE) of eligibility, 

Transfers a case to another 

district office or county (IDT or 

ICT Out), 

Is notified by ESS to apply a 

sanction for WTW noncooperation, 

Is notified by ESS the 

sanctioned customer has 

cooperated with WTW 

requirements, 

Sets a Task and sends an e-mail with the 

exemption reason and effective date to the 


Changes the status to Exempt in the C-IV 

system under the Work Registration Detail 

page. 


Sets a Task and sends an e-mail to the ESS 

regarding status change and effective date. 

Changes the status to Mandatory in C-IV on the 

Work Registration Detail page. 


Pends a WTW program in C-IV. 

Reviews participation and exemption entries for 

each AU member to ensure appropriateness. 

Initiates work registration or updates, as needed. 

Notifies the ESS via Task and e-mail of the 

scheduled RE appointment if customer is WTW 

sanctioned. 


Sets a Task and sends an e-mail to notify the 

ESS of the change. 


Takes action to remove the customer from cash 

aid within seven (7) calendar days of the date 

provided by the ESS. 

Sets a Task and sends an e-mail to notify ESS of 

the action taken. 


Adds the customer back into the AU. 


ESS of the action taken. 



CWPHB #4622 ERRATA (11/11) WORK REQUIREMENTS 7-18

Acting on Changes During Participation, Continued 

Distribution (continued) 

When the EW… Then the EW… 

Is notified by ESS to rescind 

the sanction due to good 

cause for non-participation, 

Receives a Task and e-mail 

from the ESS reporting the 

status of a customer has 

changed, 

Receives an automated Task 

to Review WEX/Community 

Service hours, 

Identifies a potential Cal-Learn 

participant, 

Rescinds the discontinuance for the customer. 


ESS of the action taken. 


Reviews the case. 

Makes any necessary changes. 


Clears the Task. 


Note: See C-IV User Guide: Tasks, Searching and 

Reassigning. 

Refers the teen to the Cal-Learn program using the 

instructions given in this Chapter. 

CWPHB #4638 (08/12) WORK REQUIREMENTS 7-18.1

Sanctions 

Introductions This section contains information regarding CalWORKs sanctions. 


What is a 

sanction? 

Who does the 

work? 

EAS 42-721. 

When a person is required to participate in the Welfare-to-Work (WTW) 

program and fails to do so, the customer is sanctioned. 

A sanction reduces the aid payment to the Assistance Unit (AU) by 

discontinuing cash assistance for the person who fails to cooperate with 

WTW requirements. 

A sanction is a collaborative effort between the Employment Services 

Specialist (ESS) and the Eligibility Worker (EW). The sanction works as 

follows: 


1 The ESS notifies the EW via a Task and Journal entry the 

customer has failed to cooperate with WTW requirements and 

the effective date of the sanction. 

Note: In district offices with designated “Sanction” EWs, the 

assigned EW will notify his or her supervisor to inform the 

“Sanction” EW of the Sanction/Penalty Task. 

2 The EW initiates the customer’s discontinuance from 

CalWORKs within seven (7) calendar days, and notifies the 

ESS via Task and e-mail. 

Note 1: The EW does not send a negative action NOA because 

the customer was already informed of his/her grant reduction 

and the date aid will be reduced with one of the following forms: 

the NA 840, NA 845, NA 816, or NA 817. The EW will review 

the NOA to ensure all budget information is correct. If the 

budget information is incorrect, the EW will send a ten (10) day 

NOA with the correct budget information (the sanction effective 

date does not change). 

Note 2: Any aid paid to the sanctioned customer(s) after the 

sanction effective date is considered an overpayment. 

3 The ESS, depending upon whether cooperation occurred before 

or after the customer was discontinued, notifies the EW when 

the customer has “cured” the sanction by completing WTW 

requirements. 

4 The EW resumes the aid payment for the customer depending 

upon whether cooperation occurred before or after the customer 

was discontinued. 



Sanctions, Continued 

Who is 

sanctioned? 


of sanction 

Sanctions will be imposed on customers based on failure to participate in the 

Welfare-to-Work (WTW) program requirements as detailed below: 

If the customer is… Then discontinue aid for… 

The Principal Earner (PE), The PE. 

The non-participating spouse or second 

parent only when instructed to do so by the 

ESS. 

A caretaker relative other The customer only. 

than the PE, 

The non-participating The spouse or second parent only when 

spouse or second parent, 

A 16-18 year old ESP 

customer, 

instructed to do so by the ESS. 

The 16-18 year old only. 

The effective date of a sanction is the first day of the month for which a timely 

Notice of Action (NOA) can be given, as this is a County-initiated action. 

Once the NOA has been sent by the ESS giving the effective date of the 

sanction, the effective date will not change. Any aid paid to the sanctioned 

customer(s) after the sanction effective date will be considered an 

overpayment. 

Example 1 The ESS sends the NA 840, or NA 845 on 4/15 advising the customer of a 

6/1 effective date of a sanction. ESS notifies EW to apply sanction on 5/6. 

Action is taken timely by EW (within 7 calendar days) and the sanction is 

imposed effective 6/1. No overpayment is charged, as the action is 

completed timely. 

Example 2 The ESS sends the NA 840, or NA 845 on 4/15 advising the customer of the 

6/1 effective date of sanction. ESS notifies EW to apply sanction on 5/6. 

Action is not taken timely by EW (within 7 calendar days) and the sanction is 

imposed 7/1. The portion of the 6/1 aid payment intended for the person who 

should have been sanctioned is an overpayment. 

Note: If the ESS fails to notify the EW timely, and the EW cannot apply the 

sanction by the effective date, an overpayment will apply. 

Example 3 The ESS sends the NA 840, or NA 845 on 4/26 advising the customer of the 

6/1 effective date of sanction. ESS notifies EW to apply sanction on 5/17. 

Action is taken timely by EW (within 7 calendar days); however, month-end 

batch for 6/1 has already run and the sanction is imposed 7/1. The portion of 

the 6/1 aid payment intended for the person who should have been 

sanctioned is an overpayment. 


Sanction Procedures 

Introduction This section gives preliminary information instructions regarding sanctions, 

and steps to take on processing the sanction. 

Preliminary 

information 

Use the instructions in the “Sanction Procedures” chart on the following page 

to impose a sanction on a customer who lives in the home and the remaining 

Assistance Unit (AU) remains eligible to CalWORKs. 

Look for instructions later in this Chapter when the: 

• Sanctioned customer: 

− Leaves or returns to the home during the sanction period. 

− Becomes exempt during the sanction period. 

• Entire AU is to be discontinued before the effective date of the sanction. 

Some points to remember are: 

• The Eligibility Worker (EW) completes sanction actions only when 

instructed to do so by the Employment Services Specialist (ESS). 

• Sanctions are applied only to the customer(s) specified by the ESS. 

• Sanctions are to be initiated within seven (7) calendar days from the 

date the request is received from the ESS. 

• The ESS provides the effective date of the sanction. 

• The EW does not send a negative action Notice of Action (NOA) 

because the customer was already informed of his/her grant reduction 

and the date aid will be reduced with one of the following forms: the 

NA 840, NA 845, NA 816, or NA 817. 

− The EW will review the NOA to ensure all budget information is 

correct. If the budget information is incorrect, the EW will send a ten 

(10) day NOA with the correct budget information. 

• A sanctioned caretaker relative may still be the payee for the cash aid. 



Sanction Procedures, Continued 

Sanction 

procedures 

Sanction 

requested on a 


case scheduled 

for 


Use the instructions below to impose a sanction on a customer in the home 

when the rest of the AU remains eligible to cash aid. 

Step Action 

1 Review the program to ensure the sanction is appropriate. If not, 

contact the ESS to discuss the situation. 

2 Determine if a CalFresh sanction should be imposed. The 

duration of the CalFresh sanction is the same as that of the 

CalWORKs sanction. 

3 Initiate the sanction, and 

• Set a Task, and 

• Send an e-mail notifying the ESS that the sanction has been 

initiated. 

Note: Do not send a negative action NOA because the customer 

was notified by the ESS with either the NA 840, NA 845, NA 816, 

or NA 817. 

4 Discontinue the customer, and: 

• Provide post Medi-Cal. 

• Change the eligibility entry to that of a person excluded from 

the AU. 

• Establish the deregistered effective date and deregistered 

reason entry. 

5 Journal the sanction reason and actions taken. 

When a WTW sanction has been requested for a CalWORKs case 

scheduled for discontinuance prior to the effective date of the sanction, the 

EW will apply the sanction as requested. 

Note: Do not end date the WTW non-compliance on the C-IV Eligibility 

Non-Compliance List page when the entire CalWORKs case has been 

discontinued and the sanctioned customer has not complied with WTW 

requirements. This will ensure the customer’s sanction will be applied if 

he/she re-applies for CalWORKs, or his/her CalWORKs case is restored or 

rescinded. 


Sanction Appeals 

Introduction This section contains information regarding appeal requests filed by 

customers when a Notice of Action (NOA) is sent informing them of the 

proposed Welfare-to-Work (WTW) program sanction. If the customer files an 

appeal, the Appeals Unit will notify both the Employment Services Specialist 

(ESS) and the Eligibility Worker (EW). 

Program 

Integrity 

Division (PID) 

Program 

actions 

Taking action required by the Appeals Unit is the EW’s responsibility. 

When the Program Integrity Division (PID) contacts a worker (via telephone 

or e-mail) and requests information on a case, the ESS and/or EW has three 

(3) working days to answer PIDs request. The Appeals Specialist needs this 

information for hearing purposes. 

Some of the actions that may be required after a customer files an appeal on 

a proposed sanction are listed below. The EW will follow instructions 

received from the Appeals Unit. 


Appeal was filed 

before the 

effective date of 

the sanction, 

Customer failed to 

appear for the 

hearing, 

Hearing decision 

is in the 

customer’s favor, 

Hearing decision 

is in the agency’s 

favor, 

The Appeals Unit will instruct the EW to restore aid 

pending the hearing decision. 

If aid was restored the Appeals Unit will instruct the EW 

to apply the sanction. 

If aid was not restored because the customer failed to 

request the appeals hearing timely no action is 

necessary. 

If aid was restored at the time of appeal no action is 

necessary. 

If aid was not restored the Appeals Unit will instruct the 

EW to restore aid. 

If aid was restored at the time of appeal the Appeals 

Unit will instruct the EW to apply the sanction. 

If aid was not restored no action is necessary. 

Overpayments When the hearing decision is in the agency’s favor, there is no overpayment 

for the period aid was continued pending the decision. The sanction is 

applied after the decision is reached. 


Other Actions Related to Sanctions 

Other program 

actions at the 

time of 

sanction 

Sometimes it is necessary to impose a sanction, but other changes in the 

program prevent the sanction from actually being imposed at the right time. 

These changes include things such as the sanctioned customer: 

• Leaves the home 

• Returns to the home 

• Becomes exempt 

Other factors such as the person’s status in the Assistance Unit (AU) and 

whether the sanction Notice of Action (NOA) was sent prior to the change will 

help determine the actions the Eligibility Worker (EW) must take, when the 

above situations occur. 



Other Actions Related to Sanctions, Continued 

Other program 

actions at the 

time of 

sanction 

Change: After 

sanction notice 

Sometimes it is necessary to impose a sanction, but other changes in the 

program prevent the sanction from actually being imposed at the right time. 

These changes include things such as the: 

Sanctioned customer: 

– Leaves the home 

– Returns to the home 

– Becomes exempt 

Entire Assistance Unit (AU) is discontinued before the effective date of 

the sanction. 

Other factors such as the person’s status in the AU and whether the sanction 

Notice of Action (NOA) was sent prior to the change will help determine the 

actions the Eligibility Worker (EW) must take when the above situations 

occur. 

Take the following actions on the changes listed when the AU has been 

notified of the sanction. 

When the 

sanctioned 

customer… 

Leaves the home 

before the sanction 

effective date, 

Returns home and 

refuses to 

cooperate with 


(WTW) program, 

Is exempt from 

participation, 

And is… Then the EW will… 

Not the PE, 

Not the only 

eligible child, 

The Primary 

Earner, 

The only eligible 

child, 

Notify and send a NOA, customer will 

be discontinued from the appropriate 

aid program(s) because he/she is out 

of the home. 

Notify the ESS via Task and e-mail. 

Take the actions listed above, and 

Ask the ESS for any instructions 

pertaining to the second parent. 

Notify the AU the program will be 

discontinued. 

Notify the ESS through a Journal entry 

that the program is being discontinued. 

Not the PE, Add to AU as a sanctioned individual. 

Is the PE, Run EDBC with correct aid code, if 

needed. 

Add to AU as a sanctioned individual. 

Ask the ESS for any instructions 

pertaining to the second parent. 

Verify exemption and change WTW 

code on the Statement of Facts and in 

C-IV. 

Notify the ESS via Journal entry and 

Task. 



Other Actions Related to Sanctions, Continued 

Change: After 

sanction 

noticediscontin 

uance and 

before sanction 

date 

Take the following actions on the changes listed when the AU has been 

discontinued from CalWORKs before the effective date of the sanction, and 

the AU subsequently reapplies and is eligible for CalWORKs. 

If the CalWORKs case was 

discontinued… 

Prior to the effective date of the 

WTW sanction, 

• Prior to the effective date of the 

WTW sanction, and the 

• Discontinuance is rescinded, 

• After the effective date of the 

WTW sanction, and the 

• Discontinuance was not 

completed timely, 

Then at reapplication … 

Apply the WTW sanction. 

Apply the WTW sanction effective 

the date provided on the previous 

NOA sent by the Employment 

Services Specialist (ESS). 

• Apply the WTW sanction to the 

AU member effective the date 

listed on the previous NOA sent 

by the ESS. 

• Compute overpayments for 

months cash aid was received 

for the AU member after the 

sanction should have been 

applied. 

Examples The following examples explain what action to take when the CalWORKs 

case is discontinued prior to a WTW sanction being applied, and the 

customer subsequently reapplies for CalWORKs. 

Example 1: Customer applies for CalWORKs on 8/3. Customer was due to 

be sanctioned on 4/1, but previous CalWORKs case was discontinued 3/31 

due to non-receipt of the QR 7. 

Action: CalWORKs is authorized on 8/13 and the WTW sanction effective 

4/1 is applied. 

Example 2: Customer applies for CalWORKs for herself and two children on 

7/28. Customer was due to be sanctioned on 6/1 but previous CalWORKs 

case was discontinued 5/31 due to non-receipt of QR 7. 

Action: The application is pended. The WTW sanction is applied to the 

customer at reapplication. The case is over income for an AU of two, but is 

eligible with an AU of three. The customer is referred to the duty ESS to cure 

his/her sanction. 


Cooperation After a Sanction 

Introduction This section explains when and how the Eligibility Worker (EW) is informed of 

cooperation to cure a Welfare-to-Work (WTW) sanction and when to restore 


Determining 

when the 

customer has 

cooperated 


cash aid 

Beginning date 

of aid 

The Employment Services Specialist (ESS) determines when the customer 

has cooperated with Welfare-to-Work (WTW) requirements by setting a Task 

and sending an e-mail to the EW stating the customer has cooperated with 

WTW and has cured the sanction. 

Aid for the sanctioned customer cannot be restored until the ESS notifies the 

EW that the customer has cooperated. The EW must take action within three 

(3) working days of this notification to restore benefits to the customer. The 

date the customer contacts ESS to cure the sanction is used to determine 

the beginning date of aid. The procedure for restoring cash aid is outlined in 

the table below: 


1 Customer contacts ESS and cures WTW sanction. 

2 ESS notifies the EW the: 

• Customer has cooperated with WTW, and 

• Date the customer contacted ESS to cure sanction. 

Note: The contact date is used to determine the beginning date of 

aid (BDA) for the sanctioned customer. 

3 EW: 

• Takes action within three (3) working days from the date of 

ESS notification. 

• Sets task to notify the ESS aid is restored for the customer. 

Once the sanction has been cured aid for the customer is restored. The 

chart below describes the BDA. 

If the case is a… Then the Beginning Date of Aid is the… 

Continuing case, First day of the month following the date the 

customer contacted the ESS to indicate 

his/her desire to cure the sanction. 

Additional person, First day of the month following the date the 

customer contacted the ESS to indicate 

his/her desire to cure the sanction, or the 

date all eligibility conditions are met, 

whichever date is later, following quarterly 

reporting rules for adding persons to the 

Assistance Unit (AU). 



Cooperation After a Sanction, Continued 


cash aid 

examples 

The following are examples of when to restore cash aid. 

Example: Continuing case – A sanctioned customer contacts the ESS on 

July 14 and indicates she wishes to cure her sanction. The customer signs 

the curing plan on July 17, which specifies that she must participate in two 

weeks of job readiness beginning on July 23. She successfully completes 

job readiness on August 5, and cures her sanction. The customer’s cash aid 

is restored back to August 1. 

Example: Pending case – The customer applies for cash aid on July 1 and 

cures sanction on July 9. The customer’s BDA is July 9; the other AU 

members’ BDA is July 1. 

Note: If the case is processed prior to the customer contacting the ESS or 

curing the sanction, then the customer’s BDA is the first of the following 

month, August 1. 


California Indian Manpower Consortium, Inc. (CIMC) 

Introduction This section contains information regarding the California Indian Manpower 

Consortium (CIMC). CIMC administers the Native Employment Works 

(NEW) program. 

Reference The reference for this section is 42-711. 

Overview The CIMC administers the NEW program. The CIMC NEW program 

provides employment and training services for Native American tribal 

members in 22 California counties and 58 tribes who receive cash 

assistance. A list of those counties and tribes is included in this section. 

Identifying and 

verifying CIMC 

NEW 

customers 

Nonparticipation 

penalties 

The goals of the CIMC NEW program are to: 

Help tribal members find and retain employment, and 

Promote self-sufficient Native American families. 

When a customer meets the participation requirements for the CIMC NEW 

program, they meet Welfare-to-Work requirements necessary for the receipt 

of CalWORKs cash assistance. People who participate in the CIMC NEW 

program will not be required to participate in Welfare-to-Work (WTW) 

program activities. 

In two-parent homes, both parents must be referred to the CIMC NEW 

program. The NEW program will determine participation requirements for 

each parent. 

When a cash aid customer identifies him/her self as a member of one of the 

participating tribes, the Eligibility Worker (EW) will make the referral to CIMC 

NEW as described on the following page. 

CIMC will verify the customer is a registered member of a participating tribe 

within 30 days of receipt of the referral for services. 

If CIMC reports the customer is not eligible for CIMC NEW services, the 

customer must be referred for employment services through the WTW 

program if not exempt. 

CIMC will notify the EW when a customer does not participate in the NEW 

program as required. The customer must then be financially sanctioned. The 

EW will send a ten (10) day Notice of Action (NOA). 


CIMC Registration Procedures 

Introduction This section explains the California Indian Manpower Consortium (CIMC) 

registration process and how to communicate with CIMC. 

Initial 

registration 

Communication 

with CIMC 

Follow these steps to register members of participating tribes for CIMC NEW 

employment services. 

Step Action 

1 Identify Native Americans who are members of participating CIMC 

tribes through their statements at application and Re-evaluation 

(RE). Refer to the following page for a list of participating tribes 

and counties. 

2 Inform the customer(s) they will be referred to CIMC NEW for 

employment services and they must meet NEW program 

requirements for continuing eligibility to cash assistance. 

3 Complete the form TAD/CIMC 001. Mail the registration form to: 

• CIMC – Central office 

Native Employment Works (NEW) 

4153 Northgate Blvd. 

Sacramento, CA 95834 

Two primary CIMC NEW program considerations are a tribal member’s 

residence and receipt of cash aid. 

Use the TAD/CIMC 001 to inform CIMC NEW when the customer: 

• Is discontinued from cash aid, or 

• Moves to another California county, or 

• Moves to another state. 

In addition to the central office listed in the table above, CIMC NEW has a 

field office in San Bernardino. The address is: 

CIMC – San Bernardino/San Jacinto Field Office 

21250 Box Springs Rd., Suite 204 

Moreno Valley, CA 92557 


CIMC Participating Tribes and Service Areas 

Introduction This section gives the CIMC tribes and their service area. 

Counties and 

tribes 

The 57 Native American tribes and 22 California counties served by the 

CIMC NEW program are listed in the following table. 

County Tribes County Tribes 

Butte Berry Creek Mendocino • Coyote Valley 

• Hopland 

• Pinoleville 

• Potter Valley 

• Redwood Valley 

• Round Valley 

• Sherwood 

Valley 

Colusa Cortina Modoc Fort Bidwell 

Del Norte • Elk Creek 

Plumas Greenville 

• Resighinin 

Fresno • Big Sandy 

Riverside • Cabazon 

• Cold springs 

• Cahuilla 

• Table Mountain 

• 

Reservation 

Morongo 

• Santa Rosa 

• Torres-Martinez 

Glenn Grindstone San Bernardino • Fort Mojave 

• San Manual 

Humboldt • Blue Lake 

San Diego • Barona 

• Karuk 

• Mesa Grande 

• Rohnerville 

• Campo 

• Trinidad 

• Pala 

• Cuyapaipe 

• Pauma 

• La Jolla 

• Rincón 

• La Posta 

• Santa Isabel 

• Manzanita 

• Viejas 

Inyo • Benton-Paiute Shasta Redding 

• Bishop 

• Big Pine 

• Lone Pine 

Kings • Rancheria 

Siskiyou Karuk 

• Santa Rosa 

Lake • Elem Indian Colony Tuolumne Tuolumne 

• Robinson 

• Sulpher Bank 

Lassen Suksanville 

Madera Picayune 




CHAPTER 8 

Resources 

Overview ........................................................................................................................ 8-1 

Basic Resources ............................................................................................................ 8-2 

Identifying Resources ..................................................................................................... 8-5 

Resource Table .............................................................................................................. 8-7 

Evaluating Resources .................................................................................................... 8-9 

Eligibility Determination Process .................................................................................. 8-10 

Motor Vehicle Value Determination .............................................................................. 8-11 

Real Estate Value Determination ................................................................................. 8-16 

Lien Process ................................................................................................................ 8-18 

Transferred Resources ................................................................................................ 8-21 

Restricted Accounts ..................................................................................................... 8-22 

Retirement/Educational Accounts ................................................................................ 8-26 


Overview 

Resources 

Introduction This section contains information regarding what items count toward the 

allowable resource/property limit in the CalWORKs program, what items are 

exempt from consideration, the limit for each family based on the ages of the 

family members, and the impact, if any, when ownership of resources is 

transferred to someone else. 


Eligibility & Assistance Standards (EAS) 42-201, 42-203, 42-205, 42-207, 

42-207, 42-209, 42-2001, 42-213, 42-2015, 42-219, 42-221, and 42-223 

Manual of Policies & Procedures (MPP) 63-501.1, 63-501.2, 63-501.5 

and 63-1101.1 



Basic Resources 8-2 

Identifying Resources 8-5 

Resource Table 8-7 

Evaluating Resources 8-9 

Eligibility Determination Process 8-10 

Motor Vehicle Value Determination 8-11 

Real Estate Value Determination 8-16 

Lien Process 8-18 

Transferred Resources 8-21 

Restricted Accounts 8-22 

Retirement/Educational Accounts 8-26 

CWPHB #4644 (01/13) RESOURCES 8-1

Basic Resources 

Introduction This section contains information regarding resource limits, eligibility 

determination, the spend-down process, and recording the eligibility 


References The following Manual of Policies & Procedures (MPP) references are 

applicable to information under this section. 

Whose 

resources to 

count 

63-501.1 

63-501.2 

63-501.5 

63-1101.1 

The resources of the following family members are included when 

determining resource eligibility: 

AU Members Non-AU Members Excluded People 

All AU members 

including those who 

are penalized due to: 

Immunizations 

School attendance 

Intentional 

Program Violation 

(IPV) after 

01/01/98 

Ineligible noncitizen 

parents 

Ineligible noncitizen 

siblings 

Excluded father in 

a Pregnancy 

Women Only 

(PWO) case 

Failure to: 

– Assign child 

support rights 

– Verify citizen/ 

noncitizen status 

Maximum Family 

Grant (MFG) 

children 


(WTW) sanctioned 


Number (SSN) 

disqualified 

Time expired 

parent(s) 

Drug convicted 

felons 

Fleeing felons 

Probation and 

parole violators 

IPV 



Basic Resources, Continued 

Whose 

resources to 

exclude 

The resources of the following family members are excluded when 

determining resource eligibility: 

AU Members Non-AU Members Non-Persons 

Adults or children 

temporarily residing in 

a shelter for battered 

persons 

Unaided stepparent 

and stepsiblings 

Unaided senior 

parent(s) and their 

other children 

Unaided halfsiblings 

excluded 

for no deprivation 


Income/Social 

Security Payment 

(SSI/SSP) and Cash 

Assistance Program 

for Immigrants 

(CAPI) customers 

Foster Care and 

Kin-GAP children 

Non-needy 


and their spouse 

Spouse of a needy 


Siblings ineligible 

due to age 

Unaided, unmarried 

parent of a child in 

common with an 

aided parent for 

whom there is no 

deprivation 

Resource limits Determine the values of all the countable resources (see “Whose resources 

are counted” block in this chapter of the handbook). The maximum resource 

limits are: 

Eligibility 

determination 

$3000 for any family which includes a member who is 60 years of age or 

older, and 

$2000 for any other family. 

Once the countable resources have been identified and their values tallied, 

determine eligibility as follows: 

If the countable value of 

Then the family is … 

countable resources is … 

At or under the resource limit, Resource eligible to CalWORKs. 

Over the resource limit, Not resource eligible to CalWORKs. 

Deny or discontinue as appropriate. 



Basic Resources, Continued 

Recording the 

resource 

eligibility 

determination 

Record the resource eligibility determination by: 

Thoroughly documenting the resource items on the Statement of Facts 

and the C-IV System pages; 

Sending the specific denial or discontinuance Notice of Action when the 

denial or discontinuance action is due to resource limits; and 

Journal the final determination in the case. 


Identifying Resources 

Introduction This section contains information regarding resource categories, liquid 

resources, non-liquid resources, determining the value of non-excluded 

resources, and lump sum income. 


Resource 

categories 

Liquid 

resources 

Non-liquid 

resources 

Eligibility & Assistance Standards (EAS) 42-201, 42-203, 42-205, 42-207, 

and 42-211.2 

Manual of Policies & Procedures (MPP) MPP 63-501.1, 63-501.2, 63- 

501.3, and 63-501.5 

Resources can be categorized as one or more of the following: 

Liquid resources 

Non-liquid resources 

Excluded resources 

Jointly-owned resources 

Lump sum income 

Liquid resources are cash or items that can be converted into cash within a 

reasonable amount of time and can be used to meet current needs. Liquid 

resources include: 

Cash on hand, checking and savings accounts, and savings certificates 

Trust deeds, notes receivable, stocks, and bonds 

Individual Retirement Account (IRA) and accessible Keogh Plans 

established solely for family members, Non-AU members, and excluded 

people with countable resources, minus penalties for early withdrawal 

Non-liquid resources are those items not available to meet current needs 

because they are not easily converted into cash. Non-liquid resources 

include: 

Personal property 

Motor vehicles 

Land and buildings 



Identifying Resources, Continued 

Excluded 

resources 

Jointly-owned 

resources 

Lump sum 

income 


lump sum 

income 

Excluded resources are items that the Assistance Unit (AU): 

Cannot use to meet current needs, and/or 

Does not have the right to sell. 

Resources held jointly with another person are considered available unless it 

is determined and verified the resources are unavailable. 

Nonrecurring lump sum income is treated as a resource in the month 

received. Use the information reported on the Quarterly Reporting (QR) 7 to 

determine continuing resource eligibility for the family for the entire upcoming 

QR Payment Quarter. 

If the customer reports lump sum income mid-quarter, the County is not 

authorized to take any action to discontinue the case for exceeding the 

resource limit. Under Quarterly Reporting/Prospective Budgeting (QR/ PB) 

rules, resource eligibility is determined only once per quarter, based on the 

information reported on the QR 7. 

Nonrecurring lump sum income include, but is not limited to: 

Income tax refunds / Earned Income Tax Credits (EITC) 

Retroactive public assistance or social insurance payments 

Lump sum insurance settlements 

Refunds on rental or utility deposits 

Lottery winnings received in single payments 

Disaster relief payments 

Note: Effective December 17, 2010, federal income tax refunds and EITC 

payments are exempt for twelve (12) calendar months beginning with the 

month of receipt. 


Resource Table 

Introduction This section contains information regarding resources to include or exclude 

for eligibility determination. 

Resource table The table below lists many resources and tells whether the value of the 

resource must be included in or excluded from the resource eligibility 

determination. Although there are many items listed, the table cannot be allinclusive. 

If you need information about a resource not listed, please contact 

the Program Development Division (PDD) through established channels for 

assistance. 

Resource Include Exclude Comments 

Agent Orange settlement X n/a 

Bank accounts: checking, 

savings, credit union accounts 

X 

See also “Restricted accounts” section in 

this chapter of the handbook. 

Burial plots 

X 

Exclude one plot per family member with 

countable resources. 

Cash X n/a 

Compensation for lost, stolen, 

or damaged property 

X 

See “insurance settlements.” 

Earned Income Tax Credit 

(EITC) 

X 

Spend down verification is not required 

unless questionable. 

Employment-related tools, 

Tools and equipment not used for current 

equipment, and inventories 

used for employment 

FEMA (Federal Emergency 

X employment. 

Management Administration) 

disaster relief payments 

X 

Household items and 

furnishings 

X 

This category includes televisions, 

stereos, video game equipment, etc. 

Insurance settlements 

Exclude the lost or damaged property 

X compensation amount. Any excess 

amount is nonrecurring lump sum. 

Jewelry, including wedding and 

Jewelry is classified as personal effects. 

engagement rings and 

heirlooms 

X 

Life insurance cash surrender 

value (CSV) 

X 

n/a 

Lottery winnings X n/a 

Livestock 

Use statements from professionals in the 

X 

livestock business, trade publications, 

and advertisements to verify value, if 

needed. 

Motor vehicles 

See “Motor Vehicle Value Determination”, 

this chapter. 

Musical instruments and 

equipment 

X 

Musical equipment is classified as 

personal effects. 

Personal computer systems 

Classified as personal effects or 

including all hardware and 

software 

X household goods. 



Resource Table, Continued 

Resource table The Resource Table is continued below: 

Resource Include Exclude Comments 

Personal effects (cameras, 

Video Cassette Recorder 

n/a 

(VCRs), Digital Video Disc 

(DVDs), collections, hobby 

items, and other valuables) 

X 

Real estate: House, land, 

See “Real Estate Value Determination”, this 

mobile home, current 

home, former home 

chapter. 

Recreational vehicles 

Includes items such as ATVs, watercraft, 

X 

trailers, and campers not used as a 

residence for the family. If used as a home, 

the item is exempt. 

Restricted accounts See “Restricted Accounts”, this chapter. 

Retirement plans / 

Retirement plans established as a 

accounts 

condition of employment - as with the 

Public Employees’ Retirement System 

(PERS) or County of San Bernardino 

retirement system - are exempt. 

Independent retirement plans (minus 

any penalty for withdrawal) are included. 

Retirement benefits – 

monthly or other periodic 

payments 

Social Security Income 

(SSI) recipient’s resources 

Stocks, bonds, mutual 

funds 

Tax refunds, rebates, 

credits 

Economic Stimulus Act of 

2008 

Trust deeds, sales 

contracts, mortgages, 

promissory notes 

Trust fund: 

Court ordered 

For a child 

Blocked until the child is at 

least age 18 years old 

Trust fund, not court 

ordered 

Victims of crime 

compensation 

X 

X 

X 

X 

X 

X 

X 

X 

Note: See “Retirement/Educational 

Accounts” this chapter. 

Retirement benefits are considered income, 

not a resource. Refer to the Income chapter 

for more information. Refer also to the 

“Pensions” page, this chapter. 

n/a 

If part of a retirement account, see 

“retirement plans/accounts” 

Exempt for 12 months, including the month 

of receipt. 

Exclude for the month of receipt and the 

following two (2) months. 

Exclude as long as the resource produces 

income consistent with its fair market value. 

The caretaker is not required to petition the 

court to release the funds. 

Considered available to the family to meet 

current needs unless evidence shows the 

fund is not available to any member of the 

family living in the home. 

n/a 


Evaluating Resources 

Introduction This section contains information regarding when to evaluate resources, 

which resources to evaluate, determining the value of non-excluded 

resources and verification of resource values. 

References The following references are applicable to information in this section: 

When to 

evaluate 

resources 

Which 

resources to 

evaluate: some 

basic rules 

Determining 

the value of 

non-excluded 

resources 


resource 

values 

Eligibility & Assistance Standards (EAS) 42-201, 42-203.3, and 42-205 

Manual of Policies & Procedures (MPP) 63-501 

Evaluate resources at: 

Application, reapplication, and restoration, 

Annual re-evaluation Re-Evaluation (RE), 

When a new family member joins the family; and 

Once each quarter when the Quarterly Review (QR) 7 is received and a 

resource is, or should be, reported as: received, sold, exchanged, or 

given away. 

When deciding which resources to include in the eligibility determination, 

some basic rules are: 

Evaluate resources available to meet a current need in the family. 

Exclude resources that are unavailable – those that the family cannot use 

to meet current needs and/or does not have the right to sell. 

The customer declares the value of resources: 

On the Statement of Facts or Quarterly Review (QR) 7, 

During an interview with the Eligibility Worker (EW), or 

Via other means as they report the acquisition of resources. 

For resources other than motor vehicles, the EW accepts the declared value 

of the item unless it is questionable. The reason a declared resource value is 

questioned must be journaled in the case. 

When resource verification is needed, the customer must provide verification 

from a credible source verifying the value of the item. 


Eligibility Determination Process 

Introduction This section contains information regarding the resource eligibility 

determination process. 

Resource 

determination 

process 

In order for a family to receive or continue to receive CalWORKs, evaluate 

resources using the steps below. Detailed information about each step is on 

the following pages. 

Step Action 

1 Identify the: 

Family members, and 

Excluded family members whose resources will be used in the 

eligibility determination. 

Resources belonging to the included and excluded family 

members. 

Countable resources listed on the Statement of Facts, QR 7, or 

C-IV Detail pages. 

2 Determine the: 

Value of the countable resources, and the 

Resource limit for the family. 

3 Compare the net countable resource amount to the resource limit. 

If the combined value of 

Then … 

countable resources is… 

Over the limit for the family, Deny the application or 

discontinue the CalWORKs 

at the end of the quarter. 

At or under the limit for the The family is eligible to 

family, 

receive CalWORKs. 

8 Journal resource values and the resource eligibility determination in 

the case. 


Motor Vehicle Value Determination 

Introduction This section contains information regarding general information, definitions, 

Kelly Blue books, and the steps required to determine the value of vehicles. 


General 

information 

Eligibility & Assistance Standard (EAS) 42-215.4 

When evaluating a vehicle for CalWORKs eligibility, the dollar value of a 

vehicle depends on the use of the vehicle. Depending on usage, the value of 

a vehicle may: 

Be exempt from consideration 

Have a flat amount deducted from the fair market value 

Have only the encumbrance deducted from the fair market value 

Be counted in full 

Each vehicle belonging to the family is evaluated separately based on its 

usage. 



Motor Vehicle Value Determination, Continued 

Definitions Encumbrance: Amount owed to another on the vehicle. Amount owed 

must be verified at application and Re-Evaluation (RE). 

Note: In order to allow an encumbrance, the lender’s name must be 

on the vehicle title as a lien holder. If the lender’s name is not on the 

title as a lien holder, the encumbrance will not be considered. This 

also applies when the vehicle is used as collateral for another loan or 

if a personal loan was taken to purchase the vehicle. 

Excluded: The value of the vehicle is not included in the resource eligibility 


Fair Market Value (FMV): The wholesale value of the vehicle is determined 

by using one of the following sources: 

Kelly Blue Book 

Estimate from automobile dealer 

Newspaper advertisements 

Other reliable sources 

Equity value: The fair market value minus any encumbrances, damage, 

and/or amount needed to make necessary repairs. 

Inaccessible Vehicle Resource: Any vehicle, licensed or unlicensed, in 

which the equity value (value of vehicle minus encumbrance, any necessary 

repairs, and damage) is $1,501 or less. 

Licensed vehicle: The vehicle is currently registered with the Department of 

Motor Vehicles (DMV) in California or any other state. 

Non-excluded vehicles: Vehicles not determined excluded. 

Reliable source: Sources of verification the family may use when they 

indicate the true value of a vehicle is less than what the Eligibility Worker 

(EW) determined. Reliable sources include the Green Sheet, AutoTrader, 

and/or statement from mechanic/auto repair/body shop. 




Kelly Blue 

Books 

The Kelly Blue Book is available on the Internet. The Kelly Blue Book 

includes information for: 

Used cars 

Older Cars & Trucks 

Early Model Cars 

Motorcycles 

Trailers 

Motor Homes 

The EW will use the following instructions to determine a motor vehicle’s 

FMV using the Kelly Blue Book: 

Step Action 

1 Type in http://www.kbb.com 

2 Enter year, make, model and style of the vehicle, and customer’s 

zip code. 

3 Select “Trade-In-Value” and click “Get Values”. 

4 Enter the mileage. 

If mileage is unknown, use 12,000 miles per year (i.e. year 

2005 vehicle, 8 X 12,000 = 96,000 miles). 

Do not select any optional equipment. 

5 Select engine type, transmission, and drive type of the vehicle, if 

not pre-selected. 

Note: If you do not have any of this information, select the first 

option listed. 

6 Remove all pre-selected equipment and click “Recalculate 

Values”. 

7 Use the “Trade-In-Value” listed under “Fair”. 

8 Subtract any verified encumbrances from the “Trade-In-Value”. 

9 Image verification of the motor vehicle’s value into the case 

record. 





Vehicle values Follow the steps in the table below to determine how much vehicle value to 

include in the resource eligibility determination. 

Step Action 

1 Identify vehicles excluded from the resource eligibility 

determination. Licensed vehicles in the following categories are 

excluded: 

Used more than 50% of the time to produce income (i.e. taxi) 

Annually produces income consistent with its fair market value 

(e.g. big rig truck) 

Used for long-distance travel necessary for employment 

(e.g. sales person; not for commuting) 

Used as a home 

Used to transport a temporarily or permanently physically 

disabled family member, excluded person, or non-family 

person (including SSI recipient) 

Used to transport the primary source of fuel or water for the 

home 

Leased vehicles 

2 Exclude any vehicle, licensed or unlicensed, that is an inaccessible 

resource (a vehicle that will not produce an estimated return of 

more than $1,501). 

3 Determine the countable value of all other vehicles. 

If the 

vehicle is … 

And is … Then … 

Not licensed Not excluded as an Count the equity value 

(includes inaccessible resource toward the total resource 

vehicles 

registered 

as "non-op”) 

limit for the family 

Licensed Used by an adult Subtract $4,650 from 

HH member (one the FMV. 

vehicle per adult) Use any excess FMV in 

Used by a child the total resource 

age 16 to 18 

years old to drive 

to work, school, 

job, training, or to 

look for work 


Licensed Not exempt, and Subtract $4,650 from 

Does not meet the FMV. 

criteria in the Compare the excess 

block immediately FMV to the equity value. 

above 

Use the greater amount 

in the total resource 






evaluating a 

licensed 

vehicle that is 

not excluded 

Intake: 

Customer with two vehicles is applying for CalWORKs. The second vehicle 

cannot be excluded. The FMV is $8000. Her encumbrance is $6,000. Using 

the table above, $4650 would be subtracted from the FMV resulting in a 

value of $3350. The equity value would be $2000 ($8000 FMV minus $6,000 

encumbrance). Because $3350 is the greater of the two amounts, it will be 

used in the total resource determination. The CalWORKs application would 

be denied for being over the resource limit. 

Continuing: 

A customer receiving CalWORKs reports getting a second vehicle on the 

QR 7 or at Re-Evaluation (RE). The vehicle cannot be excluded. The FMV 

is $8000. Her encumbrance is $6,000. Using the table above, $4650 would 

be subtracted from the FMV resulting in a value of $3350. The equity value 

would be $2000 ($8000 FMV minus $6,000 encumbrance). Because $3350 

is the greater of the two amounts, it will be used in the total resource 

determination. This makes the customer ineligible because she is over the 

resource limit. The CalWORKs case would be discontinued. 


Real Estate Value Determination 

Introduction This section contains information regarding basic rule for evaluating real 

property, net market value, and how to value real property. 


Basic rule for 

evaluating real 

property 

Net market 

value 

Eligibility & Assistance Standards (EAS) 42-213.1, 42-203.3, 42-203.4, 

42.215, and 42-215.2 

The decision about whether to include or exclude real estate in the eligibility 

determination depends on: 

Whether the family lives in or on the piece of real estate, 

Who legally owns the property, 

Whether the family has access to the property to meet current housing 

needs, or 

Whether the property produces income. 

For determination of CalWORKs eligibility, the customer’s net market value 

(NMV) interest in real property is determined by subtracting any allowable 

encumbrance against it from its market value. Acceptable evidence of 

allowable encumbrances on real property are: 

Mortgages 

Notes 

Deeds and trusts 

Tax liens 



Real Estate Value Determination, Continued 

How to value 

real property 

The following table will help you decide how to evaluate real property in the 

resource eligibility determination process. 

If the real property … Then … 

Is a house, mobile home, camper, 

houseboat, or any other dwelling 

used as a home for the family (and 

the surrounding property), 

Belongs to an unaided step-parent 

or Social Security Income (SSI) 

recipient, 

Does not meet any of the conditions 

above but is listed for sale at a price 

consistent with the value of the 

property (see Lien Process in this 

Chapter), 

Does not meet any of the conditions 

above, is available to the family, 

and the family has the legal right 

and ability to sell the property, 

Is the former home of the family; not 

the current home due to marital 

separation, 

Exclude from the resource eligibility 


Exclude from the resource eligibility 


Exclude for nine months after the month of 

application or addition of the person who 

owns the property. 

Set a Task for the ninth month. 

Include the net market value of the property 

in the resource determination tenth month. 

Discontinue CalWORKs at the end of the 

Quarterly Reporting (QR) Payment Quarter 

in which the tenth month occurs if over the 

resource limit. 

Include the net market value of the property in 

the resource eligibility determination. 

If unavailable to the family: verify and 

exclude 

If available to family: exclude for three 

months. 

- Applicants – Exclude for three months 

following the end of the month in which 

aid begins 

- Recipients – Exclude for three months 

following the end of the month in which 

the separation occurs. 

Set a Task for the third month. 

- After three months: 

Exclude if the property becomes the 

home of the family. 

Exclude for six more months if for 

sale. 

Include the net market value after 

nine months maximum exclusion. 

Note: When the exemption period ends midquarter, 

the home will be used to determine 

eligibility for the following QR payment quarter. 


Lien Process 

Introduction If the customer has real property that is not excluded, he/she must comply 

with the lien process in order to receive CalWORKs. This section contains 

information regarding the lien process for real property. 

Overview Real property owned by and available to the customer is exempted from 

consideration in the resource limit for a one-time period of up to nine months 

providing the customer: 

Grants the county a lien against the property, which is payable to the 

county when the property is sold, and 

Agrees in writing to begin immediately to make a good faith effort to sell 

the property. 

Definition A lien is a legal claim on property until the debt is paid back. 

Customer 

decides not to 

sell the 

property 

Exempt 

property 

At any time the customer decides not to sell the property during the nine- 

month period, the property is no longer exempt from the resource 

determination. The Eligibility Worker (EW) will include the property in the 

resource determination and discontinue if appropriate. 

The property becomes exempt if the customer has lost the legal ability to sell 

the property (tied up in litigation). The lien period is imposed once the 

property becomes available. 

Existing liens If the property already has a lien on it from another state, and the customer 

applies for aid in California, a new nine-month lien period is granted in 

California. 

Liens and 

encumbrances 

Any CalWORKs paid while property is in a lien (exempt) is counted as an 

allowable encumbrance when determining its value. The EW determines 

when the customer may be resource eligible by dividing the amount of 

excess property by the Maximum Aid Payment (MAP). 

At any point in the lien period, the property falls below the $2,000 limit, the 

customer is not subject to the lien process. Only the amount of aid received 

while the customer was over the property limit included in the actual amount 

of the lien. 



Lien Process, Continued 


excess real 

property and 

lien 

Lien 

procedures for 

EW 

See example below for excess real property. 

Excess real property $ 2400 

Divided by Maximum Aid Payment (MAP) (4 = $725) 725 

Equals lien period* 3.31 (or four months) 

Amount of lien (4 x 725) $ 2900 

*Use the current MAP for the AU size and round up to the next whole 

number. The customer must be below property limits on the first of the 

month. 

When evaluating for possible resource eligibility, the Eligibility Worker (EW) 

will need to calculate the amount of CalWORKs actually received to 

determine the amount of encumbrance. 

The table below gives the procedures the EW must follow when a customer 

agrees to place a lien on his/her property in order to receive CalWORKs. 

Step Action 

1 1. Give the customer a copy of the CW 82 (Agreement to Sell 

Property) to complete and sign. 

2. Once the customer signs and returns the form, have it imaged 

in C-IV. 

2 Give the customer one copy of the CW 81 (Grant of Lien) to 

complete and have notarized. 

3 Once the notarized CW 81 is received: 

Have the form imaged in C-IV. 

Forward the completed lien to Human Services (HS) Auditing 

(Attn: Regina Funderburk). 

4 1. Send the NA 102 CIV to inform the customer that: 

The property is exempt for up to nine months, and 

The customer will be ineligible to cash aid after that time if 

the property is not sold. 

2. Set a Task for the month the lien period ends. 

3. Journal all actions taken. 

5 At discontinuance or at the end of the lien (exempt) period, notify 

HS Auditing of the outcome. 

Complete a communication form/memo to HS Auditing with 

the reason “Lien: Repayable Aid”. 

Include the customer name(s), case #, and actual amount of 

aid received. 

Forward it to HS Auditing (Attn: Regina Funderburk). 

Have a copy imaged into C-IV. 




Lien Process, Continued 

Lien 

procedures for 

customer 

When the customer agrees to the lien, he/she will do the following: 

Step Action 

1 Complete and sign the CW 82 (Agreement to Sell Property) and 

turn it into the EW. 

2 Complete the CW 81 (Grant of Lien) form, including: 

The purpose of the lien (to repay the County aid), 

The amount of aid to be received during the lien period, 

The legal description, and 

The name(s) of the property owner(s) as the name(s) appear 

on the Assessor’s rolls. 

2 Sign the CW 81 form in front of a notary. 

3 Return the notarized form to the EW. 


Transferred Resources 

Introduction This section contains information regarding definitions, transfer of resources, 

resources transferred by applicant customers, and resources transferred by 

continuing customers. 

Reference The following references are applicable to information in this section. 

Eligibility & Assistance Standard (EAS) 42-203.6, 42-221.1, and 42-221.2 

Manual of Policies & Procedures (MPP) 63-501.6 

Definitions Transfer of Resources: Occurs when the ownership of a resource changes 

- the owner frees himself or herself in whole or in part from the resource. 

Note: When a resource is sold for cash, the cash is a resource, not income. 

Resources 

transferred by 

applicant 

customers 

Resources 

transferred by 

continuing 

customer 

Fair Market Value (FMV): The FMV is the assessed value of the property. 

Consider property owned by the applicant customer, and others as required, 

at the time of application when determining eligibility. Do not consider the 

value of any property transferred before the time of application. 

Eligibility will be impacted only when a continuing CalWORKs customer 

transfers ownership of non-excluded property for less than the FMV that 

would cause the family to exceed its resource limit. When a customer 

receives less than fair market value for a non-excluded resource, determine 

whether there will be a period of ineligibility by following these steps: 

Step Action 

1 Determine the fair market value of the item through reliable 

sources (newspaper advertisements, real estate agents, etc.). Use 

an average value when you find similar amounts. 

2 Subtract the amount actually received from the fair market value. 

3 Divide the difference by the Minimum Basic Standard of Adequate 

Care (MBSAC) for the family size. Do not include special needs 

payments. 

4 Round the result down to the nearest whole number. The whole 

number is the number of months in the period of ineligibility (POI). 

If the result is a fraction representing part of a month, the family will 

not have a period of ineligibility. 

5 If the period of ineligibility is one month or more: 

1. Discontinue the CalWORKs. 

2. Apply the POI effective the first of the month of the next 

Quarterly Reporting (QR) Payment Quarter following the 

transfer. 

3. Journal the case actions and POI months. 


Restricted Accounts 

Introduction This section contains information regarding rules for restricted accounts, how 

to open a restricted account, qualifying and non-qualifying withdrawals. 

Overview Effective January 1, 2008, families who receive CalWORKs can keep an 

unlimited amount of money in one or more special savings accounts in any 

financial institution such as a bank, credit union, or savings and loan to save 

for a home, education, or new business. These savings accounts are called 

restricted accounts. 

Reference The following references are applicable to information under this section. 

Applicants vs 

recipients 

Rules for 

restricted 

accounts 

Opening a 

restricted 

account 

All County Interim Notice (ACIN) I-59-11 

Eligibility & Assistance Standard (EAS) 42-213 

Funds held in a restricted account are not included in the $2,000 or $3,000 

resource limit for recipients. These rules do not apply to applicants for 

CalWORKs. New state arrivals are considered applicants when these rules 

are applied – even if the family received aid from the other state in the month 

of cash aid application in California. 

Accounts can only be considered restricted accounts and, therefore, exempt 

for CalWORKs recipients when the following criteria are met: 

The customer signs the CW 86: Agreement – Restricted Account before 

starting the restricted account. 

The money must be kept in a financial institution such as a bank or credit 

union. 

The restricted account funds must be kept separate from other accounts. 

Interest earned on the restricted account(s) must be deposited directly 

into the account by the financial institution. 

The money can only be spent on allowable expenses. Allowable 

expenses are detailed later in this section. 

If the money is not used for a qualified withdrawal, the family will receive 

a period of ineligibility. 

When a customer decides to open an account to save for a home, education, 

or new business, they must sign an agreement with the County to state they 

will abide by the rules described in the previous sections of this chapter. The 

agreement form signed is the CW 86: Agreement-Restricted Account. 

By signing this form, the customer agrees to save money for purposes 

leading to self-sufficiency. The funds are then exempt from consideration in 

the resource eligibility determination. 



Restricted Accounts, Continued 


the account 

Qualifying 

withdrawals 

Within 30 calendar days of signing the CW 86 Agreement – Restricted 

Account, the customer must provide verification of the account which 

includes: 

The name and address of the financial institution 

The name(s) as shown on the account 

The account number(s) 

All account balances and activity since the date the agreement was 

signed 

The funds in a restricted account can be spent on one or more of the 

following items and still be considered exempt from the resource eligibility 

test: 

Home purchase Education Business start-up Securing 

Permanent Rental 

Housing 

Deposits, fees, 

down payment, 

principle 

payment 

Closing costs 

Repairs and 

fixtures 

Reporting a 

withdrawal 

Fees, tuition, 

books, school 

supplies, 

equipment, 

special clothing 

needs 

Reasonable 

cost of 


to and from 

school or 

vocational 

training 

Student 

housing and 

meals 

Child care 

services 

needed to 

attend school 

Purchase, repair, and 

upkeep of business 

equipment, tools, 

uniforms or other 

protective or required 

clothing and shoes 

Payments on loan 

principal and interest 

for business assets or 

durable goods 

Rent and utility 

payments for office 

Employee salaries 

Inventory shipping 

and delivery costs 

Business fees, taxes, 

insurance, 

bookkeeping or other 

professional services 

Overdue rent 

payments to 

avoid becoming 

homeless 

Deposits, such 

as cleaning 

deposits 

First and last 

month rent 

deposits 

Utility deposits 

The CalWORKs recipient customer must report a withdrawal from a 

restricted account within 10 working days of the withdrawal. 





withdrawals 

Non-qualifying 

withdrawals 

Imposing a 

period of 

ineligibility 

Within 30 calendar days after a withdrawal, the recipient must provide proof 

of the withdrawal amount(s), and how the funds were spent. 

Examples of acceptable verification include: 

Receipts 

Cancelled checks 

Signed statements from the provider of goods or services that show the 

type and amount(s) paid 

Money from a restricted account spent on the items listed below violates the 

agreement signed by the CalWORKs customer. Therefore, the amount of the 

restricted account funds spent on the following must be considered toward 

the resource eligibility limit and could result in a period of ineligibility: 

Home P urchase Education 

Furniture 

Household 

goods 

Mode of 

transportation which 

is not the most 

economical available 

Business 

Start-up 

Personal expenses 

Entertainment 

A period of ineligibility (POI) will result if the customer: 

Securing 

Permanent 

Rental Housing 

Furniture 

Household 

goods 

Withdraws money from the restricted account for a non-qualifying 

expense 

Within 30 days after a withdrawal: 

– Does not re-deposit funds into the restricted account when an 

allowable expense was not paid or was less than expected 

– Does not verify the amount withdrawn, the amount before the 

withdrawal, and how the money was spent 

Receives interest from the restricted account and does not deposit the 

interest into the restricted account within 30 days 




Determining 

the Period of 

ineligibility 

(POI) 

Example of a 

POI 

Beginning the 

POI 

Follow the steps below to determine the number of ineligible months after a 

recipient violates the restricted account agreement. 

Step Action 

1 Determine the restricted account balance(s) before the withdrawal 

or before the interest payment was sent to the recipient. If the 

amount is not known, estimate the amount based on information 

in the case file. 

2 Subtract any amount spent on allowable expenses. 

3 Divide the difference by the Minimum Basic Standard of Adequate 

Care (MBSAC) for the family, plus any special needs, at the time 

of the withdrawal or interest payment. 

4 Round the result down to the nearest whole number. That whole 

number is the number of months in the POI. 

5 Journal action taken. 

A family of three saved $5,000 in a restricted account. The family withdrew 

$4,500 and spent $3,000 on qualifying expenses. 

Step Action Example 

1 Verify pre-withdrawal account balance $5,000 

2 Subtract amount for allowable expenses - $3,000 

= $2,000 

3 Divide $2,000 by MBSAC plus special needs ($1078 = 1.85 

for this example). 

months 

4 Round down next whole number for POI months = 1 month 

POI 

The POI begins the first of the month of the next Quarterly Reporting (QR) 

Payment Quarter following the reported non-qualifying withdrawal or interest 

payment on the QR 7. 

If the family received an aid payment for the month(s) after POI should have 

begun, that aid amount is considered an overpayment and must be repaid. 


Retirement/Educational Accounts 

Introduction This section provides information regarding which retirement and educational 

accounts are excluded for CalWORKs applicants and recipients. 

Treatment of 

retirement and 

educational 

accounts 

Some retirement and educational accounts are counted differently in the 

resource limit determination for applicants and recipients. The following 

chart identifies which accounts are excluded from or included in the resource 

limit determination. 

Accounts CalWORKs Applicants 

CalWORKs Recipients 

401(k) Exclude Exclude 

403(b) Exclude Exclude 

457 Exclude Exclude 

529 Include Exclude effective January 1, 2007 

IRA Include Exclude effective January 1, 2007 

ESA Include Exclude effective January 1, 2007 




CHAPTER 9 

Income 

Income Overview ...................................................................................................9-1 

Definitions and Terms ............................................................................................9-2 

Income Treatment and Verification Chart ..............................................................9-5 

Availability of Income – Exceptions......................................................................9-16 

Availability of Child Support Income ....................................................................9-17 

Potentially Available Income ................................................................................9-19 

Veteran’s Affairs (VA) Benefits ............................................................................9-22 

Reasonably Anticipated Income ..........................................................................9-24 

Examples – Reasonably Anticipated Income.......................................................9-26 

Earned Income Basics .........................................................................................9-29 

Paid Work Experience (WEX)..............................................................................9-31 

Self-employment ..................................................................................................9-32 

Roomer/Boarder and Self-employment ...............................................................9-35 

Self-employment as a Child Care Provider..........................................................9-37 

Income In-Kind (IIK) .............................................................................................9-39 

Unrelated Adult Male (UAM) ................................................................................9-42 

Income from Property...........................................................................................9-45 

Unemployment Insurance Benefits (UIB).............................................................9-46 

Disaster Unemployment Assistance ....................................................................9-48 

Pensions ..............................................................................................................9-49 

General Payroll Information and Examples .........................................................9-50 


Overview 

Income 

Introduction Income is any benefit in cash or in-kind, which is currently available or is 

received as a result of current or past labor or services, business activities, 

interests in real or personal property, or as a contribution from persons, 

organizations, or assistance agencies. 

This Chapter includes an income treatment and verification chart and 

additional explanations regarding identification, treatment, and verification of 

income. 


• EAS 42-203.2 

• EAS 44-101, 44-102, 44-111, 44-113, 44-115 

• EAS 82-610.1, 82-612, 82-614 

• EAS 82-820.3 



Definitions and Terms 9-2 

Income Treatment and Verification Chart 9-5 

Availability of Income - Exceptions 9-16 

Availability of Child Support Income 9-17 

Potentially Available Income 9-19 

Veteran’s Affairs (VA) Benefits 9-22 

Reasonably Anticipated Income 9-24 

Examples – Reasonably Anticipated Income 9-26 

Earned Income Basics 9-29 

Paid Work Experience (WEX) 9-31 

Self-employment 9-32 

Roomer/Boarder and Self-employment 9-35 

Self-employment as a Child Care Provider 9-37 

Income In-Kind (IIK) 9-39 

Unrelated Adult Male (UAM) 9-42 

Income from Property 9-45 

Unemployment Insurance Benefits (UIB) 9-46 

Disaster Unemployment Assistance 9-48 

Pensions 9-49 

General Payroll Information and Examples 9-50 

CWPHB #4605 (04/11) INCOME 9-1

Definitions and Terms 

Introduction This section contains the definitions and terms, which will be used in this 

chapter. Some of these terms will be described in depth, within their own 

sections, later in this chapter. 

Death benefits Death benefits are those life insurance or burial payments made to a 

deceased’s beneficiary. 

Disabilitybased 

unearned 

income 

Disability-based unearned income is income received from one or more of 


• State Disability Insurance (SDI) benefits. 

• Private Disability Insurance (PDI) benefits, whether or not there is an 

employee contribution. PDI benefits do not include disability benefits that 

are not insurance, such as veterans benefits. 

• Temporary Workers’ Compensation (TWC) benefits. 

• Social Security Disability benefits. 

Earned income Earned income is income received in cash or in kind as wages, salary, 

employer provided sick leave benefits, commissions, or profit from activities 

such as a business enterprise, farming, etc., in which the recipient of the 

income is engaged as a self-employed individual or as an employee. 

Exempt income Exempt income is not considered when completing CalWORKs Eligibility 

Determination and Benefit Calculations (EDBCs). 

Fluctuating 

income 

Income in-kind 

(IIK) 

Fluctuating income is income, which has different amounts for each month of 

the quarter. Fluctuating income includes, when the Assistance Unit 

(AU)/household has: 

• Income for one or more months of the quarter and zero income for the 

remaining months of the quarter due to income starting or stopping, 

• A partial month’s income for one month and full month’s income for the 

remaining months of the quarter due to income starting or stopping, and 

• Continuing income that changes from month to month. 

Income In-kind (IIK) is a benefit received other than in cash. IIK includes the 

value of need items provided at no charge, or with no obligation to repay in 

cash. IIK can be earned or unearned. 


CWPHB #4605 (04/11) INCOME 9-2

Definitions and Terms, Continued 

Income 

Reporting 


The Income Reporting Threshold (IRT) is the level of income, which triggers 

the need for a CalWORKs Assistance Unit (AU) to make a mandatory midquarter 

report of a change in income. The IRT is the greater of: 

• 130% of the Federal Poverty Level (FPL), or 

• The level at which an AU becomes financially ineligible. 

Interest income Interest income is interest on a savings account in a bank, savings and loan 

association, or other institution authorized to accept savings and interest, 

which is received as a result of any contractual obligation. 

Next QR 

Payment 

Quarter 

Prospective 

budgeting 

The quarter immediately following the Submit Month. 

Prospective budgeting is a method of using reasonably anticipated income 

for the determination of benefits in an AU/household. 

QR 7 The QR 7 is the Quarterly Eligibility/Status Report. The customer uses the 

QR 7 to report what happened in the QR Data Month, what has happened 

since the last QR 7 was completed, and what is expected to happen in the 

next quarter. 

QR Begin 

Month 

The QR Begin Month is the first month of the QR Payment Quarter. 

QR Data Month The QR Data Month is the month for which the customer reports all 

information necessary to determine eligibility. The QR Data Month is the 

second month of each quarter. 

QR Payment 

Quarter 

QR Submit 

Month 

The QR Payment Quarter is the quarter for which benefits are paid/issued. 

The QR Payment Quarter begins the first day immediately following the QR 

Submit Month. 

The QR Submit Month is the month in which the QR 7 must be submitted. 

The QR Submit Month is the third month of each quarter. 


CWPHB #4605 (04/11) INCOME 9-3


Reasonably 

anticipated 

income 

Reasonably Anticipated Income is the rule used to anticipate household 

prospective income. Reasonably anticipated income: 

• Means the source, amount, and date of receipt of the income is known. 

• Can be determined with reasonable certainty the customer will receive a 

specified amount of income during any month of the QR Payment 

Quarter, earned or unearned. 

• Meets both of the following conditions: 

− The income has been or will be approved or authorized within the 

upcoming quarter, or the customer is otherwise reasonably certain 

the income will be received within the quarter, AND 

− The amount of the income is known. 

Stable income Stable income is income expected to remain at the same level throughout the 

QR payment quarter. Stable income can vary from payment to payment as 

long as the pattern of receipt is stable. 

Unearned 

income 

Voluntary 

contributions 

Unearned income is any income that is not earned income or disability-based 

unearned income. 

A voluntary contribution is a contribution for which the contributor has no 

legal liability. 

CWPHB #4605 (04/11) INCOME 9-4

Income Treatment and Verification Chart 

Introduction The chart on the following pages lists: 

Verifying 

earned income 

Verifying 

unearned and 

disability-based 

unearned 

income 

Verifying 

exempt income 

Copies of 

verification 

• Specific income types 

• The income classification 

• Any verification requirements in addition to or differing from the general 

verification rules given below 

Earned income must be reported quarterly on the Quarterly Eligibility/Status 

Report (QR 7). Verification in the form of pay stubs, leave and earnings 

statements, or other credible forms of proof must be included. 

Unearned and disability-based unearned income must be reported quarterly 

on the QR 7. 

Unearned and disability-based unearned income, which is paid monthly and 

in a fixed amount, except for annual increases, must be verified at 

application, Re-Evaluation (RE), or when the amount changes. Quarterly 

verification is not required when the amount stays fixed. 

Unearned and disability-based unearned income, which is issued more often 

than once monthly must be verified with the QR 7. Credible proof must be 

attached. 

The customer’s statement on the QR 7 is sufficient verification of exempt 

income. 

When customers mail verification, photocopy the verification and return the 

original document to the customer immediately. 


CWPHB #4605 (04/11) INCOME 9-5

Income Treatment and Verification Chart, Continued 

INCOME SOURCE CLASSIFICATION/TREATMENT VERIFICATION 

Adoption Assistance Payment (AAP) 

Agent Orange Settlement 

AmeriCorps*State, 

AmeriCorps*National, 

AmeriCorps*National Civilian, 

Community Corps, etc. 

Exempt Customer’s statement on: 

• QR 7, or 

• Statement of Facts. 

Contact PDD; PDD will contact 

CDSS for the appropriate usage 

Copy of: 

• Participant’s AmeriCorps ID, 

and 

• Pay stub or 

• Other credible proof showing 

source 

AmeriCorps*Vista Exempt Copy of: 

• Pay stub, or 


Annuities 

• Insurance – claim settlement 

(e.g., death, injury, or property 

damage/loss) 

• Insurance – investment 

(e.g., whole life) 

source 

See Insurance settlement See Insurance settlement 

Unearned Copy of: 

• Check or 


source and gross amount 

See Pension fund income See Pension fund income 

• Retirement other than Railroad or 

Social Security retirement 

ARRA 

Excluded Customer’s statement on: 

• Filipino Veterans Equity 

Compensation payments of up to 

$15,000 

• 

• 

QR 7, or 

Statement of Facts. 

Awards and Scholarships 

• Provided by public or private 

entity, to or behalf of, a dependent 

child based on the child’s 

academic or extracurricular 

achievement or participation in a 

scholastic, educational, or 

extracurricular competition. 

Exempt 

Copy of: 

• Award letter, or 

• Statement from source 

• Received by or on behalf of an 

adult 

See Educational loans and grants See Educational loans and grants 

Blood or plasma donation Exempt Customer’s statement on: 

• QR 7, or 


Boarder income 

See “Roomer/Boarder and Self- • Boarder agreement or 

(income received for providing both employment” in this Chapter • Other credible proof of the 

lodging and meals) 

payment agreement, and 

• Receipts or other acceptable 

verification of expenses if 

actual expenses chosen 

Bonus/vacation pay 

Earned 

See Earned Income 

• Received while employed 

• Received as termination pay off See Lump Sum See Lump Sum 

Cafeteria plan 

See “Earned Income Basics” in See “Earned Income Basics” in 

(when benefit plan monies are added 

to an employee’s gross pay) 

this Chapter 

this Chapter 

Car allowance See Reimbursements See Reimbursements 


CWPHB #4605 (04/11) INCOME 9-6



Cash contributions 

(cash from a relative or friend to 

help met the AU’s basic expenses) 

Unearned 

Customer’s statement on: 

• QR 7, or 


Cash gifts 

• Less than $30 per AU in a 

quarter 

Exempt 


• QR 7, or 


• More than $30 per AU in a 

quarter 

Unearned 

Cash grants (common types) Unearned • Statement from source or 

• CalWORKs/TANF received 

from another state 

• Narrated telephone call with 

issuing state confirming 

amount 

• Cash Assistance Program for Exempt • Case record, or 

Immigrants (CAPI Categories 


1A, 6K, 6M, and 6T) 

source 

• General Relief (GR Category 

90) 

• Foster Care 

• Kin-GAP 

Census earnings 

Earned See Earned Income 

• Permanent 

• Temporary 

Charitable contributions – non profit 

organizations 

See Cash Gifts Statement from source 

Child Care provider income 

Self-employment 

See “Self-employment as a Child 

Care Provider” in this Chapter 

See Self-employment 

Child/Spousal Support See Family Support See Family Support 

Child/student award/scholarship See Awards and Scholarships See Awards and Scholarships 

Child/student earnings 

Exempt when the child: 


• Meets the definition of a child, 

and 

• 

• 

QR 7, or 

Statement of Facts. 

• Is enrolled in a school, college, 

university, or vocational or 

technical training school – even 

during vacation or between 

school periods. 

Earned income when: 


• The above does not apply, or 

• The child is not enrolled in 

school. 

College Work Study Exempt • Pay stub with CWS noted, or 

• Statement from college 

financial aid office 

Death benefit See source of issuance (e.g. SSA) See source of issuance 

Deferred compensation 

Earned – do not deduct from gross See Earned Income 

(employer sponsored retirement earnings whether before or after tax 

plans such as 401k, 403b, or 457) deduction 


CWPHB #4605 (04/11) INCOME 9-7



Disability Insurance Benefits 

(referred to as SDI or DIB) 

administered by the Employment 

Development Department (EDD) 

See Lump Sum for retroactive 

payments 

Disability-based unearned 

Use net amount when verification 

shows a deduction for: 

• Current or prior year federal 

income tax withholding, 

• A DIB related overpayment 

collection, or 

• Attorney fees required to 

receive DIB 

Use gross amount when verification 

shows a deduction for any other 

reason. 

• Benefit stub, 

• Award letter, 

• Copy of check, 

• ABCD 351, 

• EDD printout, or 

• IEVS abstract 

Disaster relief Exempt Customer’s statement on: 

• QR 7, or 

• Statement of Facts 

Disaster Unemployment Assistance Exempt • Benefit stub, 

• Award letter, or 

Dividends (basic) 

• Stocks/bonds 

• Whole life insurance 

Domestic Volunteer Services 

(formerly VISTA) 

Earned Income 

• Earnings 

• Salary 

• Commissions 

• Wages 

• Military pay (including Combat 

Zone pay) 

Earned Income Tax Credit (EITC) 

• Actual/recurring with earnings 

• Year-end 

Unearned – may be received on a 

monthly, quarterly, or annual basis 

• EDD printout 

Statement from source 

See AmeriCorps*VISTA See AmeriCorps*VISTA 

Earned 

See “Availability of Income – 

Exceptions” in this Chapter 

• Pay stubs, 

• Leave and earnings statement, 

• Payroll records, 

• Copy of paycheck showing 

gross, 

• Employment contact, 

• Employer’s written statement, 

• Release of Information form, or 



Exempt • Pay stub, 

• Statement on QR 7, 

• Statement of Facts, or 


source 

• Verify with supporting 

documentation only if 

questionable 


CWPHB #4605 (04/11) INCOME 9-8



Educational loans and grants 

• SEOG; NDSL; BEOG; PELL; 

FISL; GSL; SSIG; EOPS; 

CARE; BIA; CAL Grant A, B, C; 

and Perkins Loans (formerly 

NDSL) 

• Loans, grants, and adult 

scholarships other than listed 

above 

Exempt – both undergraduate and 

graduate students 

• Allow verified school fees, 

equipment, special clothing, 

transportation, and child care 

as deductions 

• Treat remainder as unearned 

income 

See Awards and Scholarships 

Award letter from college financial 

aid office 

• Award letter from college 

financial aid office, and 

• Documents/receipts to verify 

related expenses in excess of 

student budget 

• Child’s awards and 

scholarships 

See Awards and Scholarships 

Expense reimbursements 

(from employers, JESD, JTPA, 

Department of Rehabilitation) 

See Reimbursements See Reimbursements 

Family support 

Unearned 

• Copy of court order and/or 

• Child/spousal support – direct See “Availability of Child Support check received if available, 

• Child/spousal support – excess Income” this Chapter 

• Statement from payer, 

• Child support – MFG child Exempt 

Includes benefits received based 

upon the absent parent’s disability 

or retirement 

• 

• 

Statement on QR 7 or 

Statement of Facts, or 

Other credible proof, 

• Child support – minor parent 

(paid to unaided senior parent 

on behalf of minor parent) 

Exempt 

• Child support – received for a • Exempt – if turned over to the 

child out of the home 

adult child or minor child’s 

caretaker 

• Unearned – if kept by the AU 

• Child support – received as the 

result of a State or Federal 

income tax refund interception 

See Lump Sum 

• CSSD – Child and Spousal 

Support Disregard 

Exempt 

Federal payments to Indians Exempt Statement from source 

Gambling See Winnings See Winnings 

Garnishments 

• Child support 

• Other debt owed 

• Not an allowable deduction. 

• Include in gross income. 

• Overpayment recovery See Overpayment recovery 

• Pay stubs, 

• Leave and earnings statement, 

• Payroll records, 


• Statement from source, or 

• IEVS abstract 

Homeless Assistance (HA) Exempt Case record 

Income in-kind (IIK) 

See “Income In-kind” in this Statement from the provider of the 

Chapter 

Income In-kind 

Inconsequential/casual income Exempt 


• $30 or less per AU in a quarter 

• QR 7, or 

• More than $30 per AU in a Unearned when reasonably certain • Statement of Facts 

quarter 

income will be received during the 

upcoming QR Payment Quarter 


CWPHB #4605 (04/11) INCOME 9-9



Inheritance – one time payment See Lump Sum See Lump Sum 

Insurance settlement 

See Lump Sum See Lump Sum 

 

 

One-time payment 

Recurring payment Unearned Statement from source 

Interest payments (basic) 

Unearned – may be received on a Statement from source 

Certificate of deposit (CD) monthly, quarterly, or annual basis 

Savings account 

JESD/WTW/E&T related expense 

reimbursements 

See Reimbursements See Reimbursements 

Job Corps 

See Workforce Investment Act See Workforce Investment Act 

JTPA 

(WIA) 

(WIA) 

Jury duty Exempt – mileage 



Earned – San Bernardino 

County pays $15 per day 

beginning the second day 

Loans – personal 

Exempt Copy of written agreement between 

When terms of loan are 

specified in a written statement 

including the: 

lender and borrower 

– Amount of loan, 

– Repayment plan, and 

– Signature of lender and 

borrower 

When no loan agreement Unearned Statement from source, or 

exists (see previous entry) 

Statement on QR 7, or 


Lottery See Winnings See Winnings 

Low income energy assistance Exempt Customer’s statement on: 

HEAP - Home Energy 

QR 7, or 

Assistance Program 


LIHEAP - Low Income Home 

Energy Assistance Program 

REACH - Relief for Energy 

Assistance through Community 

Help 

Lump Sum 

Exempt 

Treat as resource to the extent 

retained. See Resource Chapter 

 

 

 

Award letter, 

Statement from source, 

Copy of check, 

Court papers, 

Settlement notice, or 

Release of Information form 

Meals See Reimbursements See Reimbursements 

Mileage reimbursement See Reimbursements See Reimbursements 

Native American tribal member 

income 

See Lump Sum, if received 

less often then monthly 


 

 

Derived from gaming 

Other 

 

 

Unearned income, if received 

monthly 

Exempt 

Noncitizen’s sponsor’s income Unearned 

See Citizens/Noncitizens/Refugees 

See Citizens/Noncitizens/Refugees 

Chapter 

Chapter 

On-the-job training See Earned Income See Earned Income 


CWPHB #4656 (04/13) INCOME 9-10



Overpayment recovery 

Not applicable Not applicable 

• Cash grants 

• Other sources of income • Exempt – for OP recovery from 

the same source of income, 

use income amount less OP 

adjustment 


• Disability-based unearned, 

earned, or unearned – for OP 

recovery not originating from 

the same source of income, 

use gross income amount 

Pass-through money 

Exempt 


(money belonging to another 

person but handled by an AU 

member to pay expenses for that 

person) 

Not the AU’s income 

• 

• 

QR 7, or 


Pension 

See Lump sum See Lump sum 

• One-time payment 

• Monthly payment Unearned – See “Pensions” in this • Statement from source, 

Chapter for allowable deductions • Copy of check showing gross, 

or 



Prison release funds • Earnings held in trust pending • Letter from the institution or 

release - Exempt 

parole agent, 

• Transition money – see lump • Statement on QR 7, or 

sum 


Private Disability Insurance (PDI) Disability-based unearned • Statement from source, 

(privately purchased or employer- 

• Copy of check showing gross, 

sponsored disability insurance 

or 

benefits) 



Railroad administered benefits 


payments 

See Lump sum See Lump sum 

• Death benefit – one-time 

payment 

• Retirement 

Unearned 

• Award letter, 

• Survivors’ 

See Overpayment recovery if • SSA 491 TC or SSA 1610, 

• Unemployment 

verification shows a recovery • Copy of check (will need 

• Sickness 

(for illness, injury, pregnancy, 

or birth of a child) 


See Overpayment recovery if 

verification shows a recovery 

• 

additional verification showing 

gross benefit), or 

Other credible proof showing 


Refunds of housing or utility Exempt 


deposits 

• QR 7, or 



CWPHB #4605 (04/11) INCOME 9-11



Reimbursements 

When received: 

• From an employer (not selfemployment) 

• From Department of 

Rehabilitation 

• From E&T, JESD, JTPA, WIA 

• In connection with selfemployment 

(mileage reimbursed by 

contracting party) 

• For personal clothing, food 

eaten at home, or 

rent/mortgage 

Relocation assistance 

When received from: 

Exempt 

• A public agency or 

• Paid by a private non-profit 

organization based on need 

and 

• Relocation is unavoidable due 

to a public project (freeway 

expansion) 

• A private party or organization See Lump sum 

Rental income from personal 

property or real estate 

• Exempt – the amount of the 

actual expense 

• Unearned – any amount over 

the actual expense when 

reasonably certain income will 

be received during the 

upcoming QR Payment 

Quarter 

Earned (self-employment) – add 

mileage reimbursement to gross 

self-employment before determining 

net self-employment amount 

Unearned – use the full amount 

Unearned 

See “Income from Property” is this 

Chapter 

• Any credible document from 

the source 

• Statement on QR 7 or 

Statement of Facts for E&T, 

JESD, and JTPA 


Note: Reimbursements shall not 

be considered to exceed actual 

expenses unless the provider or AU 

indicates the amount is excessive. 


Repatriate loan Exempt Case record 

Restitution payment for individuals 

of Japanese ancestry 

• Rental agreement, or 

• Other credible proof of the 


• Receipts, documents, or other 

acceptable verification of 

expenses if applicable 


• QR 7, or 


See Pension See Pension 

Retirement benefits other than 

Railroad or Social Security 

Retroactive benefits/payments See Lump Sum See Lump Sum 

Roomer income See “Roomer/Boarder and Self- • Rental agreement, or 

employment” in this Chapter • Other credible proof of the 


• Receipts or other acceptable 

verification of expenses if 

actual expenses chosen, 

• Credible proof of the payment 

agreement, or 



Royalty/residual income Earned 

May be received less often than 

monthly 



CWPHB #4605 (04/11) INCOME 9-12



Scholarships and Awards See Awards and Scholarships See Awards and Scholarships 

Self-employment Earned 

See “Self-employment” in this 

Chapter 

Senior Community Service 

Employment Provision (SCSEP) – 

Title V of the Older Americans Act 

Senior volunteer services 

• Retired Senior Volunteer 

Program 

• Foster Grandparents Program 

• Older Americans Community 

Service Program 

• Business records (receipts, 

invoices, check 

ledger/canceled checks), 

• Profit and loss statement, 

• Tax records, 


source, gross amount, and 

expenses, 

• TAD QR 7 Supplemental, or 



Exempt • Pay stub, and 

• Statement from Office on Aging 

Exempt – when received by an 

individual 60 years of age or older 

confirming SCSEP status 


• QR 7, or 


Severance pay See Lump Sum See Lump Sum 

Smog impact fee refund 

Exempt – any interest received is • Copy of check, or 

unearned income in the month 

received 

• DMV receipt 

Social Security administered 

benefits 


payments 

Death benefit – one time payment 


OASDI/RSDI/SSDI 

Unearned – use net amount when • Award letter, 

• 

• 

Old age/retirement 

Survivors’ 

verification shows a deduction for: 

• Current or prior year federal 

income tax withholding, 

• 

• 

SSA 491 TC or SSA 1610, 

Copy of check (will need 


• A SSA related overpayment gross benefit), 

collection, 

• IEVS abstract, or 

• Attorney fees required to 

receive SSA, or 



• A mandatory Medicare 

deduction 

Disability 

Use gross amount when verification 

shows a deduction for any other 

reason. 

Disability-based unearned – see 

above for net vs. gross action when 

verification shows benefit reduced 

Supplemental Security Income 

(SSI/SSP) 

Exempt 

State Disability Insurance (SDI/DIB) See Disability Insurance Benefits See Disability Insurance Benefits 


CWPHB #4605 (04/11) INCOME 9-13



Stipend • Earned – portion available to 

meet the customer’s need 

• Exempt – portion used for 

educational expenses (fees, 

special clothing, tuition, etc.) 

• Statement from source, 

• Copy of check showing gross, 

or 



Student/child earnings See Child/student earnings See Child/student earnings 

Subsidized employment Earned See Earned Income 

Summer Youth Training Program See Child/student earnings See Child/student earnings 

Tax rebates, credits, and temporary 

tax relief measures 


• QR 7 or 


Tips 

Earned 

• Pay stub, 

• As an employee 

See “Earned Income Basics” in this 

Chapter 

• 

• 

Statement on QR 7 or 

Statement of Facts, or 

QR 7 Supplemental 

• When self-employed See “Self-employment” in this 

Chapter 

See Self-employment 

Transportation reimbursement See Reimbursements See Reimbursements 

Trust distributions Unearned – may be received less • Copy of check, or 

often than monthly 



Unemployment Insurance Benefits Unearned 


(UIB) 

See “Deductions from UIB” in the • Award letter, 

• American Recovery and 

Reinvestment Act (ARRA) of 

2009 UIB increase 

“Unemployment Insurance Benefits 

(UIB)” section of this Chapter for 

details when benefits are reduced 

• 

• 

Copy of check (will need 


gross benefit), 

ABCD 351, 

See Lump sum for retroactive 

payments 

• 

• 

EDD printout, or 

IEVS abstract 

Unrelated adult male (UAM) income See “Unrelated Adult Male” in this Statement on: 

Chapter 

• QR 7, 

• Statement of Facts, or 

• CW 71 

Vacation/bonus pay See Bonus/vacation pay See Bonus/vacation pay 

Veteran’s Benefits 


payments 

Burial expense allowance 


• Compensated Work Therapy 

Program (CWT) 

Earned • 

• 

Copy of check, or 

Statement from VA 

• VA Compensation 

Unearned 

• CA 5, 

• 

• 

VA Pension 

VA Survivors’ benefits 

• 

• 

Award letter, or 

Copy of benefit check 

• Veterans Educational 

Assistance Program (G.I. Bill) 

Unearned – after deducting verified 

school fees, equipment, special 

clothing, transportation, and child 

care to determine the net nonexempt 

financial aid amount 

• Veterans Student Services Earned – after deducting education • Pay stub, or 

Program 

related expenses 

• Statement from the student 

financial aid office 


CWPHB #4605 (04/11) INCOME 9-14



Victim compensation Exempt • Notice from California Victims 

of Crime program, or 



VISTA See AmeriCorps*VISTA See AmeriCorps*VISTA 

Vocational Rehabilitation 

Maintenance Allowance (VRMA) 


Weatherization and emergency Exempt – when one-time payment 

repair of heating or cooling devices made under state or federal laws 

Winnings 

See Lump sum 

• Gambling 

• 

• 

Lottery 

Other (e.g., prize money) 

One-time payment 

Recurring payments Unearned – may be received on a 

monthly, quarterly, or annual basis 

Workers’ Compensation 


payments 

Permanent 

See Lump Sum 

• Lump sum settlement 

• Recurring payments • Exempt – any portion specified 

as reimbursement of training 

expenses for job retraining 

• Exempt – any portion paid for 

attorney fees necessary to 

obtain the income 

• Unearned – the amount 

received after allowable 

exemptions 

Temporary Disability-based unearned 

Workforce Investment Act (WIA) 

Wages 

Earned 

• Received by adult 

• Received by child See Child/student earnings 

Reimbursements 

(travel expenses, lunches, etc.) 

See Reimbursements 

• Received by adult 

• Received by child Exempt 

Work Experience (WEX) – Paid See “Paid Work Experience (WEX)” 

in this Chapter 

Wraparound services Exempt – services received 

Note: If cash is received directly 

from Wraparound, contact PDD for 

the appropriate usage 



• Statement from source, 

• Copy of check, 

• Statement on QR 7, or 


See Lump Sum 

• Copy of check showing source 

and gross amount, or 

• Award letter from the insurance 

company, attorney, or issuance 

source involved 

• Pay stub, or 

• Statement from WIA 


• Case record verifying 

Wraparound services paid 

through Foster Care, 

• Statement from Social Worker, 

or 


source 

CWPHB #4605 (04/11) INCOME 9-15

Availability of Income - Exceptions 

Available 

income 

Income is considered available in the month received. Exceptions to this are: 

• Interest income received less often than monthly; 

• Contractual income; 

• Child support collected by the County; and 

• Some monthly recurring unearned governmental benefits. 

Interest income For interest income received on a regular basis, but less often than monthly, 

apportion the income equally over the number of months it has accrued and 

use it as income beginning the month after receipt. 

Contractual 

income 

Example: 

A family reports on their April QR 7 receiving an interest check for $60 in 

April. The payment is for interest for October through March. Divide the 

payment by six months (number of months accrued), and use $10 per month 

as unearned income beginning May and ending October. 

Employees receiving income under an annual contract of employment of 

more than eight months and less than 12, shall have the income apportioned 

equally over the period of the contract beginning with the first month of the 

contract. 

Example: 

A customer has a contract to provide lawn service to a company for 10 

months (March through December) for $10,000. Divide the $10,000 by the 

number of months of the contract (10), and use $1,000 as earned income for 

each month, March through December. 

Child Support Child support collected by the County is not considered available to the 

customer. See Availability of Child Support Income section in this chapter for 


Monthly 

recurring 

unearned 

governmental 

benefits 

Monthly benefits, such as Social Security or Veterans benefits, shall be 

considered available in the month the payment was intended, rather than 

actually received, when the following criteria are met: 

• The receipt date of the income varies because mailing cycles cause two 

payments to be received in one month and none in the preceding or 

following month; 

• The source of the income is a governmental benefits program; and 

• The income is unearned and recurring. 

CWPHB #4605 (04/11) INCOME 9-16

Availability of Child Support Income 

Rule CalWORKs customers must agree to allow the County to keep support 

payments for their aided family members to help repay the aid paid for the 

family through the CalWORKs program. 

Availability of 

support 

payments - 

applicants 

Refer to the Deprivation Chapter of this Handbook for information about 

assigning support rights. 

When a family receives a support payment for the month of application but 

before the application date, that payment is considered available for the 

family to use in meeting its needs. 

When a family anticipates the receipt of a monthly support payment after the 

application date, do the following: 

Step Action 

1 Make sure the applicant understands the child support must be 

forwarded to the Department of Child Support Services (DCSS). 

2 Give the applicant the TAD 372 Direct Child/Spousal Support 

Referral form. 

3 Ask the applicant to contact you when the payment is received 

and find out the status of the pending application: 

If the application has … Then … 

Been approved or is in the 

approval process, 

Not been approved and is 

not in the approval process, 

• The applicant must 

forward the support 

payment to CDSS, and 

• The Eligibility Worker 

(EW) treats the payment 

as unavailable. 

• The applicant may use 

the support payment, 

• The EW treats the 

payment as available 

continues to Step 4. 

4 Disregard the first $50 of a current support payment. Treat the 

remainder as unearned income for Eligibility Determination and 

Benefit Calculation (EDBC). 

Note: For spousal support and child support received for a Maximum Family 

Grant (MFG) child, see the Income Treatment Chart in this Chapter. 


CWPHB #4605 (04/11) INCOME 9-17

Availability of Child Support Income, Continued 


support 

payments – 

recipients 

Support collected by the County for CalWORKs recipient customers is not 

considered available to the family because recipient customers must agree to 

relinquish support payments to help repay aid received. 

Follow the instructions below when the Assistance Unit (AU) receives a 

support payment: 

If support is received … Then … 

Directly from an absent 

parent for an AU 

member, including an 

MFG child, and not 

forwarded to DCSS, 

From any county’s 

support collection 

division, 

• Determine whether all or part of the payment 

is current from information from the 

customer, 

• Classify the amount of support in arrears as 

unearned income, 

• Disregard $50 of the payment when at least 

part is current, 

• Notify the support collection division, and 

• Give or send the TAD 372 to the customer 

as a reminder to forward support payments. 

• Determine the type of payment received, 

• Classify CSSD as exempt income, 

• Classify excess payments as unearned, and 

• Classify support for an MFG child as 

exempt. 

CWPHB #4605 (04/11) INCOME 9-18

Potentially Available Income 

County 


Customer 


The County is required to review with the customer (applicant or recipient) all 

his/her income potentials and to refer the customer to the appropriate source 

or agency of the potentially available income. 

The customer (applicant or recipient) is required to: 

• Take all actions necessary to obtain potentially available income, and 

• Provide evidence to the County all action necessary to obtain the 

potentially available income has been taken. 


CWPHB #4605 (04/11) INCOME 9-19

Potentially Available Income, Continued 

Sources of 

potential 

income 

The table below has a list of sources of potential income, who to refer, and 

verification of application. 

Benefit Who to refer Proof of application 

Disability 

Insurance 

Benefit 

Private 

retirement, 

survivor, or 

disability benefit 

Railroad 

retirement 

benefit 


Administration 

(SSA) retirement 

SSA disability 

benefit 

SSA survivor 

benefit 

Unemployment 

Insurance 

Benefit (UIB) 

Veterans’ 

benefits 

Any family member who has 

worked in the last 19 months and is 

not working due to disability or 

postpartum 

A formerly employed person who 

paid into a retirement system other 

than the SSA as a condition of 

employment or voluntarily 

contributed to a secondary 

retirement fund 

• Verification from 

California 

Employment 

Development 

Department (EDD) 

• Customer’s statement 

• Receipt from a doctor 

or records clerk 

Credible proof of 

application from the 

private retirement board 

or fund administrator 

Former railroad employees Credible proof of 

application for benefits 

from the Railroad 

Formerly employed people who 

have reached age 62 

A person with a long-term disability 

who: 

• Has work history 

• Has exhausted short-term 

disability benefits 

Note: A child whose parent is 

receiving SSA disability benefits 

must be referred for potential 

eligibility to SSA disability benefits. 

A surviving spouse or child of a 

deceased person with work history 

Any family member who has 

worked in the last 19 months. Refer 

to the section specifically about UIB 

later in this chapter. 

• Veteran of the U.S. military 

service 

• Children or un-remarried 

surviving spouse of a deceased 

veteran 

• Spouse and children of a 

disabled veteran 

Retirement Board 

Any credible document 

from the SSA stating the 

application for benefits 

was completed 

If denied benefits for 

insufficient work history, 

refer to apply for 

SSI/SSP. 

Proof a claim was filed 

from the California 

Employment 

Development Department 

(EDD) 

CA 5: Veteran’s Benefit 

Referral Form 


CWPHB #4605 (04/11) INCOME 9-20

Potentially Available Income, Continued 

Failure to 

comply 

If a family member fails to apply for potentially available income, use the 

chart below to determine the impact on eligibility. 

When the family member … And the family is 

a(n) … 

Then … 

Meets the mandatory inclusion rule: Applicant family, Deny CalWORKs 

for the entire AU 

• The applicant child; 

immediately. 

• Eligible sibling or half-sibling of 

• 

the applicant child; or 

Any parent, except an 

alternatively sentenced parent 

of the applicant child or the 

applicant child’s eligible siblings 

or half-siblings; 

Recipient family, Discontinue 

CalWORKs for 

the entire AU at 

the end of the 

current quarter. 

Is an optional person: 

Applicant family Deny CalWORKs 

for that family 

• A non-parent caretaker relative; 

member only. 

• 

• 

• 

Other potentially eligible child, 

such as a niece or nephew; 

Step-parent not otherwise 

eligible; or 

Alternatively sentenced parent, 

Recipient family, Discontinue 

CalWORKs for 

that family 

member only at 


current quarter. 

CWPHB #4605 (04/11) INCOME 9-21

Veteran’s Affairs (VA) Benefits 

Introduction This section provides information on Veteran’s Affairs (VA) benefits and the 

CW 5 referral process. The CW 5 is a condition of eligibility at intake and add 

person application. The CW 5 will also be obtained at Re-evaluation (RE). 

What are 

Veteran’s 

Benefits 

VA benefits are considered potentially available income. VA benefits are 

benefits due to a veteran, his spouse and/or dependents, after the veteran is 

no longer an active member of the military. VA benefits may consist of 

medical benefits, educational assistance, unearned income, etc. 

Who to refer VA benefits are considered potentially available income. The 

parent/caretaker relative must apply for VA benefits when the assistance unit 

contains a: 

• Veteran of the United States military service 

• Child(ren) and/or surviving spouse of a deceased veteran 

• Spouse and/or child(ren) of a veteran 

When to refer The CW 5 referral is completed at: 

When not to 

refer 

• Intake 

• Add person application 

• RE 

Do not complete the CW 5 or refer the parent/caretaker relative if the service 

person is still on active duty, or any one of the following information is 

unknown: 

• Veteran’s Social Security Number and date of birth 

• Veteran’s Military Serial Number 

• Veteran’s Administration Claim Number 


CWPHB #4605 (04/11) INCOME 9-22

Veteran’s Affairs (VA) Benefits, Continued 

Where to take 

the CW 5 

The customer will take the completed CW 5 to the County Department of 

Veterans Affairs (VA) office closest to the customer’s home. The office 

location and hours are listed below*: 

Office Address Phone Hours 

Barstow 100 E. Veterans Parkway 760.252.6257 Monday and Thursday 


Fax to Hesperia 8:00 am – 4:00 pm 

Rancho 8575 Haven Ave 

909.948.6470 Monday – Thursday 

Cucamonga Rancho Cucamonga, CA 91730 Fax 

909.948.6475 

8:30 am – 4:30 pm 

Hesperia 15900 Smoke Tree St, Ste. 145 760.995.8010 Monday – Thursday 

Hesperia, CA 92345 

Fax 

760.995.8020 

8:30 am – 4:30 pm 

San Bernardino 175 W. 5 th St., 2 nd floor 

909.387.5516 Monday – Thursday 

San Bernardino, CA 92415 Fax 

8:30 am – 4:30 pm 

909.387.6090 Friday 8:00 am – 4:00 

pm 

29 Palms 73629 Sun Valley Dr. 

760.361.3896 Wednesday 9:00am – 

29 Palms, CA 92277 

Fax to SB 12:00 pm 

Yucca Valley 56357 Pima Trail 

760.228.5234 Tuesday 

Yucca Valley, CA 92284 Fax to SB 9:00 am – 3:30 pm 

CW 5 referral 

actions 

* Note: Before going to the VA office, the customer should call the VA office 

to confirm the office is open 

The CW 5 is a mandatory form for the CalWORKs program. The chart below 

lists the actions to take when the form is not completed and returned by the 

customer: 

If the CW 5 is not returned at… Then… 

Intake, Follow instructions in the “Denial 

Add person application, 

time frames” block in the 

“Application Processing Time 

Frames” section of Chapter 1 of this 

handbook. 

RE, Take no adverse action. 

CWPHB #4643 (11/12) INCOME 9-23

Reasonably Anticipated Income 

Introduction Quarterly Reporting (QR) uses an anticipated income and prospective 

budgeting method for determining customer benefits. This method is different 

than the one previously used in Monthly Reporting Retrospective Budgeting 

(MRRB). For how to apply the following concepts, please see the Budgeting 

Chapter. 

Cases subject 

to prospective 

budgeting 

Prospective 

budgeting 

Reasonably 

anticipated 

income 

All CalWORKs Assistance Units (AUs) are subject to prospective budgeting 

methods. 

Prospective budgeting requires the use of income the customer reasonably 

anticipates he/she will receive in a quarter. Information reported on the QR 7 

is used to determine continuing eligibility for each quarter. Staff must 

consider income and household information from the QR Data Month, as well 

as anticipated changes in income and expenses when completing Eligibility 

Determination and Benefit Calculations (EDBCs). The prospective budgeting 

method also requires increased interaction between staff and customers to 

ensure the best available information is used to determine what the AU’s 

income situation will be in the future. 

Reasonably Anticipated Income is the rule used to anticipate household 








upcoming quarter, or the family/household is otherwise reasonably 

certain the income will be received within the quarter, AND 


If the amount of income, or when the income will be received is uncertain, i.e. 

it cannot be reasonably anticipated, that portion of the customer’s income 

that is uncertain or cannot be reasonably anticipated will not be counted 

when determining income eligibility and benefit levels. 


CWPHB #4605 (04/11) INCOME 9-24

Reasonably Anticipated Income, Continued 

Journaling Staff is responsible for documenting how they arrived at the reasonably 

anticipated income amount used to calculate the customers’ benefits. 

Because of the increased interaction between staff and customers (phone 

calls, mail, etc.), as well as the rationale required in determining projected 

income for future benefits, it is critical that staff thoroughly document how 

income was projected in determining benefit calculations. Journal entries 

must include, but are not limited to, the following types of documentation: 

• Income the customer states (s)he expects to receive in future months 

• Whether anticipated income will be different than income the customer 

reported receiving for the QR Data Month 

• Documentation of the reasons for not accepting the recipient’s estimate if 

the estimate is questioned 

• Other information used to determine what income will be used in the 

benefit calculations (verifications, employer’s statement’s, case history, 

etc.) if the customer’s estimate is not used 

Journals and other documentation will be particularly critical when 

documenting new income, income that is expected to change, income that 

fluctuates, and income that is so unstable that the customer cannot make a 

reasonable estimate of what income to expect in future months. For 

CalFresh Quality Control (QC) purposes, reviewers will rely heavily on case 

documentation when reviewing case files to determine if benefits have been 

used in the correct amounts. 

CWPHB #4605 (04/11) INCOME 9-25

Examples - Reasonably Anticipated Income 

Introduction The following section outlines examples of using reasonably anticipated income 

in QR/PB. These examples apply to Intake and Continuing cases, as well as 

illustrate earned and unearned income types. See the Budgeting Chapter for 

information regarding how to use each type. 

Earned income 

examples 

Earned income – Income from a new job will only be counted if the specific 

amount is known and it will be received with reasonable certainty within the 

month or quarter. 

Intake: 

Situation 1 – CalWORKs family applied on 9/10. A member of that family went 

to work on 9/12 (first day of pay period) for $7.00 per hour, 40 hours a week. 

He reports employment to the Eligibility Worker (EW) on 9/14. First paycheck 

will be received on 9/23 for one week of work. Second paycheck due 9/30. 

Paid one week in arrears as verified by employer. 

Action – This income can be reasonably anticipated and used to calculate the 

beginning quarter’s benefits because the amount of income and date of receipt 

are known. 

Situation 2 – CalWORKs family applied 9/9. Family member went to work 

9/10. Reports employment to the EW on 9/15. He is not certain how much he 

will be paid, when the first payment will be received, and whether he will be 

paid two times a month or every two weeks. He also doesn’t know if any of the 

income will be held back. The EW is unable to contact employer. 

Action – Income from the new job is not used to calculate beginning months 

benefits because the amount and date of receipt are unknown. 


CWPHB #4605 (04/11) INCOME 9-26

Examples - Reasonably Anticipated Income, Continued 

Earned income 

examples, 

continued 

Unearned 

income 

examples 

Continuing: 

Situation 1 – A customer reports on the QR 7 an AU/HH member will start a 

new job in the upcoming quarter. The family reports the payday falls within 

the next QR Payment Quarter and reports the anticipated wage amount and 

expected hours. 

Action - Because the dates and amount of the income are reasonably 

certain, this income is to be considered reasonably anticipated and therefore 

will be used in the benefit calculations for the next QR Payment Quarter. 

Documentation, in the form of a narrative entry in the case journal, of the 

customer’s statement of expected hours and wages is necessary to 

substantiate the estimate. 

Situation 2 – A customer reports on the QR 7 an AU/HH member will start a 

new job in the upcoming quarter. The AU/HH member knows he/she will 

make $10/hr., but is uncertain of the pay dates, or how many hours will be 

worked each week. 

Action – Because the dates and amounts (number of hours) of the income 

are not reasonably certain, this income is not considered reasonably 

anticipated and therefore is not used in benefit calculations for the next QR 

payment Quarter. Documentation in the form of a narrative entry in the case 

journal is necessary to show why the income was not used. 

Unearned income – Will only be counted if the specific amount is known, can 

be verified, and will be received within a month within the payment quarter. 

Intake: 

Situation 1 – CalWORKs family applies 9/18. Member is to receive UIB. 

Award letter indicates payment amount of $100 per week. The date of receipt 

for the first check is 9/19 for $200 for 2 weeks. 

Action – This income can be reasonably anticipated. The amount of payment 

and date(s) of receipt are known. Use the UIB to complete the Eligibility 

Determination and Benefit Calculation (EDBC). 

Situation 2 – CalWORKs family applies 9/18. Member is to receive UIB. 

Award letter received 9/15 indicates payment amount of $100 per week. No 

effective date given for benefits to begin. No benefits have been received. 

Action – UIB payment shall not be used, as the date of receipt is not 

reasonably certain. Although the CalWORKs family received an award letter, 

there are other criteria, which must be met before income is issued. Use UIB 

only when the receipt date of the check is known. 


CWPHB #4605 (04/11) INCOME 9-27

Examples - Reasonably Anticipated Income, Continued 

Unearned 

income 

examples, 

continued 

Child Support 

examples – 

Intake 

Continuing: 

Situation 1 – A CalWORKs family reports on the QR 7, a member has been 

verbally approved for UIB. However, the family member has not received an 

actual award letter or check, and does not know the exact start date or 

amount. 

Action – Because the date and amount of the income is not known, this 

income cannot be reasonably anticipated and is not used prospectively in the 

calculation for the upcoming QR Payment Quarter. 

Situation 2 – A CalWORKs family reports on the QR 7, a member has been 

approved for SSA benefits, provides a copy of the award letter indicating 

he/she is to receive $300 per month beginning the first of the following month, 

and each month thereafter. 

Action – Because the date and amount of the income is known, this SSA 

income is used prospectively in the calculation for the upcoming QR 


Situation 1 – A CalWORKs family applies July 16. They received a child 

support payment on July 10. 

Action – The child support payment can be considered available and treated 

as reasonably anticipated income for the month of application only. This is 

assuming the family has kept or expects to keep the child support prior to 

approval of the CalWORKs. 

Situation 2 – A CalWORKs family applies March 3. They expect to receive 

child support on March 15, but agree to send the child support payment, 

when received, to the Department of Child Support Services (DCSS). 

Action – Since the family agrees to send the child support payment to 

DCSS, the payment is not considered available and will not be treated as 

reasonably anticipated income. 

CWPHB #4605 (04/11) INCOME 9-28

Earned Income Basics 

Gross pay or 

gross earnings 

Net pay or net 

earnings 

Gross pay or gross earnings is the total amount of earnings prior to 

deductions. 

Net pay or net earnings is the amount of gross earnings less any deductions. 

This is usually the “take home pay”. 

Pay date The pay date is the day the pay is issued or received. Some pay stubs do 

not include the pay date. Ask customers to write the date received on each 

pay stub to assist them in completing the QR 7. 

Pay period The pay period is the time frame in which the pay was earned. The end date 

of the pay period is rarely the pay date. 

Benefit plan Some employers offer benefit plans that allow employees to deduct health, 

dental, and vision premiums from the benefit plan and receive any excess in 

cash. 


excess benefit 

plan cash 

When benefit plan dollars are added to gross earnings, use the chart below 

to determine the correct amount of earnings to use in the CalWORKs 

Eligibility Determination and Benefit Calculation (EDBC): 

Step Action 

1 Subtract the benefit plan dollars from the total gross pay to get the 

gross earnings subtotal. 

Total gross pay – Benefit plan dollars = Gross earnings subtotal 

2 Subtract the actual cost of the customer’s health, dental, and 

vision, whether pretax or after-tax, from the benefit plan dollars to 

get the excess benefit plan dollars (when the result is negative, 

use zero). 

Benefit plan dollars – Actual health, dental, and vision cost = Excess 

benefit plan dollars 

3 Add the excess benefit plan dollars (amount from Step 2) to the 

gross earnings subtotal (amount from Step 1) to get countable 

earnings. 

Gross earnings subtotal + Excess benefit plan dollars = Countable 

earnings 

4 Use the countable earnings from Step 3 as gross earnings in the 

CalWORKs EDBC. 


CWPHB #4605 (04/11) INCOME 9-29

Earned Income Basics, Continued 

Tips Tips are treated as earned income. Include reported tips in the gross earned 

income when completing CalWORKs EDBCs. 

When reported 

tips and pay 

stub differ 

Meals and/or 

lodging 

When an employee receives tips, the tip income should appear on that 

employee’s pay stub. The Internal Revenue Service (IRS) requires the 

employer and employee to report tip income. The employer is required use 

the tip income when determining the amount of social security, Medicare, 

and income taxes to withhold from the employee’s wages. 

Use the chart below to assist you in determining what amount of tips to use 

when the customer reports tips on the QR 7, the tips also appear on the pay 

stub, and the two amounts are not the same: 

When the reported tips are … Then use … 

Less than the tips on the pay stub, The lesser amount of tips reported 

by the customer. 

More than the tips on pay stub, The higher amount of tips reported 

by the customer. 

Sometimes the values of meals and/or lodging are included in the gross pay 

noted on pay stubs and then deducted from the gross income. 

Do not include meals and/or lodging in the gross pay used in the 

CalWORKs Eligibility Determination and Benefit Calculations (EDBCs). 

CWPHB #4605 (04/11) INCOME 9-30

Paid Work Experience (WEX) 

Introduction This section contains information regarding paid Work Experience (WEX) 

hours, and what actions to take when the hours cause the case to be over 

the income limits. 

Definition Paid WEX is subsidized employment, and is: 

• Considered training, 

• Scheduled for six (6) to twelve (12) months, 

• Not covered by Unemployment Insurance Benefit (UIB), and 

• Paid at State minimum wage. 

Paid WEX Goal The goal of the paid WEX activity is to assist the customer learn needed job 

skills to help him/her transition into an unsubsidized employment activity. It 

is expected the customer remain in a paid WEX activity (training) whenever 

possible, by reducing the hours of participation as needed. 


paid WEX 

Determining if 

customer is 

enrolled in paid 

WEX activity 

Paid WEX 

hours cause 

case to be over 

income 

Paid WEX is classified as earned income. Refer to the Income Treatment 

and Verification Chart section in this Chapter for more information. 

To determine if a customer is receiving paid WEX, the Eligibility Worker (EW) 

must look at the Employment Detail page in C-IV. If the Employer shows 

“County of San Bernardino,” and Subsidized Employment? is answered as 

“Yes,” the customer is enrolled in a paid WEX activity. 

Before discontinuing a CalWORKs case for being over income limits, the EW 

must verify if an Assistance Unit (AU) member is in a paid WEX activity (see 

information in this section), and if so, verify all household income. The EW 

must then follow the chart below: 


1 The EW sends an email to the Employment Services Specialist 

(ESS) asking for the reduction in the customer’s WEX hours. 

2 The ESS reduces the WEX hours, or closes the activity as 

appropriate, and emails the EW the adjusted WEX information. 

3 The EW: 

• Uses the reduced WEX hours to reasonably anticipate income, 

OR 

• Discontinues case if it is still over income limits after the paid 

WEX hours are reduced/eliminated. 

4 The EW and ESS Journal all actions taken. 

CWPHB #4605 (04/11) INCOME 9-31

Self-employment 

Who is selfemployed 

Net selfemployment 

A self-employed person is one who: 

• Filed taxes as self-employed the previous year and is in the same type of 

self-employment at the time of application; 

• Commonly offers his/her services, or merchandise to anyone who may 

be in the market for them; commonly provides his/her own supplies, 

materials, or merchandise; and is responsible for expenses normally paid 

by an employer; or 

• Did not file as self-employed the previous year because he/she is newly 

self-employed and/or may not precisely meet the above criteria, but 

circumstances substantiate a determination of self-employment. 

Self-employment income is generated by an individual who is in business for 

him/herself, such as: 

• Farmers 

• Babysitters 

• Housekeepers 

• Hairdressers 

• Sales (Tupperware, Avon, Amway, etc.) 

• Lawn service 

• Odd jobs 

• Rental/roomer/boarder income 

Self-employment income is always treated as earned income. Net selfemployment 

is the total profit earned from self-employment by offsetting the 

business expenses against the gross income from self-employment. To 

determine the amount of that earned income, the net self-employment must 

be calculated. Net self-employment is the amount used when completing 

CalWORKs Eligibility Determination and Benefit Calculations (EDBCs). 


CWPHB #4605 (04/11) INCOME 9-32

Self-employment, Continued 

Identifying selfemployment 

Determining 

net selfemployment 

Selfemployment 

deduction 

The following table contains examples of the types of employment, which 

would and would not qualify as self-employment. The information in the table 

is not inclusive of all examples. 

Self-employment Not self-employment 

Child or elder care providers working 

in their own home or someone else’s 

home 

Housekeepers who solicit their own 

jobs and typically work for a variety 

of private parties or businesses 

Salespeople who purchase products 

for resale (examples include 

Tupperware, Mary Kay, Avon, 

Amway) or raw materials for 

manufacture of products for sale 

such as a crafter 

People who do “odd jobs” 

Day laborers 

• Child or elder care providers 

working in a center owned and 

operated by another party 

• Home care giver for whom FICA 

taxes are paid by the party 

paying for care 

Housekeepers employed by: 

• Hotels, 

• Motels, 

• Maid services, or 

• Institutions 

Salespeople employed by 

businesses such as department 

stores and car dealerships 

People employed by temporary 

agencies or people employed by 

another party on a regular basis but 

paid “under the table” 

Net self-employment is determined by deducting the amount of selfemployment 

expenses from gross self-employment income. CalWORKs 

allows two different options for the self-employment deduction. 

There are two different options for the self-employment deductions. Give the 

CalWORKs customer the option of choosing one of the deduction methods 

below: 

• Option #1 – 40% of gross self-employment income. 

Subtract 40% from gross self-employment income. The balance 

remaining will be used as earned income in CalWORKs EDBCs. 

• Option #2 – Actual expenses. 

Gross self-employment income minus allowable expenses. The balance 

remaining will be used as earned income in CalWORKs EDBCs. 

Note: Allow 40% deduction when there are no expenses. 


CWPHB #4605 (04/11) INCOME 9-33

Self-employment, Continued 

Changing the 

deduction 

Allowable 

actual selfemployment 

expenses 

Actual selfemployment 

expense not 

allowed 

Tips and selfemployment 

Customers can change the method of deduction (40% or actual) only at Re- 

Evaluation (RE) or every six months, whichever occurs first. 

Allowable actual self-employment expenses include, but are not limited to: 

• Cost for hired labor; 

• Stocks/inventory/materials; 

• Business interest, insurance, and taxes (including those of a vehicle used 

for self-employment); 

• Actual cost of mileage for the business usage of selling, delivering 

orders, and attending meetings, etc. (This is determined by receipts or 

customer's reasonable determination of a cost per mile.); 

• Special permits, licenses, fees; 

• Payment on the principal of the purchase price of income producing real 

estate, capital investments, equipment and machinery; and 

• Space/booth rentals, including percentage of costs for portions of a 

CalWORKs AU’s residence used for the self-employment. 

Example: Customer has a typing service in home and has an office set 

up there. Determine the fraction of rooms used or percentage of square 

footage. 

Actual self-employment expenses not allowed in determining net 

self-employment income include, but are not limited to, the following: 

• Personal Federal and/or State income taxes (business taxes are allowed) 

• Work related expenses for getting to/from work site 

• Depreciation 

• Net losses 

When self-employed customers report tips as a portion of their gross 

self-employment income, add the tips to the gross self-employment prior to 

determining net self-employment. 

Example: Customer is a self-employed hair stylist and chooses the 40% 

self-employment deduction. She reports $925 in self-employment and $200 

in tips. Add the $925 to $200 in tips to get gross self-employment of $1,125. 

The allowable self-employment deduction will be 40% of the $1,125 ($450). 

CWPHB #4605 (04/11) INCOME 9-34

Roomer/Boarder and Self-employment 

Roomer income Roomer income is income received by a CalWORKs Assistance Unit (AU) 

from renting a room in their home to another individual or family. Roomer 

income is: 

Boarder 

income 

• Applicable when the CalWORKs AU is the owner of the property, and 

• Not applicable for non-owner landlord property. This is shared housing. 

Note: Roomer income is not rent. 

Boarder income is income received for renting a room and providing meals 

to another person or family. In a boarder situation, the CalWORKs AU is not 

necessarily the owner of the property. 

Shared housing Shared housing exists when two or more family groups share one residence, 

which neither family owns, and each pays mutually agreed upon amounts. 

Roomer or 

boarder income 

Use the chart below to decide whether to attribute any income from the 

roomer or boarder arrangement to the AU. 

When the AU … And … Then … 

Owns the 

residence, 

Does not own 

the residence, 

Reports receiving roomer 

or boarder income, 

Reports receiving room 

and/or board payment 

income, 

An individual or family 

pays their reasonable 

share of the housing and 

utility costs as determined 

by the parties involved, 

An individual or family 

pays more than their share 

of the housing and utility 

costs, 

• Treat the roomer or 

board income as selfemployment 

income, 

and 

• Refer to the chart on 

the following page for 

allowable deductions. 

• The housing is 

considered shared, 

and 

• There is no income to 

the AU. 

The amount in excess of 

the housing and utility 

costs is unearned income. 

Exception: When roomer and/or boarder income is received by a 

CalWORKs AU from another CalWORKs AU, the income received is treated 

as exempt income to the AU. 


CWPHB #4605 (04/11) INCOME 9-35

Roomer/Boarder and Self-employment, Continued 

Deductions – 

when the AU 

owns the 

residence 

Expenses – 

when to verify 

The CalWORKs AU may choose to use actual self-employment expenses, or 

40% of the gross as the self-employment deduction to determine net 

self-employment. 

The chart below lists allowable and non-allowable self-employment expenses 

when the AU owns the residence and elects to use actual self-employment 

expenses in determining net self-employment income: 

Allowable expenses Non-allowable expenses 

• Mortgage interest, property 

taxes, dwelling insurance 

• Business taxes 

• Mobile home space rent 

• Actual utilities defined as 

allowable for computation of 

CalFresh 

• Upkeep and repairs needed 

because of the roomer or 

boarder 

• Reasonable expenses 

generated by the roomer or 

boarder 

• The principal portion of the 

mortgage payment 

• Depreciation and losses 

• The cost of living space shared 

with the roomer or boarder 

• The cost of living space for the 

AU 

Use only verified self-employment expenses in the net self-employment 

determination. Verify roomer and boarder income and expenses: 

• At application, 

• With the QR 7 when changes occur, and 

• At Re-Evaluation (RE). 

The CalWORKs AU is not required to provide verification each quarter unless 

income or expense amounts change. 

CWPHB #4605 (04/11) INCOME 9-36

Self-employment as a Child Care Provider 

Background Many CalWORKs customers provide child care for Child Care program 

customers and are paid through the Child Care program. 

• Child Care providers are paid monthly “in arrears”; meaning payments 

are for care provided in a prior month. 

• Child Care providers are entitled to choose actual business expenses or 

the 40% of gross self-employment to determine net self-employment 

income. 

Allowable 

expenses 

Non-allowable 

expenses 

Allowable verified expenses from Child Care program income include the 

reasonable costs of: 

• Meals provided for the children when food is not provided by another 

agency or feeding program, 

• Educational supplies, 

• Cleaning supplies directly related to the child care operation, 

• Furniture and equipment directly related to the child care, 

• A pro-rata share of housing costs when a room in the home is dedicated 

to child care, and 

• Payments and maintenance for an automobile dedicated to the child care 

business only. 

Non-allowable expenses from Child Care program income include: 

• Payments or rent for the building when the CalWORKs customer 

provides care in his/her home and a room is not dedicated to child care, 

• Car payments or auto maintenance when the family vehicle is used to 

transport children for whom care is provided, and 

• Other expenses normally incurred whether the child care enterprise is 

occurring or not. 


CWPHB #4605 (04/11) INCOME 9-37

Self-employment as a Child Care Provider, Continued 

Verifying Child 

Care provider 

income 

When the C-IV 

amount differs 

from the QR 7 

Child Care 

Family Fees 

and Copayments 

Pay stubs are not issued to Child Care program providers because while San 

Bernardino issues Child Care program funds, San Bernardino County is not 

the employer. To verify the amount of Child Care program funds issued to a 

provider to care for a child or children: 

Step Action 

1 Search the C-IV system for the cases with Child Care programs 

generating income for the provider using the customer’s Social 

Security Number. 

2 Determine the number of cases for each family using the 

customer/provider. The number of warrants issued to the 

customer/provider depends upon the number of cases through 

which Child Care program funds are issued. 

3 Within each case with a Child Care program, find the amount of 

Child Care payment by checking the issuance history. 

4 Narrate in the case journal the amount of Child Care payment 

verified or print the screen and include it in the case with the 

corresponding QR 7. 

When the amount of Child Care program income reported by the customer is 

different from the amount shown in C-IV: 

• Make sure you have identified all of the cases with the Child Care 

program, 

• Contact the customer for clarification, if possible, and 

• Use the amount listed in C-IV when the dispute is not resolved. 

Contact the Child Care Case Worker for payment information for Child Care 

Family Fees and Co-payments. 

Family Fees – The Family Fee is a fee charged to a Child Care family based 

on that family’s income and family size. Family Fees are treated as earned 

income to the Child Care provider. 

Co-payments – Co-payments are required when the Child Care provider 

charges more than the allowable rate on the Child Care Regional Market 

Rate (RMR) chart. Co-payments are treated as earned income to the Child 

Care provider. 

CWPHB #4605 (04/11) INCOME 9-38

Income In-Kind (IIK) 

Definition Income In-Kind (IIK) is defined as a benefit received other than cash. IIK is 

considered for those benefits, which are considered need items. Need items 

are: 

Value of 

Income In-Kind 

(IIK) 

• Housing, 

• Utilities, 

• Food, and 

• Clothing. 

Need items received at no charge with no obligation to repay in cash are 

considered IIK. There are two types of IIK: 

• Earned – work performed in exchange for a need item. 

• Unearned – need item is provided unconditionally. 

Note: Partial need items received will not be treated as either earned or 

unearned IIK. 

When a family receives a basic need item at no charge or in exchange for 

something other than cash, the value of the need item is considered income 

when completing CalWORKs Eligibility Determination and Benefit 

Calculations (EDBCs). 

The IIK values vary with the Assistance Unit (AU) size and need item. The 

values are listed in the Operations and Reference Handbook (O&R HB) in 

Chapter G. 

Use the chart below to determine the amount of IIK to use: 

If the family … And … Then … 

Provides the actual The actual cost is Use the chart value. 

cost of the need item, greater than the chart 

value, 

The actual cost is less 

than the chart value, 

Use the actual cost. 

Does not provide the 

actual cost of the need 

item, 

- Use the chart value. 


CWPHB #4605 (04/11) INCOME 9-39

Income In-Kind (IIK), Continued 

Exceptions Income In-Kind (IIK) will not be considered in the following instances: 

• A partial need item is met, 

• A need item is exchanged for another need item, 

• Board and lodging received for temporary absence of less than 30 days, 

• IIK received from a parent when: 

− A child has applied for minor consent services, and 

− A minor parent is living with his/her senior parent. 

• Entire rent is paid by HUD or other Federal rent supplements, 

• Between two separate CalWORKs Assistance Units (AUs), 

• When provided by a private nonprofit organization (churches, Salvation 

Army, Red Cross, etc.), whether a full or partial need is met. 

(This exception does not include public agencies, or VOLAGs during the 

refugee resettlement period.) 

• When a mortgage payment is not paid due to foreclosure. 

Non-needy 

relatives 

Free housing, 

utilities, and 

food 

In non-needy relative cases, income In-Kind (IIK) will only be considered if 

the non-needy relative chooses to make a voluntary contribution to the AU. 

The County will determine if the non-needy relative wishes to contribute 

income to the support of the child(ren) in his/her care. If he/she does, the 

amount of the contribution actually received shall be determined in 

accordance with section 44-115.3. 

Natural or adoptive parents, stepparents of CalWORKs children whose 

natural parent is in the home, or any other adult whose needs are met 

through APSB, AFDC, EVH, SSI/SSP, IRAP or In-Home Care program will 

not be considered to be non-needy relatives and no IIK may be considered. 

When free housing, utilities, and food are provided during a temporary 

absence from the home, use the chart below to determine how much income 

to use as IIK: 

If the absence is … Then the value of free housing, utilities, and 

food … 

Less than one month, Is exempt. 

More than one month, Reasonably anticipated to be received during 

the QR Payment Quarter is considering IIK, but 

only to the extent the costs exceed what the 

customer is paying to maintain the home to 

which he/she expects to return. 


CWPHB #4605 (04/11) INCOME 9-40

Income In-Kind (IIK), Continued 

Need item 

shared with 

persons not in 

AU 

If the customer shares a need item with persons who are not members of the 

AU or whose needs are not considered in the AU, the value of IIK attributable 

to the AU is the lesser of: 

• The pro rata share of persons whose needs are considered in the AU of 

the net market value or cost of the item, or 

• The IIK chart value (see O&R HB) for the number of persons whose 

needs are considered in the AU. 

Example: 

An AU of a mother and two children shares free housing with another person, 

making a household of four, and the customer presents satisfactory evidence 

the net market value of the housing is $120. Assuming the chart value of 

housing for three is $275, the IIK value of housing used would be the AU’s 

pro rata share of $120 is $90 ($120 ÷ 4 in household x 3 in AU). 

CWPHB #4605 (04/11) INCOME 9-41

Unrelated Adult Male (UAM) 

Definition An Unrelated Adult Male (UAM) is a male who: 

Impact of UAM 

on AU 

UAM is a 

roomer or 

boarder 

• Is at least 18 years of age, 

• Lives with a CalWORKs Assistance Unit (AU), and 

• Is not related by blood or marriage to any member of the AU, unborn, or 

Maximum Family Grant (MFG) child. 

When a UAM resides with the AU, the impact of this living arrangement must 

be evaluated to determine the possibility there is income to the AU for 

completing CalWORKs Eligibility Determination and Benefit Calculations 

(EDBCs). Use the chart below to evaluate the impact of the living 

arrangement between the UAM and the AU: 

If the… Then evaluate the possibility of… 

Basic needs of the AU are being 

met by the UAM, 

UAM gives the AU an 

unrestricted cash contribution, 

UAM is actually a roomer or 

boarder, 

Income in-kind for the AU. 

See Income In-Kind section in this 

Chapter. 

Unearned income. 

Self-employment income for the AU. 

See Room/Boarder and Self- 

Employment section in this Chapter. 

An unrelated adult can be considered a roomer or boarder as long as there is 

a written statement from the caretaker in the AU to that effect. In addition, 

obtain supporting evidence such as: 

• Evidence roomer or boarder income is reported for income tax purposes, 

• The caretaker has a license to operate a rooming house, 

• There is evidence living space is furnished separate from that occupied 

by the AU, or 

• Receipts indicating payment of room rent or room and board. 


CWPHB #4605 (04/11) INCOME 9-42

Unrelated Adult Male (UAM), Continued 

Classifying 

income from 

the UAM 

Income to the AU from a UAM can be classified as: 

• Exempt 

• Earned or unearned cash contribution 

• Earned or unearned Income In-kind (IIK) 

Use the following table to help you classify income from a UAM: 

When the UAM … Then consider … 

Contributes cash to meet his share No income to the AU. 

of basic need items, 

Contributes cash to meet specific 

needs of the AU other than food, 

housing, utilities, and clothing, 

Pays the full cost of one or more 

need items in exchange for the AU 

paying the full cost of one or more 

other need items, 

Contributes money the AU can Earned or unearned income 

spend toward their own share of depending on the situation. 

basic needs, 

Provides full need items at no Earned or unearned IIK based on the 

charge, 

lesser of the actual value or the IIK 

value table. 

Pools his income with the income of The total amount of the UAM’s 

the AU, 

income is considered a cash 

contribution and treated as unearned 

income. 

Is reported to be a roomer or boarder Self-employment income to the AU if 

by the AU, 

the roomer/boarder and ownership 

criteria described earlier in this 

Chapter are met. 


CWPHB #4605 (04/11) INCOME 9-43

Unrelated Adult Male (UAM), Continued 

Documentation Upon notification a UAM resides with a CalWORKs AU, send or give the 

caretaker relative/payee the following forms: 

• CW 71 Cover Letter, and 

• CW 71 – Statement of CalWORKs Caretaker and Unrelated Adult. 

Customer 

disputes 

treatment of 

UAM income 

The CW 71 must be returned within 10 days. Use the chart below for 

compliance issues: 


Completes and returns the CW 71 Evaluate any financial contribution to 

within 10 days, 

the AU. 

States the UAM refuses to complete Accept the CW 71 with the 

and sign the CW 71, 

information the customer provides. 

Fails to return the CW 71, • At application, deny application 

immediately. 

• Continuing, discontinue at the 

end of the current quarter with 

10-day notice. 

Note: Only obtain a new CW 71 when the customer reports a change in 

arrangements, such as rent, utilities, monetary contributions, etc. 

When a customer completes a CW 71 and disagrees with the treatment of 

UAM income because they misunderstood how to complete the form, use the 

chart below to: 

Step Action 

1 Ask the customer to describe the actual situation and narrate in 

the case journal. 

2 Send or give the customer another cover letter and CW 71. 

3 

Request the customer return the corrected CW 71 within 30 days. 


Returns the CW 71 within 30 

days, 

Fails to return the CW 71 

within 30 days, 

Make any changes necessary 

as a result of the revised 

form. 

• Discontinue CalWORKs 

for the customer only for 

failure to cooperate at the 

end of the current 

payment quarter, and 

• Use the information from 

the previous CW 71. 

CWPHB #4605 (04/11) INCOME 9-44

Income from Property 

Income from 

property 

Income from property can be generated through things such as: 

• Rental of real property; 

• Rental of a room in a home owned by an AU; 

• Sale of real estate; 

• Rental of personal property such as trucks, tools, trailers, and the like; 

• Interest from investments and bank accounts; 

• Sale of crops; and 

• Sale of livestock. 

Treatment Income from property can be treated as earned or unearned income 

depending on the circumstances. Refer to the following table for: 

• The classification of income from property, and 

• A summary of the deductions resulting in the net amount of the income to 

consider. 

Income source Treatment Deductions 

Rental of real estate Unearned Deduct the following from the gross rent: 

• Taxes and assessments, 

• Mortgage interest – do not deduct the 

principal payments, 

• Insurance, 

• Utilities – when paid by the owner, and 

• Upkeep and major repairs. 

OR 

• Deduct 15% of the gross rent and 

Rental of rooms 

Room and board 

Selfemployment 

earnings 

• Subtract $4.17 monthly from the result. 

Apply the deductions for self-employment 

income described earlier in this chapter when 

the ownership criteria are met. 

Interest payments Unearned None. 

Rental of personal property Unearned Deduct maintenance expenses 

Sale of real estate; AU Unearned • The portion of the payment that is interest 

receives periodic payments 

is income to the AU. 

• The principle amount is the conversion of a 

real property resource to a cash resource. 

Sale of crops Earned Use net earnings; refer to EAS section 

44-113.1.f 

Sale of livestock Earned Use net earnings; refer to EAS section 

44-113.1.g 

CWPHB #4605 (04/11) INCOME 9-45

Unemployment Insurance Benefits (UIB) 

Treatment Unemployment Insurance Benefits (UIB) are treated as unearned income 

when completing CalWORKs Eligibility Determination and Benefit 

Calculations (EDBCs). 

Deductions 

from UIB 

Who must 

apply for UIB 

Who is not 

required to 

apply for UIB 

When the UIB payment shows a deduction has been taken from the benefit, 

use the chart below to determine the correct amount of UIB to use when 

completing CalWORKs EDBCs: 

When the deduction is for … Then use the … 

• Current tax year federal income 

tax withholding, 

Net amount of the UIB. 

• Federal income tax intercept for 

a tax due from a previous year, 

• A UIB overpayment collection, or 

• Attorney fees required to receive 

the UIB, 

Other obligations, debts, or 

garnishments, 

Gross amount of the UIB. 

Customers, both applicant and recipient, must apply for UIB when: 

• They become unemployed, or 

• Their hours of employment are less than 40 hours per week. 

Do not require a person to apply for UIB who: 

• Has not worked in employment covered by the Unemployment Insurance 

Compensation Law in the past 19 months. 

• Has a pending application, is currently receiving, or has exhausted 

his/her UIB or DIB. 

• Has an illness or injury that is expected to last at least 30 days and 

prevents the person’s ability to be regularly employed or participate in 

Welfare-to-Work activities. 

• Was previously denied or discontinued from UIB and has no subsequent 

employment, which would change the previous determination. 

• Is employed 40 hours or more weekly. 

• Is participating in a strike. 

• Is 18 years old and younger and is aided as a child. 


CWPHB #4605 (04/11) INCOME 9-46

Unemployment Insurance Benefits (UIB), Continued 

How to apply Customers may apply for UIB by: 

Proof of UIB 

application 

EDD Real-Time 

Match 

• Submitting an application via internet at www.edd.ca.gov 

• Printing the application from the internet and mail to Employment 

Development Department (EDD) for processing 

• Calling one of the toll free numbers below: 

English 1-800-300-5616 Mandarin 1-866-303-0706 

Spanish 1-800-326-8937 Vietnamese 1-800-547-2058 

Cantonese 1-800-547-3506 TTY (Non-Voice) 1-800-815-9387 

Customers usually receive a written response to their application (claim) for 

UIB within five to seven working days. The following are all examples of proof 

an application for UIB was made: 

• Benefit approval letter; 

• Benefit denial letter; 

• Computer print-out from EDD showing the date the claim was filed; or 

• EDD Real-Time Match showing the weekly benefit amount for the claim, 

the total claim amount available, or a claim was filed but zero benefits are 

available for the base year. 

Information regarding the EDD Real-Time Match screen-prints can be found 

in the MEDS Easy Desk Source. 

CWPHB #4605 (04/11) INCOME 9-47

Disaster Unemployment Assistance 

Introduction The Disaster Unemployment Assistance (DUA) program provides benefits to 

customers who suffered job loss or endured unemployment as a result of the 

freeze in California in January 2007. 

DUA became effective March 13, 2007 after the following sixteen counties in 

Central and Southern California were declared a major disaster: Fresno, 

Imperial, Kern, Kings, Los Angeles, Madera, Merced, Monterey, Riverside, 

San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Stanislaus, 

Tulare, and Ventura counties. 

The original filing deadline of April 13, 2007 was extended through 

May 25,2007. 

Who is eligible Customers who have the legal right to work in the United States but are not 

eligible for regular unemployment benefits, including customers who have 

exhausted their regular unemployment benefits or are self-employed may be 

eligible. 


DUA 

The DUA program provides benefits of up to $450 a week for up to 26 weeks 

to customers. The Eligibility Worker can determine whether a customer is 

receiving DUA or regular Unemployment Insurance Benefits (UIB) by viewing 

EDD records. DUA is indicated by “DUA” and UIB is indicated by “UI”. 

Treatment DUA benefits are not considered income for purposes of determining 

CalWORKs eligibility and grant determination. 

CWPHB #4605 (04/11) INCOME 9-48

Pensions 


pension 

income 

Allowable 

pension 

deductions 

Pension income is treated as unearned income. Use the chart below to 

determine the correct amount of income to use in completing CalWORKs 

Eligibility Determination and Benefit Calculations (EDBCs). 

When the money is … Then … 

A pension account where 

contributions were required as a 

term of the employment (SBCERA 

and PERS plans as examples), 

whether or not the employed person 

still works for the agency, 

A monthly benefit check from the 

pension account, 

From a mandatory pension account 

which was “cashed out” but placed in 

an independent retirement account, 

From a mandatory pension account 

which was “cashed out” and not 

placed in an independent retirement 

account, 

The pension account is considered a 

resource – not income – and is not 

counted toward the family’s resource 

limit. 

Count the monthly benefit as 

unearned income; continue to 

exempt the money remaining in the 

original pension account. 

Count the cash value, minus 

penalties for withdrawal, as a 

resource – not as income. 

• Count the pension account as 

income in the month received. 

• Count remaining funds as cash 

resource in subsequent months, 

as retained. 

When the UIB payment shows a deduction has been taken from the benefit, 

use the chart below to determine the correct amount of UIB to use when 

completing CalWORKs eligibility determination and benefit calculations: 

When the deduction is for … Then use the … 

• Current tax year federal income tax 

withholding, 

Net amount of the pension. 

• Federal income tax intercept for a tax 

due from a previous year, 

• A pension overpayment collection, or 

• Attorney fees required to receive the 

pension, 

Other obligations, debts, or garnishments, Gross amount of the pension. 

CWPHB #4605 (04/11) INCOME 9-49

General Payroll Information and Examples 

Introduction The following section contains general payroll information and pay stub 

examples. 

Reviewing pay 

stubs 

When reviewing pay stubs, it is important to watch for the items listed below: 

• Pay Date and Pay Period Ending - Confirm the stubs received are for the 

period to be evaluated. 

• Deductions – If there are deductions for bonds, savings, credit union, or 

other accounts, be sure to check the case for current balance verification. 

• Benefit Plans and Health Care Deductions – Health Benefit and Flex Plan 

amounts are added to the gross pay. Deductions for Medical, Vision, 

and/or Dental insurance are then deducted from the total, up to the 

maximum amount of the benefit. 


CWPHB #4605 (04/11) INCOME 9-50

General Payroll Information and Examples, Continued 

Terms The following terms and corresponding numbers are used on the pay stub 

example below: 

1. Gross – The total amount earned before deductions. 

2. Net – Amount earned less any deductions (usually the take home 

amount). 

3. Pay Period – The to and from dates included in a particular time frame 

the individual is being paid for. 

Note: The end of the pay period is rarely the date the check/payment is 

received. 

4. Pay Period Ending (PP End) – The last date of the pay period 

5. Pay Date – the date a check is issued. Some stubs do not include this 

date. Encouraging the customer to write the date received on each stub 

as the check is received will assist the customer in completing the QR 7 

accurately. 

Labor Ready 

Ontario, CA 

4. Pay Period End 

DEPT EMPL NO CLOCK NO EMPLOYEE NAME SOCIAL SECURITY NUMBER 

14 0524 0007 SMITH, JOHN 500-50-5000 

UNIT AMOUNT RATE GROSS 

YEAR TO 

DATE 

DEDUCTION AMOUNT 

PAY DATE CHECK NO 

05-24-03 00445 

PAY PERIOD 

BEGIN DATE END DATE 

05-01-03 05-15-03 

YEAR TO 

DATE 

HOURLY 75 00 6 75 506 25 870 75 FIT 32 25 78 66 

1. Gross 

2. Net 

5. Pay Date 

3. Pay Period 

FICA 42 59 56 75 

SIT 3 05 5 01 

SDI 2 78 3 96 

TOTAL 

WAGES 

LESS 

DEDUCTIONS 

506 25 870 75 

80 67 144 38 

NET PAY 425 58 726 37 


CWPHB #4605 (04/11) INCOME 9-51


Weekly pay 

stub example 

Additional 

information 

Conrad Constructors 

Rialto, CA 

11851 

Pay period End 

08/23/03 YTD 

Hourly Plant WA 

(44.50@8.50) 

378.25 6118.63 

O/T 011 (4.50@4.25) 19.13 115.32 

Federal Withholding -20.00 -261.00 

Social Security Employee -24.64 -565.95 

Medicare Employee 

CA – Withholding 

Gross: 

378.00+19.13= 

-5.77 

-2.71 

-132.36 

-12.54 

CA – Disability Employee 397.38 -3.58 -8215 

Plant Form Setup 0.00 2486.00 

O/T 221 0.00 24.25 

Clean Up 0.00 256.00 

Holiday 011 0.00 128.00 

340.68 

Net: 

340.68 

The payroll stub above does not include the pay date or pay period. This 

payroll stub reflects a weekly pay period ending 8/23/03. The pay date is 

9/05/03 as taken from the QR 7. This date should match the pay date 

schedule in the case record. 


CWPHB #4605 (04/11) INCOME 9-52


Bi-weekly pay 

stub example 

ADP 

JSP INTERNATIONAL 

4062 GEORGIA BLVD Period Ending: 10/19/2003 

Pay date 

SAN BERNARDINO, CA 92407 Pay Da te: 10/24/2003 

909 - 880 - 1855 

Taxable Marital Status: single 

Exemptions/Allowances: 

Federal: 3 

State: 3 

Social Security Number: 

Earnings Rate Hours This Period Year to Date 

Regular 14.90 80.00 1192.00 17662.02 

Overtime 22.35 38.25 854.89 7008.41 

Shift 14.90 7.75 .77 85.20 

Double time 105.50 15.82 66.43 

Holiday 728.64 

Sick Gross 

1186.64 

Vacation 1066.52 

Profit Sharing 1859.33 

Gross Pay $2063.48 28703.19 

Deductions Statutory 

Federal Income Tax -257.26 2980.60 

Social Security Tax -126.35 1983.56 

Medicare Tax -29.55 463.90 

CA State Income 

Tax 

-91.66 898.04 

CA SUI/SDI Tax -18.35 287.94 

Other 

Net Pay= 

Checking 

Dental 

Life Insurance 

-1389.16 

-3.00 

-3.69 

Total of the “Other” 

section. $1515.56 

Review case record 

for Checking/Savings 

23006.49 

66.00 

81.81 

Med125 -19.50 verification. 

429.00 

Savings -.2500 550.00 

Vision -3.06 67.32 

401K Loan -35.00 

401K -61.90 

NetPay 0.00 

Your Federal taxable wages 

this period are $1976.02 


CWPHB #4605 (04/11) INCOME 9-53


Semi-monthly 

pay stub 

examples 

Pay Period Ending Employee Number Employee Name Department 

09/30/2003 1623000 Jackson, Jane 54-3000 

****Earnings**** ****DEDUCTIONS**** 

TYPE PERIOD 

YTD TYPE PERIOD YTD 

REG. HOURS 

REG. PAY 

JOB SITE ALL 

GROSS PAY 

Gross 

32.60 

220.05 

28.90 

248.95 

32.60 

220.05 

28.90 

248.95 

FICA 

SMOCK DEP. 

CA DISAB. 

NET PAY 

0049 INVENTORY AUDITORS INC 10/05/03 

15.86 

10.00 

2.41 

220.86 

Pay Period Ending Employee Number Employee Name Department 

10/15/2003 1623000 Jackson, Jane 54-3000 

****Earnings**** ****DEDUCTIONS**** 

TYPE PERIOD YTD TYPE PERIOD YTD 

REG. HOURS 

REG. PAY 

JOB SITE ALL 

GROSS PAY 

Gross 

30.00 

202.50 

25.20 

227.70 

Pay date 

30.00 

422.55 

54.10 

476.65 

FICA 

SMOCK DEP. 

CA DISAB. 

NET PAY 

0049 INVENTORY AUDITORS INC 10/20/03 

Pay date 

13.15 

10.00 

2.16 

202.39 


CWPHB #4605 (04/11) INCOME 9-54 

15.86 

10.00 

2.41 

220.86 

7.93 

10.00 

4.57 

423.25


Monthly pay 

stub example 

Additional 

information 

State of California 

Office of the 

Controller 

SOCIAL 

SECURITY 

NUMBER 

STATEMENT OF 

EARNINGS AND 

DEDUCTIONS 

DO NOT PAY 

THIS IS NOT A 

CHECK 

SURNAME AGY DEPT EMP 

# 

MILTON 

25- 

021 

WARRANT 

CONTROL 

02-5548 

WITHHOLDING 

ALLOWANCE 

0025 2541 M - 5 

FEDERAL TAX YEAR PAY PERIOD CYCLE 

002-200-2000 

2003 

2003/09 

08/01-08/31 

STRAIGHT FED TAX CA TAX 

GROSS 

MISC. DEDUCTIONS 

800 00 48 16 22 19 

Net 

Pay Period 

Gross 

PA 

CD 

NET PAY 

08/05/03 

Case should reflect pay date as once a month. 

DIRECT 

DEPOSIT 729 65 


CWPHB #4605 (04/11) INCOME 9-55


Pay stub with 

tips and/or 

meals example 

Additional 

information 

HOURS 

PAY 

PERIOD 

EARNINGS 

NAUGLES 

1801 E. Imperial Hwy 

P.O. BOX 1408 

Brea, CA 92671 

Pay Period End 

PERIOD BEG: 

09/21/2003 

DEPT 

0097 

NAUGLES RESTAURANTS INC. 

PER END 

10/04/2003 

EMPLOYEE NAME 

L. S. Smith 

REGULAR OVERTIME TIPS RATE 

47.00 

1039.00 3.75 

317.25 

3793.24 6.84 

This pay stub reflects a two-week pay period beginning 09/21 and ending 

10/04. Pay date is not included. According to case information and QR 7, pay 

date is 10/17/2003. 

Tips are shown separate and added into gross earnings. 

526678 


CWPHB #4605 (04/11) INCOME 9-56 

6.75 

17.60 334.85 

4294.73 

DEDUCTIONS FEDWITHHOLDING STATEWITHHOLDING FICA SDI 

GROSS 

SOCIAL SECRITY NUMBER XXX-XX-XXXX 

11.97 

261.70 

CHECK NO. 

531972 

1.76 

38.65 

CURRENT 

YTD 

CURRENT 

YTD 

CURRENT 

YTD 

CURRENT 

YTD 

NET PAY 321.12 

NET


Pay stub 

with flexible 

benefit plan 

example 

Additional 

Information 

County of San Bernardino 

222 W. Hospitality Lane 

San Bernardino, CA 92415-0018 

Gross: 

Flex Benefit excess: 0 

Gross earnings: $816.60 

Pay Group: C07-FLSA Covered – 7 Day Period Advice#:: 

Pay Begin Date: 10/18/2003 SR#:: 

Pay End Date: 10/31/2003 

Pay Period: PP 0323 Advise Date:11/12/2003 

ID# Dept Job Title Pay Rate TAX DATA: Federal CA State 

0 52341-CW EWI $10.21 Hourly 

Marital Status: Married Married 

Allowances: 2 2 

Addl. Pct:: 

Addl. Amt:: 

HOURS AND EARNINGS 

Start Date End Date Description Rate H ours Earnings 

TAXES 

Description Current YTD 

10/18/2003 10/24/2003 Flexible Benefit Plan Dollars 87.50 Fed. Withholding 45.08 182.60 

Regular Time 10.21 40.00 408.40 Fed MED/EE 12.37 64.84 

10/25/2003 10/31/2003 Flexible Benefit Plan Dollars 87.50 CA Withholding 1.52 31.20 

Regular Time 10.21 40.00 408.40 CA OASDI/EE 5.97 31.30 

Total: 991.80 Total: 64.94 281.78 

BEFORE – TAX DEDUCTIONS: AFTER – TAX DEDUCTIONS EMPLOYER PAID BENEFITS 

Description Current YTD Description Current YTD Description Current YTD 

Delta Care 11.18 67.08 

Kaiser 268.91 1613.46 

Retirement Refund Gen. 88.98 533.88 

11762 

11061743 

Assoc. Dues 6.45 38.70 

Survivors’ Ben 1.85 Checking 11.10 

account 

Life Ins. Cnty Pd. 4.20 25.20 

Retire Employer Pd. 40.31 214.46 

Survivor’s Benefit 1.85 11.10 

Work Comp. Clerical 4.86 25.32 

Total: 369.07 2214.42 Total: 8.30 49.80 Total: 51.22 276.61 

TOTALS: FED TAXABLE GROSS GROSS TAXES DEDUCTIONS NET PAY 

Current:: 622.73 991.80 64.94 377.37 549.46 

YTD: 3736.38 5950.80 389.64 2264.22 3296.76 

LEAVE PLAN PRIOR EARNED TAKEN ADJUST CURRENT 

Sick 16.96 3.39 0.00 0.00 20.35 

Holiday 16.00 0.00 0.00 0.00 16.00 

Description ID# Current 

Earnable Compensation 0 549.46 

Direct Deposit Checking: 549.46 

Gross pay was calculated by first determining the total amount of flex pay for 

this pay period: $175 ($87.50 + $87.50). The amount of health and dental 

deduction were then subtracted from the flex benefit total: $175.00 - $280.09. 

Since the amount of the deduction exceeds the benefit amount, the excess is 

zero. The gross is then the total amount of earnings for this pay period: 

$408.40+ $408.40=$816.80. 

This pay stub reflects a direct deposit payroll arrangement into a checking 

account. The case record should contain current verification of this account. 

CWPHB #4605 (04/11) INCOME 9-57



CHAPTER 10 

Reporting 

Chapter Overview .......................................................................................10-1 

SECTION 1 Definitions and Terms 

Overview.....................................................................................................10-2 

Definitions and Terms.................................................................................10-3 

SECTION 2 Reporting Requirements 

Overview.....................................................................................................10-5 

Quarterly Report (QR 7) .............................................................................10-6 

Mid-quarter Reports....................................................................................10-8 

SECTION 3 Quarterly Report (QR 7) and Other Required Forms 

Overview.....................................................................................................10-9 

Quarterly Report – QR 7...........................................................................10-10 

Quarterly Report – The Process ...............................................................10-11 

Other Required Forms ..............................................................................10-13 




SECTION 4 QR 7 Completeness Criteria 

Overview...................................................................................................10-14 

QR 7 Completeness Criteria.....................................................................10-15 

QR 7 Completeness – Comparing QR 7 to Mid-quarter Reports .............10-18 

QR 7 – Request to Stop Benefits..............................................................10-19 

QR 7 Completeness – Part 1....................................................................10-20 

QR 7 Completeness – Part 2....................................................................10-23 

QR 7 completeness – Income Verifications..............................................10-25 

QR 7 Completeness – Address Change...................................................10-27 

QR 7 Completeness – Certification ..........................................................10-28 

SECTION 5 Processing a Complete, Incomplete, or Late QR 7 and Good Cause 

Overview...................................................................................................10-29 

Processing a Complete QR 7 ...................................................................10-30 

Processing an Incomplete QR 7 ...............................................................10-31 

Late QR 7 .................................................................................................10-34 

Examples of a Complete QR 7 .................................................................10-35 

Examples of an Incomplete QR 7 .............................................................10-37 

Discontinuance for a Missing or Incomplete QR 7....................................10-38 

Good Cause..............................................................................................10-39 




SECTION 6 Mandatory Mid-quarter Reports 

Overview ................................................................................................... 10-41 

Mandatory Mid-quarter Reports ................................................................ 10-42 

Incoming Reporting Threshold (IRT) ........................................................ 10-43 

Address Change ....................................................................................... 10-46 

Drug Felony Convictions, Fleeing Felon Status, and 

Parole/Probation Violations ...................................................................... 10-47 

Reduction in ABAWD Work Hours ............................................................ 10-49 

SECTION 7 Voluntary Mid-quarter Reports 

Overview ................................................................................................... 10-50 

Voluntary Mid-quarter Reports .................................................................. 10-51 

Changes in Income ................................................................................... 10-52 

Changes in Assistance Unit (AU) / Household (HH) Members ................. 10-54 

Request for Special Need Payment .......................................................... 10-56 

SECTION 8 Annual Reporting/Child Only (AR/CO) Cases 

Overview……………………………………………………………………...…10-57 

Reporting Requirements………..……………………………………………..10-58 

Requests for Discontinuances and County Initiated Actions………….…..10-62 

Case Transition……………………………………………………………...…10-63 


Overview 

Reporting 

Introduction This Chapter includes the reporting requirements and: 

• Covers the information needed to determine whether or not a QR 7 

Quarterly Eligibility/Status Report, is complete or incomplete, 

• Explains how to process the QR 7, and 

• Explains Mandatory and Voluntary Mid-quarter reports. 

Reference The following references are applicable to the information under this topic. 

• EAS 40-103, 40-181.2, and 40-187 

• EAS 44-211 

• EAS 44-316 

• EAS 63-102 

• EAS 63-505.3 and 63-508 

• EAS 80-301 

Special Note In order to provide consistent information regarding QR 7 completion and 

customer reporting requirements, this chapter contains information for both 

the CalWORKs and CalFresh. 




Reporting Requirements 10-5 

Quarterly Report (QR 7) and Other Required Forms 10-9 

QR 7 Completeness Criteria 10-14 

Processing a Complete, Incomplete, or Late QR 7 and Good 10-29 

Cause 

Mandatory Mid-quarter Reports 10-41 

Voluntary Mid-quarter Reports 10-50 

CWPHB #4605 (04/11) REPORTING 10-1

Overview 

Section 1 


Introduction This section contains some of the terms and definitions used in this Chapter. 

Reference The following reference is applicable to the information under this topic. 

• EAS 40-103 and 40-181.2 

• EAS 44-316 

• EAS 80-301 






Overview This section introduces some of the terms and definitions used in this 

chapter. 


Terms 

Below are some of the terms and definitions used in this chapter: 

Extended Filing Date – The first working day of the Next Quarterly 

Reporting (QR) Payment Quarter. 

Late QR 7 – A QR 7 not received by the County by the 11 th of the QR Submit 

Month. 

Mandatory Mid-quarter Reports – Reports customers are required to make 

within 10 days to the County. 

Next QR Payment Quarter – The quarter immediately following the Submit 

Month. 

QR 7 – The Quarterly Eligibility/Status Report is completed by the customers 

on a quarterly basis to report changes in their circumstances. 

QR 7 Addendum – The QR 7 Addendum is sent to the customer with the 

QR 7; it lists examples of income and expenses, and the penalties for 

committing fraud. 

QR 7 Reporting Period – The first day of the QR Submit Month through the 

last day of the QR Data Month. 

QR Begin Month – The first month of the QR Payment Quarter. 

QR Data Month – The month for which the recipient customer reports all 

information necessary to determine eligibility. The QR Data Month is the 

second month of each quarter. 

QR Payment Quarter – The quarter for which benefits are paid/issued. A 

quarter is comprised of three consecutive months. 

QR Submit Month – The month in which the QR 7 is required to be 

submitted to the County. The QR Submit Month is the third month of each 

quarter. 





Terms 

(continued) 

Reasonably Anticipated Income – The rule used to anticipate household 








upcoming quarter, or the family/household is otherwise reasonably 

certain the income will be received within the quarter, AND 


Responsible Household Member – Any member of the household who is 

18 or older who has knowledge of all household information and 

circumstances for reporting purposes. 

Voluntary Mid-quarter Reports – Reports customers may make to the 

County anytime during the quarter. The County may only take action to 

change benefits based on voluntary mid-quarter reports when benefits 

increase as a result of the reported change. 


Overview 

Section 2 


Overview All CalWORKs and/or CalFresh families, with the exception of 

Non-Quarterly Reporting (NQR) CalFresh households, are required to report 

once a quarter on the Quarterly Report (QR 7). There are also a number of 

mid-quarter reports the customer is required to report mid-quarter. 

This section contains information regarding the customer’s reporting 

requirements under Quarterly Reporting. It includes the general 

requirements for the QR 7 and Mandatory Mid-quarter reports. For complete 

information about the QR 7 and Mandatory Mid-quarter reports, see those 

specific subject sections later in this Chapter. 


• EAS 40-103, 40-181.2, and 40-187 

• EAS 44-211 

• EAS 44-316 



Quarterly Report (QR 7) 10-6 

Mid-quarter Reports 10-8 


Quarterly Report (QR 7) 

Introduction This section contains information regarding what the customer is required to 

report on the QR 7. 

QR 7 required 

information 

QR 7 

completeness 

criteria 

Assistance with 

QR 7 

completion 


QR 7 reported 

information 

Customers must answer all questions on the QR 7, complete all items, and 

attest under penalty of perjury they have truthfully reported all required 

information. Each item on the QR 7 pertains to CalWORKs and/or CalFresh 

eligibility. Customers are required to report: 

• All income received from the QR Data Month, 

• Any changes in household composition or property since the submission 

of the last QR 7, and 

• Any changes in income the household anticipates will occur in the 

upcoming QR payment quarter. 

The QR 7 is complete if: 

• The form is signed and dated no earlier than the first day of the QR 

Submit Month, and 

• All Questions and items are fully answered and information on the QR 7, 

together with attached documentation, provide sufficient information 

to allow for the determination of eligibility and/or benefit level 

(reasonably anticipated), and 

• Required verification is provided. 

Assistance in completion and filing of the QR 7 will be provided to customers 

who are prevented from completing or filing a QR 7 due to one of the 

following: 

• Mental or physical disability, 

• Non-English speaking, 

• Lacking sufficient reading and writing skills, or 

• Customer request 

Treat information reported on the QR 7 as information known by the 

customer up through the last day of that QR 7’s reporting period. The QR 7 

reporting period is the first day of the QR Submit Month through the last day 

of the QR Data Month. 

Note: Questions #1b and 5 on the QR 7 allow the customer to report specific 

changes for the upcoming quarter. (See QR 7 Completeness – Part 1 of this 

Chapter for more information). 



Quarterly Report (QR 7), Continued 

Examples The following examples demonstrate how information reported and verified 

on a QR 7 is to be treated. A Journal entry must be made by the Eligibility 

Worker (EW) to explain how usage of income was determined. 

Example 1 – A customer reports weekly gross earnings in Question #1 and 

does not indicate a change of any kind is expected in Question #1b and/or 9. 

Result – Income is used as weekly gross earnings and the income is used to 

determine benefits for the upcoming quarter. 

Example 2 – Customer reports weekly gross earnings in Question #1, but 

indicates the job stopped or will stop in Question #1b and/or 9. 

Result – Income is not used to determine benefits for the upcoming quarter. 

Example 3 – A customer reports no earnings in Question #1, but indicates 

on Question #1b a new job will be starting the last week of the Submit 

Month. The customer also reports the expected hours, rate of pay, and pay 

dates. 

Result – Income from the new job is reasonably anticipated for the upcoming 

quarter and used according to what is reported on the QR 7. No verification 

is required. 

Example 4 – A customer reports no earnings in Question #1, but indicates a 

new job will be starting in Question #9. The number of work hours, pay rate 

and/or pay frequency are not known. 

Result – After contacting the customer, the income from the new 

employment cannot be reasonably anticipated. It is not used for the 

upcoming quarter. 


Mid-quarter Reports 

Introduction This section gives a brief overview of the reports the customer is required to 

make mid-quarter. These required mid-quarter reports are called Mandatory 

Mid-quarter reports. For complete information about Mandatory Mid-quarter 

reports, see the Mandatory Mid-quarter reports section later in this chapter. 

Mandatory Midquarter 

reports 

Under Quarterly Reporting, customers are required to report certain changes 

within 10 calendar days of the date the change becomes known to the 

CalWORKs and/or CalFresh customer. These types of reports are called 

Mandatory Mid-quarter reports. 

Mandatory Mid-quarter reports for each program are as follows: 

• CalWORKs: 

− Income exceeding the Income Reporting Threshold (IRT), 

− Address changes, 

− Felony drug convictions, 

− Fleeing felon status, and 

− Violations of the conditions of probation or parole. 

• CalFresh: 

− Address changes, and 

− CalFresh only: ABAWDS who fail to meet the work requirement. 

Note: Beginning April 1, 2009, the American Recovery and 

Reinvestment Act (ARRA) of 2009 suspended the ABAWD work 

requirement. This suspension is due to continue through September 30, 

2010. During this time period ABAWDs are not required to report work 

hours. 


Overview 

Section 3 

Quarterly Report (QR 7) and Other Required Forms 

Introduction This section contains information regarding the Quarterly Report (QR 7), the 

QR 7 process, and other forms related to the Quarterly Report process. 

Information regarding completeness criteria and the required actions for 

processing complete, incomplete, or late QR 7s can be found in later 

sections in this chapter. 


• EAS 40-181.2 



Quarterly Report – QR 7 10-10 

Quarterly Report – The process 10-11 

Other Required Forms 10-13 


Quarterly Report – QR 7 

Introduction Once a customer starts to receive CalWORKs and/or CalFresh, the customer 

must keep the Eligibility Worker (EW) informed about changes, in order to: 

• Ensure CalWORKs and/or CalFresh benefits are correct 

• Make the EW aware of other needs that can be met through the 

CalWORKs program 

• Make sure CalWORKs and/or CalFresh benefits, Notices of Action, and 

other correspondence are sent to the correct address 

QR 7 process 

In order to streamline the written reporting process, CalWORKs and/or 

CalFresh customers report their eligibility status quarterly on the Quarterly 

Eligibility/Status Report (QR 7). C-IV automatically sends the QR 7 to all 

CalWORKs and CalFresh families at the end of the QR Data Month, with the 

exception of Non-Quarterly Reporting (NQR) CalFresh households. 

Briefly, the stages to this process are: 


1 C-IV automatically generates and mails QR 7s to all CalWORKs 

and QR CalFresh customers. C-IV: 

• Prints a barcode on each QR 7 identifying it to a specific case 

number; 

• Uses the mailing addressed entered into C-IV; and 

• Mails the QR 7 at the end of the customer’s QR Data Month. 

Note: Intake must generate a QR 7 when processing an 

application after cut-off/main payroll in the data month. 

2 The customer receives the QR 7 by the first day of the QR Submit 

Month, completes it, and mails or delivers it to the EW by the fifth 

day of the QR Submit Month to avoid causing delays in their 

receipt of CalWORKs and CalFresh benefits. 

The customer has until the first working day of the Next QR 

Payment Quarter – the extended filing date – to submit the QR 7 

to avoid discontinuance. 

3 The Office Assistant (OA) scans the QR 7 and records it as 

received into the C-IV system. 

4 The EW evaluates the information reported on the QR 7 during 

the QR Submit Month and makes changes in the program(s) 

and/or benefits for the Next QR Payment Quarter. 

5 The customer receives benefits in the Next QR Payment Quarter 

based on the information reported, or the program(s) is 

discontinued when the customer becomes ineligible and no 

further CalWORKs and/or CalFresh benefits are issued. 


Quarterly Report – The process 

Introduction Customers are required to report changes they experience so benefits will 

more closely meet their needs. Meeting reporting requirements can mean 

overpayments/overissuances will be avoided or supplements can be issued 

as soon as possible. 

Reporting 

requirements 

Quarterly 

reporting 

EW’s role in 

QR 7 process 

All CalWORKs and/or CalFresh customers, with the exception of 

Non-Quarterly Reporting (NQR) CalFresh households, are required to report 

once a quarter on the quarterly report (QR 7). There are also a number of 

Mandatory Mid-quarter reports, which must be reported within 10 days of the 

occurrence, and Voluntary Mid-quarter reports, which can be reported 

anytime during a quarter. 

This section provides guidelines on the reporting requirements and time 

frames for QR 7s and Mid-quarter reports. 

Customers must complete and submit the QR 7, Quarterly Eligibility/Status 

Report, to remain eligible. The report is mailed to each CalWORKs and/or 

CalFresh customer just before the end of the QR Data Month. The customer 

is required to wait for that month to end, complete the QR 7, and submit it to 

the County by the fifth day of the QR Submit Month. 

There are two essential QR 7 steps Eligibility Workers (EWs) must take. The 

table below describes those steps for Intake versus Continuing. Each of the 

EW functions has a role in the QR 7 process. 

Intake Continuing 

Intake EW’s must generate/create a 

QR 7 in the C-IV system when 

processing an application after main 

payroll. If this is not done: 

• The system does not recognize a 

QR 7 is due for the case. 

• No Notice of Action (NOA) or NA 

960 X letter is generated and sent 


• Batch does not discontinue the 

case for no QR 7. 

Note: If the Continuing EW 

discontinues the case with no NA 960 

X letter or documented attempt to 

contact the customer, the 

discontinuance is not correct. 

Continuing EW’s must process all 

QR 7s. To process a QR 7 means 

to: 

• Evaluate the QR 7 for 

completeness 

• Evaluate the impact of the 

information reported on 


• Discontinue the CalWORKs 

and/or CalFresh when the 

family fails to submit a 

complete QR 7 within the 

required time frames. 



Quarterly Report – The process, Continued 

Generating the 

QR 7 – 

Examples 

EW’s role in 

mid-quarter 

reporting 

process 

The following are examples of when to generate a QR 7 in C-IV: 

Example 1: Customer applies for CalWORKs and CalFresh on March 30th. 

The application is approved on April 27th. The initial payment quarter is 

March, April and May. The customer is required to provide a QR 7 for the 

Data Month of April in the month of May. Because the application was 

processed after cut-off in April (April 27th), the QR 7 will not be automatically 

generated in C-IV. The EW must create the QR 7 in C-IV and provide it to the 

customer. See the C-IV User guide for generating QR 7s in C-IV. 

Example 2: Customer applies for CalFresh on November 25 th , the case is 

denied due to questionable information regarding household composition. 

The customer files an appeal and the case is determined to have been 

denied incorrectly. The denial is rescinded on January 15 th and the Beginning 

Date of Application (BDA) is determined to be the original application date. 

The initial payment quarter is November, December and January. The 

customer is required to provide a QR 7 for the Data Month of December in 

the month of January. Because the rescind action is being completed in 

January, the QR 7 will not be generated automatically in C-IV. The EW must 

create the QR 7 in C-IV and provide it to the customer. 

Another important part of an EW’s job is to process Mid-quarter Mandatory 

and Voluntary reports. These are treated differently from the QR 7 process 

and are also treated differently from each other. 

This Chapter provides minimal guidelines on processing Mid-quarter reports. 

See the Budgeting Chapters in the CalWORKs and CalFresh Handbooks for 

in-depth information. 


Other Required Forms 

Introduction The QR 7 reporting process may involve other forms: 

Other required 

forms 

• To inform new customers of their reporting responsibilities 

• When more information is needed 

• When others live with the Assistance Unit/household (AU/HH) 

The following is a list of other forms used with the QR 7, depending on the 

family’s situation: 

Form title Use 

QR 7 Addendum Mailed with the QR 7, the addendum lists 

examples of items that must be reported and the 

penalties for committing CalWORKs and 

CalFresh fraud. 

QR 7 Sample An example of a completed QR 7 as a reference 

for customers. It is given to customers at 

QR 7A – How to Fill out 

Your QR 7 Quarterly 

Eligibility/Status Report 

application and when requested. 

The QR 7A instructs CalWORKs and/or 

CalFresh customers on how to fill out the 

Quarterly Report (QR 7). It is given to 

customers at application and each annual 

reevaluation/Re-Evaluation (RE). It should also 

be made available anytime a customer requests 

it. 

TAD QR 7 Supplement Used for reporting tips, self-employment income, 

and sometimes self-employment expenses. 

QR 72 - Sponsor’s Used to obtain quarterly income and resource 

Quarterly Income and information from the noncitizen’s sponsor. It 

Resources Report must be completed quarterly by the sponsor to 

report income, resources, and dependent 

information. 

QR 73 - Senior Parent Required quarterly to verify senior parent’s 

Quarterly Income Report income when a minor parent lives with a senior 

parent(s). 

NA 960 X A Notice of Action sent to advise the family the 

QR 7 has not been received and case 

discontinuance may result if the QR 7 is not 

submitted by the extended filing date. 

NA 960 Y A Notice of Action sent to advise the family the 

QR 7 they submitted is incomplete or incorrect 

and case discontinuance might result if the 

correct QR 7 is not submitted by extended filing 

date. 

NA 961 

The letter is sent after a 

CalWORKs only 

NA 960 X or NA 960 Y has been sent advising 

the family the case may be discontinued as a 

result of the incomplete or missing QR 7. 


Overview 

Section 4 

QR 7 Completeness Criteria 

Introduction This section contains the completeness criteria for the Quarterly Report 

(QR 7). Actions to take when a QR 7 is complete, incomplete, or late will be 

covered in a later section of this Chapter. 


• EAS 40-181.2 

• EAS 44-316 



QR 7 Completeness Criteria 10-15 

QR 7 Completeness – Comparing QR 7 to Mid-quarter 

Reports 

10-18 

QR 7 – Request to Stop Benefits 10-19 

QR 7 Completeness – Part 1 10-20 

QR 7 Completeness – Part 2 10-23 

QR 7 Completeness – Income Verifications 10-25 

QR 7 Completeness – Address Change 10-27 

QR 7 Completeness – Certification 10-28 


QR 7 Completeness Criteria 

Introduction This section contains the basic requirements needed for determining whether 

or not a QR 7 is complete. Use this section in conjunction with the other 

information in this Chapter in making this determination. 

Basic 

completion 

requirements 

Timely QR 7 

submission 

and the 

extended filing 

date 

Answered 

questions 

Verification 

Policy 

Before the Eligibility Worker (EW) can evaluate eligibility for the Next QR 

Payment Quarter for a customer based on the QR 7 and other information 

available, the customer must submit a complete QR 7 in a timely manner. 

The basic requirements follow. 

To be considered timely, the QR 7 must be submitted by the 11 th of the QR 

Submit Month. Benefits for the QR Payment Quarter will most likely arrive on 

the issuance date++ of the QR Payment Quarter if the QR 7 is submitted by 

the 11 th of the Submit Month. 

The customer must submit a complete and correct QR 7 by the first work day 

of the QR Payment Quarter at the very latest in order to keep the program(s) 

active. This due date is known as the “extended filing date”. When the 

customer submits their QR 7 that late in the Submit Month, benefits will arrive 

late. 

All the questions on the QR 7 must be answered in order for the report to be 

considered complete. If a question is not answered with a “YES” or “NO” 

response, the question can be considered complete if the customer provided 

enough information to answer the question. If a customer answers “YES” to 

a question, more information is required. 

Compare the information given with other verified information in the case. All 

information should be consistent. 

Cases should not be discontinued for an incomplete QR 7 when there is 

enough verification and information provided with the QR 7 to reasonably 

anticipate income for the next quarter. Determination of income used 

must be clearly documented in the case journal. 



QR 7 Completeness Criteria, Continued 

Income QR 7 

with all pay 

stubs provided 

Income QR 7 

with some pays 

stubs provided 

Questionable 

information 

When all the pay stubs from the Data Month are provided, with or without a 

year-to-date (YTD) amount, it makes the income QR 7 complete. This has 

not changed with Quarterly Reporting. 

Note: YTD calculations are no longer appropriate for Quarterly Reporting 

income calculations because the prior month’s YTD is not available as it was 

in Monthly Reporting. 

Because Quarterly reporting allows for the averaging and the reasonable 

anticipation of income, the following table explains how to handle the QR 7 

when some, but not all, pay stubs have been provided: 

If the customer provides… Then… 

Three out of four or one out of two pay 

stubs (with or without a YTD amount) 

and there are four weekly or two biweekly 

income amounts reported on 

the QR 7 and the income is not 

expected to change or stop, 

A single pay stub (with or without a 

YTD amount) and there are four weekly 

or two bi-weekly income amounts 

reported on the QR 7 in question 1 and 

the income is expected to change or 

stop, 

• Review case historical data 

(customer is always paid with the 

same frequency and amount), or 

• Contact the customer to clarify the 

income amounts reported and verify 

gross amounts, and 

• Average the income reported and 

then multiply by the correct 

multiplier, and 

• Journal how: 

− Clarification was obtained, and 

− Income determination was 

made. 

If income reported is questionable, and all attempts to clarify income have 

been exhausted, the QR 7 is then considered incomplete. All attempts to 

contact the customer, along with reasons the information reported is 

questionable must be Journaled. 



QR 7 Completeness Criteria, Continued 

Other forms 

required 

TAD QR 7 

Supplement 


address 

Some situations will require the customer to attach other forms to the QR 7. 

Use the following list as a guide: 

If the family includes a … Then they must also submit a … 

Sponsored alien, QR 72 - Sponsor’s Quarterly Income 

Minor parent living with a senior 

parent, 

and Resources Report. 

QR 73 - Senior Parent Quarterly 

Income Report. 

The TAD QR 7 Supplement is acceptable verification of tips and 

self-employment income and expense, but is not mandatory for any of these. 

The customer’s report of the income on the QR 7 is enough verification. 

The customer must give enough information when they move so they can be 

located if necessary. If the address portion of the QR 7 is not complete or 

missing, but a new address was reported mid-quarter prior to the receipt of 

the QR 7, the case cannot be discontinued. 


QR 7 Completeness – Comparing QR 7 to Mid-quarter 

Reports 

Introduction When a QR 7 is received, the Eligibility Worker (EW) must compare the 

information reported on the QR 7 with any information reported outside the 

QR 7. This section contains the required actions when comparing this 

information. 

Comparing 

QR 7 with 

information 

reported 

outside the 

QR 7 

Resolving a 

discrepancy 

If a customer has made a Voluntary or Mandatory Mid-quarter report, the 

information from that Mid-quarter report will be considered part of the case 

record, regardless of whether or not it resulted in a mid-quarter benefit 

change. When the customer submits a QR 7 subsequent to a Mid-quarter 

report, the EW will first review changes reported on the QR 7 to ensure 

circumstances reported as a mid-quarter report are also reflected on the 

QR 7 and must proceed as follows: 

If the information reported on the 

QR 7 is … 

Consistent with the information 

provided in the Mid-quarter report, 

Not consistent with the information 

provided in the Mid-quarter report, 

or not reported, 

Process the QR 7. 

Then … 

The EW will: 

• Take action to resolve the 

discrepancy, and 

• Determine what the actual 

current AU/HH situation is. 

When attempting to resolve a discrepancy between what was reported on a 

Mid-quarter report and what was reported on a QR 7, the EW must first 

attempt to contact the customer by phone to resolve the discrepancy. If 

unable to contact the customer or obtain resolution to such contact, the EW 

will: 

• Journal the attempt to contact the customer and the nature of the 

discrepancy, and 

• Send an NA 960Y, if time allows. 

Once the discrepancy is resolved, the QR 7 is considered complete. The 

EW will journal the: 

• Discrepancy, 

• Contact with the customer, and 

• Resolution. 


QR 7 – Request to Stop Benefits 

Introduction Customers can request their Cash Aid, CalFresh, Medi-Cal, and/or State 

CMSP be stopped. The QR 7 includes a question where this request can be 

made. This section covers the actions to take when a customer uses their 

QR 7 to request benefits be stopped. 

Request to stop 

benefits 

The first question on the QR 7 allows customers to request their Cash Aid, 

CalFresh, and/or Medi-Cal be stopped at the end of the Submit Month. 

When a customer completes this question and signs and dates the QR 7, 

use the table below to determine the correct action(s) to take. 

If the customer checks 

the… 

Then… 

Cash Aid box, • Discontinue CalWORKs only at the end of 

the Submit Month, 

• Transfer to post Medi-Cal, and 

• Send adequate notice of discontinuance. 

Cash Aid and CalFresh 

boxes, 

Cash Aid and Medi-Cal 

boxes, 

Note: Transfer to Transitional CalFresh, if 

appropriate. 

• Discontinue CalWORKs and CalFresh at 

the end of the Submit Month, 

• Transfer to post Medi-Cal, and 

• Send adequate notices of discontinuance. 

• Discontinue CalWORKs and Medi-Cal the 

end of the Submit Month, and 


Note: Transfer to Transitional CalFresh, if 

appropriate. 

Cash Aid, CalFresh, and • Discontinue all three programs at the end of 

Medi-Cal boxes, 

the Submit Month, and 

• Send adequate notice(s) of discontinuance. 

CalFresh box, • Discontinue CalFresh only at the end of the 

Submit Month requested, and 



QR 7 Completeness – Part 1 

Introduction This section contains the completeness criteria for Part 1 of the QR 7, which 

contains Data Month information reported in Questions 1 through 5. 

Part 1 In Part 1 of the QR 7 the customer reports about what happened in the Data 

Month. There are five questions in this Part, and they pertain solely to the 

Data Month. 

Part 1 

Questions 1, 1a 

and 1b – 

Income 


CalFresh 

Assistance Units/households (AUs/HHs) with income must report the date or 

dates the income was received and the gross amount of the income. If that 

information is left off the QR 7, but is included on the verification attached to 

the QR 7, the answer is considered to be complete. 

Types of income: 

• Unearned income, which is received monthly in a fixed amount each 

month only needs to be verified when it is first received and when the 

amount changes. 

• Earned income must be verified quarterly. (When a recipient reports 

someone has begun a new job, give information about the Child Care 

program and/or make a referral for services.) 

• Other income may require verification; refer to the “Income Classification 

Chart”, in the Income Chapter, for help. 

Verification of income known to the agency: 

• If the customer cannot send verification with the QR 7 because they sent 

it to another HSS agency staff member, get the verification from that staff 

member. 

• Individuals who work as Child Care providers and are paid through the 

County of San Bernardino Child Care program must report their earnings. 

Since these providers are not given a pay stub, verify their income by 

looking in the C-IV system. Refer to the “Self-employment as a Child 

Care Provider” information in the Income Chapter. 

• If the customer fails to report UIB, SDI, or RSDI but the agency has 

access to the information through the PVS 40, the answer is considered 

complete. 



QR 7 Completeness – Part 1, Continued 

Part 1 

Questions 1, 1a 

and 1b – 

Income 

(continued) 

Verification available through the case record: 

• If there is a Release of Information form authorizing the County to contact 

the income source and the duration of the release has not passed, 

contact the income source for verification if the customer is having 

difficulty. 

• If the customer fails to report and/or verify a paycheck, but the Eligibility 

Worker (EW) is able to reasonably anticipate and average income for the 

upcoming quarter, the answer is considered complete. 

Note: Anytime a customer advises of having difficulty obtaining income 

verification, assistance must be provided. Having the customer complete a 

Release of Information is just one way of providing assistance to obtain the 

needed verifications. 

Question 1a asks the customer to enter the total number of hours worked or 

in training in the Data Month. 

Question 1b asks the customer if there are income or money changes the 

customer expects to happen in the next three months (Next QR Payment 

Quarter). 

The customer is only required to report information (changes or expected 

changes) known by the last day of the QR Data Month for that QR 7’s 

reporting period in Question 1. The Eligibility Worker (EW) will use the 

information reported here and on the rest of the QR 7 to determine eligibility 

and benefits for the next QR Payment Quarter. 

Examples 1b The following examples demonstrate information reported in Question 1b of 

the QR 7. 

Part 1 – 

Questions 2, 3, 

4 and 5 

CalFresh 

Example 1 – Household (HH) reports they expect $1000 in income each 

month of the upcoming quarter from a new job. The income is anticipated to 

continue and the customer has reported the amount and frequency. 

Results – The $1000 monthly earnings are used each month of the 

upcoming quarter (No verification is required). 

Example 2 – HH reports $200 gross weekly earnings in Question 1. This 

income has been ongoing for two years. In Question 1b, the HH indicates 

$1000 in earnings is expected for each month of the upcoming payment 

quarter. The HH indicates the change is due to a pay raise. 

Results – The new income amount is anticipated for the upcoming quarter 

and should be used for the upcoming payment quarter. 

The questions in this section are designed to assist CalFresh households in 

reporting information which may increase the amount of benefits they may be 

eligible to. 




Part 1 

Question 2 – 

Medical Costs 

CalFresh 

Part 1 

Question 3 – 

Dependent 

Care expenses 

CalFresh 

Part 1 

Question 4: 

Child support 

paid out 

CalFresh 

Part 1 

Question 5 - 

Changes 

Question 2 asks the customer if anyone in their household disabled or 60 

years or older pays medical cost. In order to be allowed as a deduction from 

income, medical expenses must be verified. Refer to the Deductions Chapter 

for more information. 

Question 3 asks the customer if anyone in their household pays for the care 

of a child, disabled person, or other dependent while working, seeking work, 

or attending school or training. 

Dependent care expenses are important to the CalFresh benefit calculation. 

In order to be allowed as a deduction from income, dependent expenses 

must be verified. Refer to the Deductions Chapter for more information. 

If the Child Care program pays part of the expense, check the Child Care 

program for missing verification when the customer reports they’ve already 

provided it to the County and has not included it with the QR 7. 

Question 4 asks the customer if anyone in their household pays courtordered 

child support. Support payments to individuals outside the home are 

an allowable exclusion from income in the CalFresh but not in the 

CalWORKs program. Refer to the Deductions/Exclusions Chapter for more 

information. 

Failure to provide proof of paid support does not cause the QR 7 to be 

incomplete. 

Question 5 contains information the customer reports about what changes in 

questions 2 through 4 the customer expects to happen in the next three 

months (or Next QR Payment Quarter). 

The customer is only required to report information (changes or expected 

changes) known by the last day of the QR Data Month for that QR 7’s 

reporting period in Questions 2 through 4. 

The Eligibility Worker (EW) will use the information reported here and on the 

rest of the QR 7 to determine eligibility and benefits for the Next QR Payment 

Quarter. 


QR 7 Completeness – Part 2 

Introduction This section contains the completeness criteria for Part 2 of the QR 7, which 

contains reported information for changes that occurred since the last QR 7 

in Questions 6,7, 8 and 9. 

Part 2 Part 2 of the QR 7 contains the information the customer will report about 

what happened since the last QR 7 (as of the first day of the last Submit 

Month through the last day of the current Data Month). The information 

reported here must be consistent with the information provided in any 

Mandatory or Voluntary Mid-quarter report. Verification must be provided as 

required. 

Question 6: 

Property 

changes 

CalWORKs & 

CalFresh 

Question 7: 

People moving 

into or out 


CalFresh 

Question 8: 

Drug-related 

felony 

convictions, 

parole or 

probation 

violations, or 

fleeing felons 


CalFresh 

The customer must keep the County informed about changes in property. If 

the customer bought, got, sold, traded, or gave away any property since the 

last QR 7 (as of the first day of the last Submit Month through the last day of 

the current Data Month), it must be reported here. If this question is 

answered “YES”, the rest of the question must be completed, as applicable, 

or the QR 7 is considered incomplete. 

The customer must keep the County informed about the people living in the 

home so benefits can be adjusted as needed. 

The customer is required to report any people moving in or out since the first 

day of the last Submit Month through the last day of the current Data Month. 

If this question is answered “YES”, the rest of the question must be 

completed or the QR 7 is considered incomplete. 

The customer must keep the County informed about changes in status 

regarding drug related felonies or convictions, parole, or parole violations, 

and when they are fleeing due to a felony. 

• The customer must report information here if the information was not 

previously reported on another QR 7 or on the most recent Statement of 

Facts. 

• Information already reported does not have to be reported for this 

question each quarter. 

• When a subsequent family/household member is a fleeing felon, is 

convicted of a drug-related felony, or violates terms of probation or 

parole, that information must be reported. 

• If this question is answered “YES”, the rest of the question must be 

completed or the QR 7 is incomplete. 




Question 9: 

Anything else 


CalFresh 

Certification – 

Fraud warning 

This question is for miscellaneous use by the customer who has something 

to report not specifically asked for in one of the previous questions. The 

information reported here frequently requires verification. 

Note: If the customer reports a change in citizenship status (ineligible noncitizen 

to eligible citizen) obtain verification and take appropriate action. See 

Chapter 5 for Citizen information and Chapter 9 for action on reported 

changes. 

The QR7 must be signed and dated after the last day of the month of the 

report. 

The QR 7 must be signed by: 

For CalWORKs – the customer and aided spouse, domestic partner, and 

the other parent if living in the home. 

For CalFresh – the Head of Household, a responsible household 

member, or the household’s Authorized Representative (AR). 

Note: An obvious date error on the QR 7 will not cause the QR 7 to be 

considered incomplete (see the “Certification errors – signatures” block in 

this chapter). 


QR 7 Completeness – Income Verifications 

Introduction This section contains the completeness criteria regarding income 

verifications for the QR 7. 

Required 

verifications 

Income verification is required to determine if a QR 7 is complete; however, if 

a customer or Assistance Unit (AU) member is paid weekly or biweekly and 

fails to provide verification for each pay date of the Data Month, the QR 7 can 

be considered complete when the: 

• Customer confirms the amounts reported on the QR 7 are the gross 

amounts for each paycheck and the income is reasonably anticipated to 

continue, or 

• Amounts listed on the QR 7 are consistent with amounts listed on the 

previous QR 7 for this income type or employer. 

To be considered complete, the information on the QR 7, together with 

attached documentation and historical information or customer contact, must 

provide sufficient information to allow for the determination of eligibility and/or 

benefit level. 



QR 7 Completeness – Income Verifications, Continued 


complete 

versus 

incomplete 

QR 7 for 

verification 

reasons 

The following examples demonstrate how the QR 7 can be determined 

complete or incomplete when income verification(s) is missing. 

Example 1 – Customer provides QR 7 on September 5 th . In Question 1 of 

the QR 7, the customer reports four weekly paychecks for the Data Month of 

August. Only one pay stub, for August 11 th , is provided. The pay stub lists 

both gross and net amounts of pay. 

Example 2 – Same situation as above, but the customer reports two 

bi-weekly pay dates for the Data Month of August and only provides pay 

verification for August 11 th and lists both gross and net amounts of pay. 

Actions for both – Compare the August 11 th income verification to the 

amounts listed in Question 1 of the QR 7, then use the chart below to 

determine if the QR 7 is complete or incomplete. 

If the amount on the 

pay stub is the… 

Gross amount reported 

on the QR 7, and the 

income is expected to 

continue, per the 

remaining questions on 

the QR 7, 

Gross amount reported 

on the QR 7, and the 

income is expected to 

continue, per the 

remaining questions on 

the QR 7, 

Net amount reported on 

the QR 7, 

And when… Then the QR 7 is considered… 

• Review of the case 

historical data 

matches QR 7 

(customer is always 

paid with the same 

frequency and 

amount), or 

• Contact with the 

customer clarifies the 

income amounts 

reported and verifies 

gross amounts, 

• Case historical data 

amounts are not 

available or differ 

from the amounts 

reported, or 

• The customer cannot 

be reached, 

No other income 

verification has been 

provided for the Data 

Month, 

Complete: 

• Average the income reported 

and then multiply by the 

correct multiplier, and 

• Journal how: 

− Clarification was obtained, 

and 

− Income determination was 

made. 

Incomplete: 

• Send a NA 960 Y Letter, 

• Follow the steps in Processing 

an Incomplete QR 7, this 

section, and 

• Journal: 

− How case historical data 

differs from that reported 

on the QR 7, 

− Attempts to contact 

customer, and inability to 

reach him/her, and 

− All actions taken. 

Incomplete: 

• Send a NA 960 Y Letter, 

• Follow the steps in Processing 

an Incomplete QR 7, this 

section, and 

• Journal the lack of gross pay 

verification and all actions 

taken. 


QR 7 Completeness – Address Change 

Introduction This section contains the completeness criteria for the Address Change 

section of the QR 7. 

Address 

Change 


CalFresh 

Address 

change 

reported 

mid-quarter 

The customer must complete this section only when the address has 

changed. When a change of address is reported, if the customer receives 

CalFresh, the Eligibility Worker (EW) must ensure shelter deductions are 

correctly applied. Refer to the CalFresh Policy Handbook for more 

information regarding shelter deductions. 

Other processes to review when a customer reports a move are: 

• Does the customer reside in the same TAD district as before? 

− If not, the case may need to be transferred to the correct district. 

− Refer to the Operations and Reference (O&R) Handbook for more 

information regarding Inter-District Transfers (IDTs). 

• Does the customer reside in the same county as before? 

− If not, the case will need to be transferred to the correct county. 

− Refer to the Operations and Reference (O&R) Handbook for more 

information regarding Inter-County Transfers (ICTs). 

• Does the customer reside in the same state as before (California)? 

− If not, the case may need to be discontinued. 

− Refer to the Residence Chapter for more information regarding 

temporary absence from the State. 

• Has the Assistance Unit/Head of Household composition changed? 

If the customer reports a change of address mid-quarter and then does not 

report the change on the QR 7, the QR 7 is considered complete. 


QR 7 Completeness – Certification 

Introduction This section contains the completeness criteria for the Certification section, 

or signature section, of the QR 7. 

Certification 


CalFresh 

Certification 

errors – 

signatures 

Certification 

errors - 

Examples 

This section of the QR 7 contains the signature(s) of: 

For CalWORKs - the payee, domestic partner, aided spouse of the 

payee, and the other parent of the cash aided children if living in the 

home. 

For CalFresh - the head of household, any responsible household 

member, or the household’s authorized representative. 

The signature(s) of the person(s) listed above must be dated within the 

Submit Month of the QR 7 up through the extended filing date. 

Missing signatures and/or dates mean the QR 7 is incomplete. 

Take realistic case actions related to signature requirements. Do not take an 

unnecessary discontinuance action if you can determine the signature is 

acceptable based on the date the QR 7 was mailed, the month and year the 

QR 7 was printed, the verification attached, the date stamp, and any other 

credible evidence. 

Use the following to help you decide what actions to take when the signature 

block is completed but is incorrect: 

When the signature date And the date 

Then the… 

is in the… stamp is in the… 

Data Month, Data Month, Entire QR 7 is incorrect. 

Data Month - prior to the 

date the QR 7 was mailed, 

Submit Month, Certification block is correct. 

Note: The EW will Journal the 

signature date is an obvious 

date error. 

Data Month - after the date 

the QR 7 was mailed, 

Submit Month, Entire QR 7 is incorrect. 

Signed with the previous 

year soon after a new year 

begins, 

Submit Month, Certification block is correct. 

Following are examples of when the QR 7 may be considered complete or 

incomplete based on when the customer dates the QR 7. 

Scenario: A QR 7 for the December 2011 Data Month is mailed to the 

customer on 12/27/2011. 

If the signature And the date stamp 

Then the… 

date is… 

is… 

12/28/2011 12/29/2011 Entire QR 7 is incorrect. 

12/3/2011 1/5/2012 Certification block is correct. 

12/30/2011 1/5/2012 Entire QR 7 is incorrect. 

1/3/2011 1/5/2011 Certification block is correct. 


Overview 

Section 5 

Processing a Complete, Incomplete, or Late QR 7 

and Good Cause 

Introduction This section contains the actions Eligibility Workers (EWs) must take when 

processing a complete, incomplete, or late QR 7. Information on how to 

determine whether a QR 7 is complete can be found in the previous section 

of this Chapter. 


• EAS 40-181.2 



Processing a Complete QR 7 10-30 

Processing an Incomplete QR 7 10-31 

Late QR 7 10-34 

Examples of a Complete QR 7 10-35 

Examples of an Incomplete QR 7 10-37 

Discontinuance for a Missing or Incomplete QR 7 10-38 

Good Cause 10-39 


Processing a Complete QR 7 

Introduction This section contains the actions to take to process a correct and complete 

QR 7. 

Actions Do the following when the QR 7 is correct and complete: 

Step Action 

1 Compare the current QR 7 with the information on the prior 

quarter’s QR 7, in Mid-quarter reports, and elsewhere in the case. 

Look for changes such as: 

• The income the family/HH receives 

• The people living in the home 

• The family/HH’s address 

• Additions to or deletions from the family/HH’s resources 

• Changes in employment or health status causing a 

reevaluation of Welfare-to-Work/Work Registration 

exemptions or participation 

2 Review the case for pending actions or pending information the 

customer is required to report with the QR 7. 

3 Complete the actions triggered during Steps 1 and 2 above. 

4 Complete appropriate pages in C-IV with any changes and run 

EDBC. 

5 Journal any actions taken during QR 7 processing in the case 

journal and include all reasons for using or not using any income 

or information reported on the QR 7. 

6 Immediately route QR7, with verifications, to imaging. 


Processing an Incomplete QR 7 

Introduction This section contains the actions to take when an incomplete QR 7 is 

received by the 10-day notice deadline or after the 10-day notice deadline. 

Actions Follow the steps below when an incomplete QR 7 is received by the 10-day 

notice deadline: 

Step Action 

1 Complete the NA 960 Y to notify the customer: 

• The QR 7 was received incomplete 

• What to do to comply with reporting requirements 

• The consequences for non-compliance 

2 Print a blank QR 7 from C-IV (includes barcode for customer’s 

case) and complete the following sections: 

• The month and year for which the QR 7 is still needed 

• The payee/Head of Houshold’s name and case number in the 

address block 

• The Eligibility Worker’s (EW’s) file number and telephone 

number 

• The incorrect or incomplete question(s) circled in red ink 

• The signature block circled in red ink. See the instructions 

regarding the signature block given earlier in this chapter. 

3 Mail the QR 7 from Step 2 with the NA 960 Y and a postage-paid 

return envelope. 

For CalWORKs only - A reminder letter will automatically be sent 

to the AU later in the month. If it isn’t, send the reminder letter 

manually. 

4 If the additional QR 7 is: 

• Received complete and is correct, process the QR 7 and stop 

here. 

• Not received, proceed to step 5. 



Processing an Incomplete QR 7, Continued 

Actions 

(continued) 

Chart is continued from previous page. 

Step Action 

5 Determine eligibility based on the customer’s response: 


Additional QR 7 is: 

• Submitted after timely 

notice deadline, 

• Still incomplete, and there is 

sufficient time for the 

customer to provide a 

complete QR 7 by the first 

day of the QR Payment 

Quarter, 

Additional QR 7 is: 

• Submitted after timely 

notice deadline, 

• Still incomplete, and there is 

not sufficient time for the 

customer to provide a 

complete QR 7 by the first 

day of the QR Payment 

Quarter, 

Corrected QR 7 is received 

after the 11 th of the month but 

before the extended filing 

date, 

Corrected QR 7 is not 

received by the end of the 

extended filing date, 

Send another QR 7 (see 

Step 2) with a letter and 

return envelope advising 

the customer: 

• The QR 7 is still 

incomplete, and 

• If a complete QR 7 is 

provided by extended 

filing date, their case will 

not be discontinued. 

The discontinuance action 

proposed on the NA 960 Y 

still applies. 

Refer to the instructions for 

processing late QR 7s. 

• Discontinue CalWORKs 

and CalFresh 

• Refer to the instructions 

for processing late QR 7s. 



Processing an Incomplete QR 7, Continued 

Incomplete 

QR 7 received 

after 10-day 

notice 

Corrected 

QR 7s 

Follow the chart below when incomplete QR 7 is received after the 10-day 

notice deadline: 

If there is… Then… 

Sufficient time for the AU/HH to 

provide a complete QR 7 by the first 

work day of the QR Payment 

Quarter, 

Not sufficient time for the AU/HH to 

provide a complete QR 7 by the first 

work day of the QR Payment 

Quarter, 

• The previous NA 960 X Notice of 

Action (NOA) still applies 

• Send another QR 7 (see Step 2 

in the previous table) with a letter 

and a return envelope advising 

the customer: 

− The QR 7 is incomplete, and 

− If a complete QR 7 is not 

provided by the first workday 

of the QR Payment Quarter, 

the case will be discontinued. 

The previous NA 960X NOA still 

applies. 

When the customer submits the corrections on the additional QR 7, the 

combination of the original and any additional QR 7s meets the requirement 

for a “complete QR 7”. The EW will: 

• Write on the bottom of the front side of the first QR 7 “1 of __” (enter the 

total number of QR 7s which made for a complete QR 7), 

• Write on the bottom of the front side of the second QR 7 “2 of __”, 

continue this until all QR 7s have been labeled, and 

• Journal the receipt of two (or more) QR 7s resulting in a complete QR 7. 


Late QR 7 

Introduction This section includes the actions to take when a complete QR 7 is not 

received by the 11 th day of the Quarterly Report (QR) Submit Month. 

Actions Follow the chart below when the customer has not submitted a QR 7: 

When the QR 7 is not 

received by the… 

End of the 11 th day of the QR 

Submit Month (or the work 

day immediately following 

the 11 th day if that day is a 

weekend or holiday), 

20 th of the month, or the last 

working day prior to the 

Balderas-Woods (BW) 

reminder notice is sent, 

End of the first work day of 

the QR Payment Quarter 

(the extended filing date), 

Then… 

On the first working day after the 11 th , 

complete procedures to generate or 

manually send the NA 960 X notifying the 

customer of the pending discontinuance 

caused by failure to comply with the QR 7 

reporting requirement. 

• Attempt to contact the customer in 

person or by phone to remind them of 

the QR 7 requirement. 

• Journal the attempt to contact the 

customer in the case journal. 

Note: If the customer does not have a 

phone number in the case record, a Journal 

entry is still required stating no attempt was 

made by phone because there is no 

telephone number available. 

• Discontinue the program(s) on the 

second workday of the QR Payment 

Quarter. 

• The discontinuance effective date is the 

last day of the QR Submit Month. 


Examples of a Complete QR 7 

Introduction This section contains information and specific examples to help determine if 

a QR 7 is complete. 

Example 1 Situation – March QR 7 is received April 10 th for the May, June, July 

quarter. No earnings previously reported for this case and no changes 

reported in Question 1 of the March QR 7. Customer reports new 

employment as of April 1 st in Question 1b, but no other information is 

provided. 

The Eligibility Worker (EW) contacts the customer inquiring about the new 

income and discovers the customer knows the rate of pay, frequency, and 

number of hours. The customer also expects this income to continue 

through the upcoming quarter. 

Action – This QR 7 is considered complete and is not to be discontinued as 

clarification has been obtained from the customer. The EW must: 

• Use the income in the upcoming quarter for May, June, and July as it is 

considered stable, and 

• Journal all information obtained, actions taken, and any documentation 

done in the case. 

Example 2 Situation – Same as example 1; however, in this situation the EW contacts 

the customer to inquire about the new income and discovers the customer is 

no longer employed. 



• Not use the income in the upcoming quarter for May, June, and July as it 

is not considered stable, and not expected to continue, and 

• Journal all information obtained, actions taken, and any documentation 

done in the case. 

Example 3 Situation – Same as example 1; however, in this situation the EW contacts 

the customer to inquire about the new income and discovers the customer is 

still in training and is unable to estimate how many weekly hours will be 

worked. 



• Not use the income in the upcoming quarter for May, June, and July as 

the employment is new and the customer is unable to estimate weekly 

hours of employment, and 

• Journal all information obtained, actions taken, findings, and any 

documentation done in the case. 



Examples of a Complete QR 7, Continued 

Example 4 Situation – March QR 7 received April 10 th . New earnings reported for the 

Data Month of March. Customer reports having received the first paycheck 

on February 23 rd . Per the March QR 7, the customer is paid $8.50 per hour 

and works 20 hours per week with a pay frequency of weekly. The customer 

attached the February 23 rd pay stub and only one pay stub for the Data 

Month of March. 


even though there is one pay stub for the Data Month provided, the income is 

stable and can be reasonably anticipated to continue. The EW must: 

• Use the gross income from either pay stub and multiply by 4.33 to find 

the average use in the upcoming quarter for May, June, and July, and 

• Journal how earnings were determined and used for the upcoming 

quarter, actions taken, and any documentation done in the case. 


Examples of an Incomplete QR 7 

Introduction This section contains information and specific examples to help determine if 

a QR 7 is considered incomplete. 

Example 1 Situation – March QR 7 is received April 10 th for the May, June, and July 

quarter. New earnings are reported for the Data Month of March. One pay 

stub for March is attached to the QR 7. 

The Eligibility Worker (EW) contacts the customer to clarify the income and 

to ask why the pay stubs were not provided. The customer states the pay 

stubs were lost; however, the income is expected to continue and the hours 

always fluctuate. 

Action – This QR 7 is incomplete as the income is expected to continue, the 

hours are fluctuating, and all pay stubs were not provided. Fluctuating 

income must be averaged. Averaging cannot take place without the 

verifications. The EW must: 

• Send the NA 960 Y Letter for incomplete QR 7, 

• Journal contact information, findings, and how determination was made, 

and 

• Discontinue the case if verifications are not received. 

Example 2 Situation – March QR 7 is received April 10 th for the May, June, July quarter. 

No earnings previously reported for this case and no changes reported in 

Question 1. Customer reports new employment as of April 1 st in Question 

1b, but no other information is provided. 

The EW attempts to contact the customer but the customer does not have a 

telephone number listed in the case record. 

Action – Because the EW was not able to contact the customer, this QR 7 is 

considered incomplete as there is not sufficient information to determine 

eligibility and/or benefit level for the upcoming quarter for May, June, and 

July. The EW must: 

• Send Y-Letter for incomplete QR 7, 

• Journal the reported change in Question 1b, findings, and the attempt to 

contact the customer for clarification, and 

• Discontinue the case if clarification and/or verifications are not received. 


Discontinuance for a Missing or Incomplete QR 7 

Introduction This section includes information on discontinuance actions taken when no 

QR 7 is received. 

Required forms The following notices are required when processing a discontinuance action: 

• NA 960 Y Letter – This notice is used if a QR 7 is received but is 

incomplete. 

• NA 960 X Letter – This notice is used to inform a customer the QR 7 was 

incomplete and/or not received. 

• NA 961 Letter – This notice is also called a Balderas Woods (BW) letter. 

This notice reminds the customer the QR 7 is incomplete and is sent after 

the NA 960 Y or NA 960 X has been sent. 


procedure 

Follow the discontinuance procedure outlined in the table below when 

discontinuing for missing or incomplete QR 7. 

Step Action 

1 Ensure the correct notice has been sent to the customer regarding 

the incomplete or missing QR 7. 

2 Verify the correct combination of notices have been sent to the 

customer. 

3 Journal discontinuance reason. 

4 Discontinue the case. 


Good Cause 

Introduction A customer may request a good cause determination for failure to meet the 

Quarterly Reporting requirements. 

Request for 

good cause 

determination 

A request for a good cause determination is any clear expression to the 

County, whether verbal or written, the customer wants an opportunity to 

present his/her explanation for not meeting the Quarterly Reporting 

requirements. A request for State Hearing may also be considered a request 

for a good cause determination when the issue to be heard specifically 

relates to Quarterly Reporting requirements. 

CalWORKs - A good cause exemption will be granted only if the parent, 

other caretaker relative, or an authorized representative makes the request, 

unless the determination is based on a request for restoration. 

CalFresh - Any person can request a good cause determination, but if 

someone other than a parent, other caretaker relative, or an authorized 

representative makes the request (unless based on a request for 

restoration), a good cause exemption will not be granted. 

Good cause Good cause exists when the customer cannot reasonably be expected to 

fulfill his/her reporting responsibilities due to factors outside his/her control. 

The burden of proof rests with the customer. 

Good cause exists only in the following situations: 

• The customer is suffering from a mental or physical condition, which 

prevents timely and complete reporting. 

• The customer’s failure to submit a timely and complete report is directly 

attributable to County error. 

• The County finds other extenuating circumstances. 

• The customer does not posses reading and/or writing skills required to 

understand and complete the QR 7 form and assistance to complete the 

QR 7 was not made available to the customer. 



Good Cause, Continued 


when a good 

cause 

determination 

is made 

When a customer who has been discontinued for failure to submit a complete 

QR 7 requests restoration or good cause determination the month following 

the discontinuance, the Eligibility Worker (EW) will determine if the customer 

had good cause for failure to submit a complete QR 7. Once the good cause 

determination has been completed, use the table below to determine the 

correct action(s) to take: 

If the customer… Then the EW will… 

Had good cause for failure to submit 

a complete QR 7, 

• Rescind the discontinuance, 

• Redetermine eligibility, and 

• Calculate benefits based on the 

information contained in the 

QR 7. 

Did not have good cause, The discontinuance stands. 


Overview 

Section 6 

Mandatory Mid-quarter Reports 

Overview Quarterly Reporting requires the County to take action on specific changes 

occurring “mid-quarter” or outside the QR 7 reporting process. Mid-quarter 

changes to benefits under Quarterly Reporting include changes resulting 

from customer Mandatory reports, certain Voluntary reports, and Countyinitiated 

actions. Customers may report mid-quarter changes in writing, by 

phone, or in person. 

This section covers the information customers must report mid-quarter. 

Information customers may report mid-quarter will be covered in the section 

“Voluntary Mid-quarter Reports”. Budgeting and benefit changes resulting 

from Mandatory and Voluntary Mid-quarter reports and County-initiated 

actions can be found in the Budgeting Chapters of the CalWORKs and 

CalFresh Policy Handbooks. 


• EAS 40-187 

• EAS 44-316 



Mandatory Mid-quarter Reports 10-42 

Income Reporting Threshold (IRT) 10-43 

Address Change 10-46 


Parole/Probation Violations 

10-47 

Reduction in ABAWD Work Hours 10-49 


Mandatory Mid-quarter Reports 

Introduction This section contains an overview of the items customers must report midquarter. 

The following pages contain additional information regarding these 

Mandatory Mid-quarter reports. 

Mandatory Midquarter 

reports 

Under QR/PB, customers are required to report Mandatory Mid-quarter 

changes to the County within 10 calendar days of the date the change 

becomes known to the customer. For both CalWORKs and CalFresh, 

customers may report the Mandatory Mid-quarter change in writing or 

verbally (either in person or by phone). 

When a customer reports a mid-quarter change, the Eligibility Worker (EW) 

must document in the case journal: 

• The substance of the report, and 

• The date of the report. 

Mid-quarter changes, which must be reported for CalWORKs must not 

always be reported for CalFresh. But, if the customer of a case with both 

CalWORKs and CalFresh reports a change required to be reported for 

CalWORKs, the EW must review the change for CalFresh also. 

Mandatory Mid-quarter reports for each program are as follows: 

• CalWORKs Only: All CalWORKs customers must report the following 

changes within 10 days: 

- When income exceed the Income Reporting Threshold (IRT); 

- Address changes; 

- Drug felony convictions; 

- Fleeing felon status; and 

- Violation of conditions of probation or parole. 

• CalFresh Only: CalFresh customers must report the following changes 

within 10 days: 

- Address changes; and 

- Non-Assistance CalFresh cases only: Customers required to meet 

the ABAWD work rule must report any reduction in the number of 

hours worked to less than 20 hours per week or 80 hours per month. 

Note: the ABAWD program, along with the reporting requirements, has been 

waived through September 30, 2010. 


Income Reporting Threshold (IRT) 

Introduction This section includes the definition, mandatory reporting requirements, and 

informing requirements for the Income Reporting Threshold (IRT). Additional 

information regarding the IRT is included in the Budgeting Chapter of this 

handbook. 

Definition Income Reporting Threshold (IRT): The level of income, which triggers the 

need for a CalWORKs family to make a mandatory report of a change in 

income. The IRT chart can be found in the Charts, Tables and Lists chapter 

of this handbook. 

Persons 

included in IRT 

Reporting 

requirement 

When a CalWORKs family has earned income or begins receiving earned 

income, the family must report to the County within 10 days when the total 

combined gross earned and unearned income of the following family 

members exceeds that family’s IRT: 

• Assistance Unit (AU) members, 

• Non-AU members, and 

• Excluded family members. 

The IRT is the greater of: 

• 130% of the Federal Poverty Level (FPL) for that family size, or 

• The level at which an AU becomes financially ineligible. 

The IRT requirement means if any of the family members listed above has 

earned income or begins receiving earned income, the AU must report to the 

County when the family’s total combined income, earned and unearned, 

exceeds the IRT at any time during the quarter. This rule applies as follows: 

• AUs with earnings only or a combination of earned and unearned income 

are required to report within 10 days when the family’s total income 

exceeds the IRT. 

• AUs with no income or unearned income only are required to report only 

if they receive new earnings that, when combined with other family 

income, exceeds the IRT. 

• AUs with unearned income only (including disability-based unearned 

income) are not required to report when that income by itself or 

combined with new unearned income exceeds the IRT. 



Income Reporting Threshold (IRT), Continued 

IRT and lump 

sum 

Customers may report nonrecurring lump sum income when it exceeds the 

IRT by itself or in combination with other family income. Eligibility Workers 

(EWs) are reminded under QR/PB, nonrecurring lump sum income is treated 

as property in the month received and not income. 

See chart below for further clarification on lump sum income. 

If the family… Then… 

Reports nonrecurring lump sum as 

exceeding the IRT, 

Fails to report nonrecurring lump 

sum income mid-quarter, 

The EW will not consider the lump 

sum as income to be used in 

Redetermining the AU/HH’s 

financial eligibility. 

There is no consequence for failing 

to report it. 

Note: The family is only required to 

report the receipt of nonrecurring 

lump sum on the QR 7. 

IRT informing The County must inform each CalWORKs family at least once per quarter of: 

• The requirement to report the receipt of gross monthly income exceeding 

the IRT, 

• The consequences of failing to report, and 

• The dollar amount of gross monthly income for the CalWORKs Family 

MAP size, which exceeds the IRT. 

Failure to 

report income 

exceeding IRT 

Informing must also occur: 

• When the CalWORKs Family MAP size changes, 

• At Re-Evaluation (RE), and 

• At customer request. 

The QR 2, Reporting Changes for Your Cash Aid Assistance Unit and 

CalFresh Household, meets this reporting requirement. 

If a family fails to report income exceeding the IRT, it can result in: 

• An overpayment (OP) for the AU, 

• Fraud prosecution, and 

• Fraud penalties, including disqualification from the program. 

For more information regarding the consequences for failure to report, see 

the Budgeting and Fraud/QC/Appeals Chapters of the CalWORKs Policy 





Required action When income in excess of the IRT is reported, the County must determine if 

the AU remains financially eligible. If the AU is no longer financially eligible 

to CalWORKs, the County must discontinue the CalWORKs mid-quarter at 

the end of the month 10-day notice can be provided. For more information, 

see the Budgeting Chapter of the CalWORKs Policy Handbook. 

IRT and 

CalFresh 

Although the mid-quarter requirement to report income in excess of the IRT 

applies to CalWORKs only, if CalWORKs benefits are discontinued due to 

the increased income, the impact to the family’s CalFresh benefits must also 

be determined if both programs are active. 

If CalWORKs is discontinued, the CalFresh Household (HH) must be 

transferred to Transitional CalFresh. For more information, see the 

Budgeting and Transitional CalFresh Chapters of the CalFresh Policy 



Address Change 

Introduction This section contains the mandatory reporting requirements for address 

changes. 

Reporting 

requirements 

Move out of 

state 


County 

Customers are required to report changes in their residence address to the 

County within 10 days. This reporting requirement is necessary in order to 

provide the County with the most up-to-date address so customers can 

receive benefits and Notices of Action (NOAs) in a timely manner. 

If a customer reports moving out of state, the Eligibility Worker (EW) will 

discontinue benefits at the end of the month in which 10-day notice can be 

provided, even if it is mid-quarter. 

CalWORKs: If the customer moved out of state and was not entitled to 

receive cash aid in California (see Temporary Absence in the Residence 

Chapter), the EW will identify an overpayment (OP) for those months aid was 

continued due to the inability to provide 10-day notice. 

CalFresh: If the HH will not reside in the state, a timely Notice of Action 

(NOA) is not required, but a NOA is still required. An overissuance (OI) will 

be identified if the customer was residing out of state and continued to 

receive benefits from California. 

CalWORKs: When a customer reports moving to another county, the EW 

will initiate an Intercounty Transfer (see ICT procedures in the Operations 

and Reference Handbook). The EW will discontinue CalWORKs at the end 

of the ICT transfer period, even if it is mid-quarter. 

CalFresh: Foods Stamps will continue to require the customer reapply in the 

new county of residence, but the County will continue to provide CalFresh 

benefits until the end of the CalWORKs ICT transfer period if both programs 

are active (if only CalFresh is active, see the CalFresh Policy Handbook). 

The CalFresh will be discontinued at the same time as the CalWORKs 

program so both the CalWORKs and CalFresh can be assigned the same 

quarter in the new county. 

Example: On February 5 th , a customer informs the County she now lives in 

Kern County. Due to the CalWORKs ICT transfer period, the County will 

continue the customer’s benefits until March 31 st . Kern County will pick up 

the CalWORKs on April 1 st . CalFresh benefits will be discontinued in this 

County March 31 st to coincide with the transfer period in the CalWORKs 

program. The customer may reapply for CalFresh at any time after moving 

to Kern County, but will not be eligible to receive CalFresh in Kern County 

until April 1 st . This County is responsible for ensuring the customer can 

easily access CalFresh benefits for February and March. 




Introduction This section includes the mandatory reporting requirements when a 

CalWORKs Assistance Unit (AU) member is convicted of a drug felony, 

becomes a fleeing felon, or violates a condition of parole or probation. 

Reporting 

requirement 

CalWORKs customers are required to report within 10 days when an AU 

member is convicted of a drug felony, becomes a fleeing felon, or violates a 

condition of parole or probation. 

CalFresh customers are not required to report mid-quarter a change in drug 

or fleeing felon status or parole/probation violations. However, if a 

CalWORKs AU reports a drug or fleeing felon or parole/probation violation, 

the Eligibility Worker (EW) is required to act on the reported information in 

the CalFresh. 

Note: Mid-quarter reports of drug/fleeing felon or parole/probation violation 

status do not impact CalFresh only Household (HH) members mid-quarter. 

See the CalFresh Budgeting Chapter for information regarding action(s) for 

reports of drug/fleeing felon or parole/probation violation status for CalFresh 

HH members. 

Required action CalWORKs AU members with drug felony convictions, fleeing felon status, 

and parole/probation violations are ineligible to CalWORKs benefits. As 

such, these individuals must be discontinued. The EW must take midquarter 

action to reduce or discontinue benefits, as appropriate, at the end of 

the month 10-day notice can be provided. 

When both CalWORKs and CalFresh are active, the EW must discontinue 

the individual from the Public Assistance CalFresh (PAFS) household at the 

same time as the CalWORKs action, at the end of the month 10-day notice 

can be provided. 

Discontinuing an adult from the CalWORKs AU may result in a need to 

change the aid code for the case. 

Effective 1/1/2005, the rules regarding CalFresh eligibility for some AU 

members with drug felony convictions has changed. Refer to the CalFresh 

Policy Handbook. 

Example: If the only aided adult in an aid code 30 (All Other Families) is 

discontinued due to the adult’s drug, fleeing felon, or parole/probation status, 

the aid code must be changed from 30 to 33 to reflect its transition to a Zero 

Parent status. Similarly, if the family is aided on an aid code 35 (Two- 

Parent), and one adult is discontinued from the AU due to the adult’s drug, 

fleeing felon, or parole/probation status, the aid code would change to 30. 




Parole/Probation Violations, Continued 

Overpayments 

and 

overissuances 

For both CalWORKs and CalFresh, if the AU/household (HH) reports a drug 

felony conviction, fleeing felon status, or violation of the conditions of parole 

or probation for one of its members, but it is too late to provide 10-day notice 

of adverse action, the County must issue the benefits for the next month at 

the previous (higher) level. The EW is required to determine whether an 

overpayment (OP) or overissuance (OI) exists. 

CalWORKs: The County must identify an OP for benefits released at a 

higher level than the customer was entitled to receive when 10-day notice 

could not be provided, regardless of whether the customer reported the 

change timely (within 10 days) or not. 

CalFresh: No OI would be identified if the HH reported the change timely 

(within 10 days). An OI would be identified if the HH failed to report the 

change within 10 days. 

Example: A customer assigned to the April/May/June quarter timely reports 

within 10 days her husband was convicted of a drug felony on April 24 th . The 

County must discontinue the husband from cash aid at the end of the month 

10-day notice can be provided. The EW is unable to provide 10-day notice in 

time to reduce May benefits. Therefore, the EW must discontinue benefits 

for the husband effective May 31 st and reduce benefits for June. There is a 

CalWORKs OP for May. However, no CalFresh OI exists for May, because 

the family reported the change timely (within 10 days). 


Reduction in ABAWD Work Hours 

Introduction This section includes the mandatory reporting requirements for Able Bodied 

Adults Without Dependents (ABAWDs). 

ABAWD waiver Beginning April 1, 2009, the American Recovery and Reinvestment Act 

(ARRA) of 2009 suspended the ABAWD work requirement. This suspension 

is due to continue through September 30, 2010. During this time period 

ABAWDs are not required to report work hours. 

Reporting 

requirements 

For cases with active CalFresh and without active CalWORKs, ABAWDs are 

required to report all changes affecting CalFresh eligibility on a quarterly 

basis on the QR 7. The County will determine ABAWD status prospectively 

on a quarterly basis. 

ABAWDs meeting the work requirement through employment are required to 

report within 10 days when hours of work drop below: 

• 20 hours per week, or 

• 80 hours per month. 

A reduction in the number of hours in unpaid County-supervised work 

activities, such as Workfare, is not subject to mandatory mid-quarter 

reporting since the County has access to this information. 

Required action The County must act on reported reductions in an ABAWD’s hours of work 

participation mid-quarter. Upon receipt of a report, the Eligibility Worker 

(EW) must first determine whether the individual: 

• Qualifies for an ABAWD exemption, or 

• Meets good cause criteria. 

If none of the above conditions is met, the EW must determine whether the 

reduction in work participation hours will result in discontinuance due to 

exhaustion of the “3-out-of-36-month” time limit. 

If a discontinuance or sanction is appropriate, the EW must take action to 

reduce or discontinue benefits at the end of the month 10-day notice can be 

provided. 

See the Work Requirements/ABAWD Chapter of the CalFresh Policy 

Handbook for more information. 

Overissuances CalFresh overissuances are based on timely reporting by the customer. See 

the Budgeting Chapter of the CalFresh Policy Handbook for more information 

regarding identifying overissuances. 


Overview 

Section 7 

Voluntary Mid-quarter Reports 

Overview Both CalWORKs and CalFresh customers may voluntarily report changes in 

income and circumstances which may increase their benefits at any time 

during the quarter. Examples of such changes include, but are not limited to 

when: 

• An Assistance Unit/household’s (AU/HH’s) income decreases, 

• Someone moves into the home, 

• A CalWORKs AU member becomes pregnant or makes a different 

request for special need, or 

• Allowable CalFresh deductions increase (CalFresh only). 


• EAS 44-211 

• EAS 44-316 



Voluntary Mid-quarter Reports 10-51 

Changes in Income 10-52 

Changes in Assistance Unit (AU) / Household (HH) Members 10-54 

Request for Special Need Payment 10-56 

CalFresh Deduction Change 10-57 


Voluntary Mid-quarter Reports 

Introduction When a CalWORKs and/or CalFresh customer voluntarily reports midquarter 

a change in income or circumstance which may increase their 

benefits, the Eligibility Worker (EW) is required to take action on the reported 

change. 

Required 

actions 

This section includes an introduction to the actions to take when the 

customer makes a Voluntary Mid-quarter report of changes such as when: 

• An AU/HH’s income decreases, 

• Someone moves into or out of the home, 

• A CalWORKs Assistance Unit (AU) member becomes pregnant or makes 

a different request for a special need, or 

• Allowable CalFresh deductions increase (CalFresh only). 

Additional information regarding required actions can be found in the 

Budgeting Chapters of the CalWORKs and CalFresh Policy Handbooks. 

The County will only take mid-quarter action on those Voluntary Mid-quarter 

reports, which result in an increase in benefits. 

Benefits must not be decreased mid-quarter as a result of voluntarily 

reported changes or changes not required to be reported. The EW must not 

take action to initiate a decrease. The decrease must be suppressed and 

“held over” for County action until the next quarter when the EW is 

determining eligibility and benefit levels for the next quarter using information 

reported on the next QR 7. 

See the following section for more information regarding Voluntary Midquarter 

reports. 


Changes in Income 

Introduction This section includes an overview of the verification requirements, required 

actions, and effective date of change for Voluntary mid-quarter reported 

changes in income. 

Changes in 

income 

Verification 

requirements 

Mid-quarter 

income change 

reported on the 

QR 7 

Voluntarily reported changes in income do not include mandatory reports of 

income exceeding the Income Reporting Threshold (IRT). 

When a customer voluntarily reports a decrease in income, the County must 

request verification immediately. If the customer is unable to provide 

verification, the Eligibility Worker (EW) must assist the customer in obtaining 

such verification. Action to issue a mid-quarter supplemental payment based 

on the reported decrease in income cannot be taken until verification is 

provided. 

When a customer voluntarily reports an increase in income, no verification is 

required. 

A voluntary mid-quarter change in income (increase or decrease) can be 

reported on the QR 7. When this occurs, the EW must immediately request 

the customer provide verification of the decreased or discontinued income in 

order for a supplement to be issued for the QR Submit Month. Verification of 

the decreased or discontinued income is not needed to determine benefits 

for the next QR Payment Quarter. The customer’s report of the information 

and his/her signature on the QR 7 is all the verification necessary. 

If a family reports on the QR 7 a decrease in income for the Submit Month 

and ongoing, and no verification is provided, this information will be used to 

reasonably anticipate income for the Next QR Payment Quarter, unless 

questionable. 

Example: On the May QR 7 received in June, a family reports a decrease in 

work hours effective June 1 st and ongoing resulting in a decrease in income. 

The EW requests verification of the decrease, and it is not provided. While 

the June benefits are not recalculated using the decreased hours and 

income, the decreased hours and income are used to determine the 

reasonably anticipated income for the Next QR Payment Quarter, unless 

questionable. 



Changes in Income, Continued 

Required action 

on mid-quarter 

report of 

change in 

income 


of change 

The EW must immediately request verification of decreased income. Once 

verification is provided, the EW must determine the result of the change in 

income on benefits by completing a budget (running EDBC). The County 

can only take action on those voluntarily reported income changes, which 

increase benefits. 

If the voluntarily reported income change results in a decrease or 

discontinuance of benefits, the County must not act on the information in the 

current quarter. The EW must send a Notice of Action (NOA) informing the 

customer the voluntarily reported change in income did not increase their 

benefits and reminding the customer to report the information on their next 

QR 7. 

Increase: The effective date of the increase in benefits due to a voluntary 

report of decreased income is the first of the month the change is reported or 

the change occurred, whichever is later. 

Example: A customer assigned the April/May/June quarter loses her job 

April 15 th . The customer calls the EW on May 5 th and provides verification of 

her job loss on May 10 th . The EW determines the decrease in income results 

in an increase in benefits. The effective date of the change is May 1 st ; the 

first day of the month the change was reported. 

Decrease: The effective date of a decrease in benefits due to a voluntary 

report of an income change is based on when the change is required to be 

reported on the QR 7. See the Budgeting Chapter for more information. 


Changes in Assistance Unit (AU)/Household (HH) Members 

Introduction This section includes an overview of the verification requirements, required 

actions, and effective date of change for voluntary mid-quarter reported 

changes in Assistance Unit/Household (AU/HH) members. 

Changes in 

AU/HH 

Verification 

requirements 

Required 

actions 

Changes in AU/HH include both customer voluntary reports of new AU/HH 

members and AU/HH members leaving the home. 

When a customer voluntarily reports a new AU/HH member, the Eligibility 

Worker (EW) will follow the normal add person requirements for each 

program (CalWORKs and CalFresh) to add the new member. The reported 

new: 

• CalWORKs AU member cannot be added until the SAWS 2 or CW 8 

(CW 8A) and all verification necessary to add the person is provided, and 

• CalFresh HH member cannot be added until all verification necessary to 

add the person is provided. 

Exception: If the new CalWORKs AU Member is a newborn (mother 

received pregnancy special needs), all that is needed to add the child 

immediately (pending receipt of required verification - CW 8A, birth 

certificate) is the: 

• Parent’s report of the newborn’s: 

− Name, 

− Gender, and 

− Date of Birth. 

• EW’s establishing whether or not the child is residing with the mother. 

No verification is required when the AU/HH reports a member leaving the 

home. 

Once the required verification is provided, the EW must determine the result 

of the reported change in AU/HH. The County can only take action on those 

voluntarily reported income changes, which increase benefits. 

If the voluntarily reported AU/HH change results in a decrease or 

discontinuance of benefits, the County must not act on the information in the 

current quarter. The EW must send a Notice of Action (NOA) informing the 

customer the voluntarily reported AU/HH change did not increase their 

benefits and reminding the customer to report the information on their next 

QR 7. 



Changes in Assistance Unit (AU)/Household (HH) Members, 

Continued 



Increase: The effective date of the increase in benefits due to a voluntary 

report of an AU/HH change is the first of the month following the date the 

change is reported, not when the change actually occurred. 

Example: A customer is assigned the April/May/June quarter. The 

customer calls the EW on May 5 th and reports her 10-year-old nephew 

moved in April 30 th . She completes an add person application and provides 

all necessary information to add her nephew on May 14th. The EW 

determines the addition of the nephew results in an increase in benefits. The 

effective date of the change is June 1 st , the first day of the month after the 

change was reported. 

Decrease: The effective date of a decrease in benefits due to a voluntary 

report of an AU/HH change is based on when the change is required to be 

reported on the QR 7. See the Budgeting Chapters of the CalWORKs and 

CalFresh Policy Handbooks for more information. 


Request for Special Need Payment 

Request for 

Special Need 

Payment 

CalWORKs only 

Verification 

requirements 



Using 


special needs 

supplement in 

the CalFresh 

budget 

A customer may voluntarily report having a special need at any time during 

the quarter. Requests for special needs can include: 

• Recurring special needs, 

• Nonrecurring special needs (including Homeless Assistance), and 

• Pregnancy special needs. 

This section will discuss the Voluntary Mid-quarter request for recurring, 

nonrecurring, and pregnancy special needs. 

When a customer makes a voluntary report of a special need (other than 

nonrecurring) the County will request the information needed to determine 

the customer’s eligibility to the special need. The Eligibility Worker (EW) will 

allow the customer 10 calendar days to provide the necessary verification. 

See the Special Needs Chapter of the CalWORKs Policy Handbook for more 

information regarding required verification. 

When a customer makes a voluntary report of having a recurring special 

need, the EW shall treat the report as Voluntary Mid-quarter report resulting 

in increased benefits. See below for the effective date of change for 

recurring and pregnancy special needs. See the Special Needs Chapter of 

the CalWORKs Policy Handbook for additional information. 

Recurring special needs: The effective date of the special need is the first 

of the month of the request, once the required verification has been provided. 

Issue the special need payment for the remainder of the quarter and 

terminate at the end of the quarter the special need is expected to end, 

based on the verification provided by the customer. 

Nonrecurring special needs: Nonrecurring special needs, including 

homeless assistance, are not affected by Quarterly Reporting rules. 

Pregnancy special needs: The effective date for pregnancy special needs 

is the first of the month in which the verification of pregnancy is received. 

The pregnancy special needs will continue to be paid through the end of the 

quarter the child is expected to be born. See the Pregnancy Special Needs 

section of the Special Needs Chapter of the CalWORKs Policy Handbook for 


Any mid-quarter increase to a CalWORKs grant due to approval of a special 

need allowance, would result in a decrease to CalFresh benefits mid-quarter. 

Therefore, the additional CalWORKs grant is held over and not used for the 

upcoming CalFresh quarter. 


Overview 

Section 8 

Annual Reporting/Child Only (AR/CO) Cases 

Overview Annual Reporting (AR) for most CalWORKs child only cases was 

implemented effective 10/01/12. These cases are referred to as Annual 

Reporting/Child Only (AR/CO) cases. An AR/CO case is a case in which all 

adults in the Assistance Unit (AU) are: 

Timed-out, 

Drug felons, fleeing felons, or in violation of probation or parole, 

Ineligible due to citizenship status (including sponsored noncitizens failing 

to provide sponsorship information), 

Ineligible due to failure to provide a Social Security Number, 

Receiving Supplemental Security Income (SSI), 


Strikers, 

Ineligible due to an Intentional Program Violation (IPV) conviction prior to 

July 1998, or 

Sanctioned for failure to comply with program requirements other than 

Welfare-to-Work (WTW). 

Cases that are not considered AR/CO cases contain one or more adults and 

all adults are: 

Subject to a WTW sanction, 

Penalized, where the adult remains in the AU; however, his/her portion of 

the grant is removed (e.g., immunization/school attendance penalties and 

IPV convictions since July 1998), or 

An aided step-parent, Registered Domestic Partner (RDP) or optional 

person. 

Note: CalFresh cases associated with the CalWORKs AR/CO case must 

follow CalFresh Change Reporting (CR) rules (refer to the CalFresh Policy 

Handbook (CFPHB) for information regarding CR rules). 


All County Letters (ACLs): 12-49 and 13-28 



Reporting Requirements 10-60 

Requests for Discontinuance and County Initiated 

Actions 

10-64 

Case Transition 10-65 



Introduction Annual Reporting/Child Only (AR/CO) cases and CalFresh cases associated 

to these AR/CO cases are not subject to Quarterly Reporting (QR) 

requirements; therefore, a QR 7 is not required and is no longer generated for 

these cases. Customers are required to report once a year by completing an 

annual Re-Evaluation/Recertification (RE/RC). The associated CalFresh 

cases are required to report per Change Reporting (CR) rules (see the 

CalFresh Policy Handbook (CFPHB) regarding CR rules). 

Re-Evaluation/ 


In AR/CO cases, the RE/RC must be completed in month 12, the final month 

of the AR/CO benefit period. Information regarding the RE/RC forms and any 

additional information provided by the Assistance Unit (AU) will be used to 

determine continuing eligibility and future benefit amounts based on all 

eligibility conditions. 

During the RE/RC interview, the Eligibility Worker (EW) must ask the 

customer about any known changes to the income reported on the SAWS 2 - 

Statement of Facts and request verification to ensure that the correct income 

is used to prospectively budget benefit and grant amounts for the annual 

benefit period. EWs will Journal all factors used in determining current 

income along with any reasonably anticipated changes. 

EWs will inform customers regarding: 

Mandatory Mid-Year reports for AR/CO (see the “Mandatory mid-year 

report: AR/CO” block in this section of the handbook), 

Reporting decreases in income along with providing verification of the 

decrease any time throughout the year so that benefits may be 

recalculated and increased if appropriate, and 

CalFresh CR requirements during the certification period and provide the 

DFA 377.5 – CalFresh Household Change Report to the customer. 

Example: An AR/CO case has a RE/RC due in January 2013. During the 

RE/RC, the customer reports and verifies earned income on the RE/RC forms 

and does not anticipate any changes to the income. The EW would use this 

income information to determine the grant allotment amount for the following 

annual AR/CO benefit period, which begins February 1, 2013. The new 

AR/CO benefit period will be February 2013 through January 2014. The new 

CalFresh RC period will be February 2013 through July 2013, because the 

customer has earned income (refer to the CFPHB for information regarding 

CR rules). 




Mandatory 

mid-year 

report: AR/CO 

Mandatory 

mid-year 

reports: QR vs. 

AR 

AR/CO customers are required to report the following mid-year changes, 

verbally or in writing, within 10 days of the change: 

Income exceeding the Income Reporting Threshold (IRT), 


Someone moves in or out of the home, 



Violations of conditions of probation or parole. 

Customers may use the AR 3 – Mid-Year Status Report For Cash Aid and 

CalFresh to report changes that occur since the last RE/RC in writing during 

the year. 

AR/CO customers must report mandatory mid-year changes within 10 days. 

The table below provides a comparison of the mandatory reporting 

requirements for CalWORKs QR and Annual Reporting (AR). 

QR - CalWORKs AR - CalWORKs 






probation or parole. 




Fleeing felon status, 


probation or parole, or 

Someone moves in or out of the 

home. 

Note: In addition to previous mandatory reports, AR/CO customers must now 

report when someone moves in or out of the home. 




Action on 

mandatory 

mid-year 

reports: AR/CO 

Voluntary 

mid-year 

reports 

EWs must take action on all mandatory reported changes. Customers 

determined to be ineligible based on an increase in income over IRT or due to 

someone moving in or out of the home are discontinued with a 10-day Notice 

of Action (NOA), effective the end of the month in which the change occurred. 

When a customer’s grant would decrease based on an increase in income 

over IRT or someone moving in or out of the home: 

Decrease the grant with a 10-day NOA for the remainder of the RE/RC 

period effective the first of the month following the month in which the 

change occurred, and 

Compute an overpayment when a 10-day NOA for the first of the month 

following the month in which the change occurred cannot be provided. 

Reports of an increase in income over IRT or someone moving in or out of 

home during the RE/RC in month 12 must be used to determine the grant 

amount for the following RE/RC period. 

Example: An AR/CO AU (not receiving CalFresh) has a RE due in June 

2013. The AU reports the undocumented dad moves into the home and has 

income. When the AU reports someone moving into the home, all associated 

eligibility factors including income of the new household member must be 

considered. Because this is a mandatory mid-year report, the dad’s income 

would be used in calculating the CalWORKs grant and benefits decreased 

with timely and adequate notice effective the first of the month in which the 

change occurred. 

Customers may voluntarily report, verbally or in writing, any changes which 

may increase their CalWORKs grant or CalFresh benefits. If a decrease in 

income is reported mid-year, EWs must redetermine the benefit amount for 

the current month and any remaining months in the RE/RC period, and 

increase benefits for the current and subsequent months, if applicable. 

Voluntary reports that result in a decrease in benefits are not acted on 

mid-year in CalWORKs. 




Voluntary 

mid-year 

reports: 

Examples 

The following examples identify action taken on AR/CO cases with an 

associated CR CalFresh case. Refer to the CFPHB for more information 

regarding CR. 

Example 1: AR/CO case has an RE/RC due in April 2013. The customer 

reports a decrease in earned income on December 28, 2012, and provides 

verification of the decrease. The EW will redetermine the benefit amount for 

the current month (December) and the remaining months in the CalWORKs 

RE period and the CalFresh six-month RC period. 

Example 2: AR/CO case has an RE/RC due in August 2013. On August 3, 

2013, the customer reports a decrease in earned income and provides 

verification of the decrease. The EW would use this information to 

redetermine the grant for August and issue a supplement, if appropriate. The 

decreased income would also be used to determine the benefit amount for the 

next CalWORKs RE period and the CalFresh six-month RC period. 

Example 3: AR/CO case has an RE/RC due in November 2013. In April 

2013, the customer reports a $40 increase in earned income. The new 

income amount is not over the IRT. The EW will take no action on the 

CalWORKs case because this is a voluntary mid-year report; however, the 

EW must issue a No-Change NOA. For CalFresh, the change must be acted 

on as per CR rules. 

Example 4: AR/CO case (not receiving CalFresh benefits) has a RE due in 

December 2013. In May 2013, the customer reports one of the children began 

receiving Supplemental Security Income (SSI). Because this is a voluntary 

report that would result in a decrease in benefits, the child is not discontinued 

until the end of the AR period, December 31, 2013. 


Requests for Discontinuance and County Initiated Actions 

Introduction This section contains information regarding voluntary requests for 

discontinuance of benefits and county initiated mid-year actions. 

Voluntary 

requests for 



County 

initiated 

mid-year 

actions 

Customers may request discontinuance of a program at any time during the 

Annual Reporting (AR) period. When the customer requests discontinuance: 

Verbally – 10-day notice must be provided prior to the discontinuance. 

In writing: 

- Adequate notice is provided, and 

- Discontinuance will be completed at the end of the month in which the 

request was made. 

County initiated actions may occur at any time during the 

Re-evaluation/Recertification (RE/RC) period. County initiated changes in 

eligibility status must be acted on at the end of the month in which timely and 

adequate notice can be provided. County-initiated actions include, but are not 

limited to, the following: 

Child is/becomes ineligible due to age, 

Sanction or penalty is imposed or removed, 

Child is placed in Foster Care (FC), 

Aid is approved for a child or individual who is currently being aided in 

another Assistance Unit (AU), 

AU is no longer a California resident, 

Person becomes incarcerated, 

Overpayment/Overissuance (OP/OI) begins or ends, 

Customer failed to cooperate with Income Eligibility and Verification 

System (IEVS) requirements, 

AU member is deceased, 

Young adult transferred into his/her own AU, 

State hearing decision results in a change, and 

Changes known to the agency (e.g., PVS 40, New Hire, etc.). 


Case Transition 

Introduction Under some circumstances, a case will transition between Annual 

Reporting/Child Only (AR/CO)/Change Reporting (CR) and Quarterly 

Reporting (QR). Eligibility Workers (EWs) must provide notice to the customer 

when a case transitions from AR/CO and CR to QR, or vice versa. When a 

case transitions from QR to AR/CO and CR, or vice-versa, the case retains 

the same QR cycle and Re-Evaluation/Recertification (RE/RC) due date. 

The Submit Months are not changed. 

Intake AR/CO 

cases 

Transition 

between 

AR/CO and QR 

Note: Upon the transition to QR, the EW must inform the customer of the QR 

rules and provide the new Income Reporting Threshold (IRT) to the customer 

(the QR 2 – Reporting Changes for Your Cash Aid And Food Stamp 

Household may be given to the customer). 

Due to the potential of cases transitioning between AR and QR, CalWORKs 

intake cases beginning as AR must be assigned a QR cycle. The QR cycle is 

based on the Beginning Date of Aid (BDA) when originating in AR status. This 

will allow for ease of transition to QR when appropriate. 

When an adult is added back to an Assistance Unit (AU) and the case 

transitions from AR/CO to QR, the QR 7 cannot be due in the same month in 

which the adult is added. 

When the adult has a QR 7 due in one month but transitions to AR/CO the 

following month, the case will not be discontinued if the customer fails to 

submit the QR 7. The grant will remain the same until the next RE/RC 

provided there are no mandatory mid-year reports. 

Note: Refer to the CalFresh Policy Handbook (CFPHB) for information 

regarding transitioning between CR and QR. 



Case Transition, Continued 

Case 

movement 

between 

AR/CO and 

QR: Examples 

Following are examples of action taken when a case transitions between 

AR/CO and QR: 

Example 1: A mother applies for CalWORKs for herself and two children on 

March 1. The mother refuses to assign support rights during intake. 

CalWORKs is approved for the two children and the mother is sanctioned. A 

Notice of Action (NOA) is sent to the AU advising of the sanction and the 

AR/CO case status. On May 25, the mother agrees to assign support rights. 

The sanction is removed and the mother is added back to the AU effective 

June 1. Notice must be sent to the mother advising that the AU is now subject 

to QR rules. The QR cycle and RE/RC month are based on the BDA. The 

next QR 7 would be due in August for the July Data Month. 

Example 2: Effective June 1, a CalWORKs timed-out mother in an AR/CO 

case is added back to the AU due to child support reimbursement. The case 

is now subject to QR rules. Because there was no break in aid, the case will 

retain the QR cycle established prior to becoming an AR/CO case. Notice 

must be sent to the mother advising that the AU is now subject to QR rules. 

Example 3: An AR/CO case receiving CalFresh has a RE/RC due in 

June 2013. On April 2, the AU reports the father moved into the home. He 

has no income. The father is eligible to CalWORKs and is added to the AU 

effective May 1. Additionally, the AU transitions from AR/CO to QR 

effective May 1. A QR 7 would not be due until June 2013, the next QR 7 

Submit Month and RE/RC month. 




CHAPTER 11 

Special Needs 

Chapter Overview ..................................................................................... 11-1 

SECTION 1 Pregnancy Special Needs (PSN) 

Overview................................................................................................... 11-2 

Pregnancy Special Needs (PSN) – Basics ............................................... 11-3 

Determining PSN Payment Time Frames................................................. 11-5 

PSN Examples.......................................................................................... 11-7 

SECTION 2 Recurring Special Needs 

Overview................................................................................................... 11-9 

Recurring Special Needs – Basics ......................................................... 11-10 

Recurring Special Needs – Payment Levels .......................................... 11-12 

Determining Recurring Special Needs Time Frames ............................. 11-13 

SECTION 3 Nonrecurring Special Needs 

Overview................................................................................................. 11-15 

Nonrecurring Special Needs – Basics .................................................... 11-16 

Nonrecurring Special Needs – Payment Requirements ......................... 11-17 




SECTION 4 Homeless Assistance 

Overview................................................................................................. 11-19 

Homeless Assistance – Basics............................................................... 11-21 

Determining Homelessness.................................................................... 11-24 

Determining Homelessness – Examples ................................................ 11-25 

Homeless Assistance Payment Indicator (HAPI).................................... 11-28 

Once-in-a-Lifetime .................................................................................. 11-30 

Temporary Homeless Assistance ........................................................... 11-32 

Homeless Management Information System (HMIS)….......................... 11-35 

Permanent Homeless Assistance........................................................... 11-38 

Permanent Homeless Assistance – Arrearage Payments...................... 11-40 

Permanent Homeless Assistance – Arrearage Payment Examples....... 11-43 

Permanent Homeless Assistance – Housing.......................................... 11-45 

Permanent Homeless Assistance – Utilities ........................................... 11-47 

Homeless Assistance and Intercounty Transfers ................................... 11-49 

Homeless Assistance Overpayments ..................................................... 11-50 

Returned Homeless Assistance Warrants .............................................. 11-52 


Overview 

Special Needs 

Introduction The Special Needs Chapter contains information regarding CalWORKs 

special needs payments. 

There are four types of CalWORKs special needs: 

• Pregnancy special needs (PSN), 


• Nonrecurring special needs, and 

• Homeless Assistance (HA). 

Areas covered for each type of special need include: 

• Eligibility, 

• Verification, 

• Time frames involved, and 

• Payment limits. 


• ACL 03-18 

• EAS 44-211 

In this chapter This chapter contains the following sections: 


Pregnancy Special Needs 11-2 

Recurring Special Needs 11-9 

Nonrecurring Special Needs 11-15 

Homeless Assistance 11-19 

CWPHB #4605 (04/11) SPECIAL NEEDS 11-1

Overview 

Section 1 

Pregnancy Special Needs (PSN) 

Introduction This section contains information regarding Pregnancy Special Needs (PSN). 

Reference The following references are applicable to information under this topic. 

• ACL 03-18 

• EAS 44-211.6 

• EAS 44-211.64(QR) 



Pregnancy Special Needs – Basics 11-3 

Determining PSN Payment Time Frames 11-5 

PSN Examples 11-7 


Pregnancy Special Needs (PSN) – Basics 

Introduction A Pregnancy Special Needs (PSN) payment is allowed for Assistance Unit 

(AU) members who meet eligibility criteria and are pregnant. 

PSN eligibility 

requirements 

PSN and MAP – 

Family and AU 

To be eligible for PSN payments, a female must: 

• Have a verified pregnancy, and 

• Be eligible to receive CalWORKs, if an applicant, or 

• Be receiving CalWORKs, if a recipient. 

Note: A sanctioned person is not eligible to a PSN payment, because a 

sanctioned person is not eligible to or receiving CalWORKs. 

When calculating Family Maximum Aid Payment (MAP), the following family 

members may be allowed a PSN payment: 


• Maximum Family Grant (MFG) children, and 

• Non-AU members if: 

− Ineligible noncitizens, or 

− Member’s income is counted. 

When calculating AU MAP, only AU members are eligible to receive PSN. 

PSN requests A customer can request a PSN payment via the phone, QR 7, etc. Once a 

customer has reported a pregnancy, the Eligibility Worker (EW) will allow the 

customer 10 days to provide the necessary pregnancy verification. If the 

customer fails to provide the verification within the 10 days, the EW will: 

• Deny the request, 

• Send the appropriate Notice of Action (NOA) to deny the request for 

failure to provide verification, and 

• Journal all actions taken. 

Note: If the customer provides the verification after the 10 days and a denial 

NOA was sent, the EW will consider this a new request. 



Pregnancy Special Needs (PSN) – Basics, Continued 

Pregnancy 

verification 

EW’s failure to 

request 

verification 

PSN payment 

limit 

To be eligible to a PSN payment, the customer (applicant or recipient) must 

provide medical proof she is pregnant. The verification must: 

• Be a written statement from a physician, physician’s assistant, or 

authorized member of a health clinic, and 

• Include the anticipated date of birth. This date is also referred to as the 

Expected Date of Confinement or EDC. 

The customer is only required to verify pregnancy initially (when the 

pregnancy is reported) and when the pregnancy continues beyond the EDC. 

If the Eligibility Worker (EW) fails to request pregnancy verification, then the 

customer is entitled to PSN payments for the months otherwise entitled, no 

matter when the pregnancy verification is signed or when it was submitted. 

The PSN payment is $47 per month per eligible pregnant female in the AU. 

The $47 PSN payment is in addition to the MAP for the AU. 


Determining PSN Payment Time Frames 

Introduction This section contains information regarding when to start and stop the 

Pregnancy Special Need (PSN) payments for pregnant females. When to 

start a PSN payment depends on: 

Pregnant 

woman only 

(PWO) - 

applicant 

Determining 

third trimester 

Pregnant teen 

only - applicant 

• Whether the female is an applicant for or recipient of CalWORKs, 

• The age of the female, and 

• If others are aided in the Assistance Unit (AU). 

The PSN payment will stop the end of the quarter of anticipated birth unless 

the child is added to the AU mid-quarter. See “PSN stop date – exception” 

block in this section for more information. 

A pregnant woman with no eligible children who has applied for CalWORKs 

is eligible to PSN payments from the date of application through the end of 

the quarter of anticipated birth if she: 

• Is in her third trimester, and 

• Is eligible to receive CalWORKs. 

A pregnant woman with no eligible children is not eligible to CalWORKs until 

her third trimester, with the exception of pregnant teens. See “Cal-Learn 

exception” block in the Assistant Unit/Responsible Persons Chapter. 

The third trimester begins the third month immediately prior to the month of 

anticipated birth and continues through the month of birth. The third 

trimester actually encompasses four months. 

Example: 

The third trimester for a pregnant woman with an Expected Date of 

Confinement (EDC) of September 14 would begin in June and continue 

through September, assuming the child is born in September. 

A pregnant teen only is eligible to receive PSN payments from the date of 

application through the end of the quarter of anticipated birth if she: 

• Is 18 years of age and younger, 

• Has no other eligible children in the AU, 

• Has not obtained a high school diploma or its equivalent, and 

• Is otherwise eligible to or receiving CalWORKs. 



Determining PSN Payment Time Frames, Continued 

Pregnant adult 

or minor - 

applicant 

Pregnant 

female - 

recipient 

PSN stop date - 

exception 

PSN stop date– 

MFG child 

A pregnant woman (adult or minor) is eligible to receive PSN payments from 

the date of application through the end of the quarter of anticipated birth, if 

she has applied for CalWORKs as: 

• Part of an AU with at least one other eligible person, or 

• The caretaker relative of a Supplemental Security Income (SSI)/State 

Supplementary Payment (SSP), KinGAP, or Foster Care child. 

Note: A pregnant adult with no eligible children who has applied for 

CalWORKs must be in her third trimester to be eligible to receive PSN 

payments. 

A pregnant woman recipient, regardless of age, is eligible to receive PSN 

payments from the first of the month of the request (once it is verified) 

continuing through the end of the quarter in which the child is expected to be 

born or the end of the month prior to the newborn being added to the AU, 

once required verification has been provided if she is eligible to and receiving 


PSN payments are paid through the end of the quarter in which the child is 

expected to be born with one exception. 

Exception: If a customer voluntarily reports the birth of the child 

mid-quarter, and the child is added mid-quarter (the benefits will increase), 

the PSN payments will stop the month prior to the month in which the child is 

added to the AU. 

Example: A customer has an EDC of March 16. She is a Cycle 2 customer 

(Feb/Mar/Apr). The PSN payments are scheduled to stop April 30 at the end 

of the quarter of anticipated birth. She reports the birth of her child on March 

20, and the child is added to the AU April 1, as the addition of the newborn 

causes her CalWORKs grant to increase for April. In this case, the PSN 

payments will stop the end of March; the month prior to the month the 

newborn is added to the AU (April). 

PSN payments in cases in which Maximum Family Grant (MFG) rules apply 

will continue through the end of the quarter in which the MFG child is born. 

Example: Same situation as in “PSN stop date” – exception block, except 

the newborn is an MFG child. Although the child is born March 20, the PSN 

payments will continue through April (the end of the quarter), as the addition 

of an MFG child will not cause the CalWORKs benefits to increase. 


PSN Examples 

Introduction This section contains a series of examples to assist the Eligibility Worker 

(EW) in determining the third trimester and the correct Pregnancy Special 

Need (PSN) payment start and stop dates. 

Third trimester- 

Example 

PSN time 

frame– 

Example 1 

A Pregnant Woman Only (PWO) applies for CalWORKs on February 16. Her 

Expected Date of Confinement (EDC) is April 30. 

The third trimester for this applicant is January through April. Her PSN 

payments will begin in February and continue through the end of the quarter 

of anticipated birth. Assuming this applicant has a Feb/Mar/Apr quarter, the 

PSN payments will start in February and continue through April. 

A customer assigned the July/Aug/Sept quarter (Cycle 1) reports her 

pregnancy on August 25 and provides medical verification of her pregnancy 

on September 3. Her EDC is November 7. 

The PSN payment time frame for this customer is August through December 

(the first of the month the verified pregnancy was reported through the end of 

the quarter of anticipated birth). See table below: 

Quarter QR Payment Quarter QR Payment Quarter 

QR Month BEGIN DATA SUBMIT BEGIN DATA SUBMIT 

Month July August September October November December 

Actions 

Pregnancy Pregnancy Continue Continue End PSN 

reported 

Start PSN 

verification 

provided 

Continue 

PSN 

PSN PSN 

Note: Refer to the exception to the PSN stop date when completing the 

unborn-to-born action. 



PSN Examples, Continued 

PSN time 

frame– 

Example 2 

Example – 

verification 

provided after 

denial 

A continuing customer assigned the Apr/May/June quarter (Cycle 1) reports 

on May 15 she is pregnant and provides verification on May 20. Her EDC is 

July 28. 

The PSN payment time frame for this customer is May through September 

(the first of the month the verified pregnancy was reported through the end of 

the quarter of anticipated birth). See table below: 



Month April May June July August September 

Actions Pregnancy Continue Continue Continue End PSN 

reported and 

verification 

provided 

PSN PSN PSN 

Start PSN 

Note: Refer to the exception to the PSN stop date when completing the 

unborn-to-born action. 

A customer assigned the Aug/Sept/Oct quarter (Cycle 2) reports she is 

pregnant on August 15. The Eligibility Worker (EW) requests the customer 

provide the verification within 10 days. When the customer fails to provide 

verification by the tenth day, the EW sends a Notice of Action (NOA) denying 

the request. With the September QR 7 received on October 5, verification of 

pregnancy for August through December is provided. The effective months 

of the PSN are October through January. See table below: 



Month August September October November December January 

Actions Pregnancy 

Verificatio Continue Continue End 

reported 

n of PSN PSN PSN PSN 

provided payment payment payment 

Request 

denied for 

failure to 

provide 

verification 

within 10 

days 

Begin 

PSN 

payment 


Overview 

Section 2 

Recurring Special Needs 

Introduction This section contains information regarding recurring special needs. 


• ACL 03-18 

• EAS 44-211.2 

• EAS 44-316.312(d)(1)(QR) 



Recurring Special Needs – Basics 11-10 

Recurring Special Needs – Payment Levels 11-12 

Determining Recurring Special Needs Time Frames 11-13 


Recurring Special Needs – Basics 

Introduction A recurring special need payment is allowed for Assistance Unit (AU) 

members who meet the eligibility criteria. 

Definition A recurring special need is one resulting in an added cost to the family and is 

expected to occur during two or more months in a calendar year. 

Eligibility 

requirements 

Recurring 

special needs 

and MAP – 

Family and AU 

Special need 

requests 

To be eligible to recurring special needs payments, a customer must: 

• Provide verification of their need, and 

• Be eligible to receive CalWORKs, if an applicant, or 

• Be receiving CalWORKs, if a recipient. 

Note: A sanctioned person is not eligible to a recurring special needs 

payment, because a sanctioned person is not eligible to or receiving 


When calculating Family Maximum Aid Payment (MAP), the following family 

members may be allowed recurring special needs: 


• Maximum Family Grant (MFG) children, and 

• Non-AU members if: 

− Ineligible noncitizens, or 

− Member’s income is counted. 

When calculating AU MAP, only AU members are eligible to receive recurring 

special needs. 

Once a customer has requested a recurring special need, the Eligibility 

Worker (EW) will allow the customer 10 days to provide the necessary 

verification. If the customer fails to provide the verification within the 10 

days, the EW will: 

• Deny the request, and 

• Send the appropriate Notice of Action (NOA) to deny the request for 

failure to provide verification. 

If the customer provides the verification after the 10 days and a denial NOA 

was sent, the EW will consider this a new request. 



Recurring Special Needs - Basics, Continued 

Required 

verification 

Failure to 

request 

verification 

Recurring 

special need 

types 

Recurring special needs are generally the result of a serious medical 

condition of one or more family members. Verification of the need must be a 

written statement from a physician, physician’s assistant, or authorized staff 

member, and includes: 

• What the need is; 

• The condition for the need; and 

• The period over which the need will continue. 

Verify the recurring special need: 

• When the family makes a request for the need, and 

• At the time of Re-Evaluation (RE), or 

• Before the next RE based on the type of the need and the potential for 

change. 

If the EW fails to request recurring special needs verification, then the 

customer is entitled to recurring special needs payments for the months 

otherwise entitled, no matter when the verification is signed or when it was 

submitted. 

Recurring special need payments can be authorized and issued for the 

following special needs: 

• Therapeutic diets, 

• Special transportation need, 

• Special laundry service, 

• Housework, 

• Special telephone equipment, and 

• Excessive use of utilities. 

Payment limit The total recurring special need payments, excluding Pregnancy Special 

Needs (PSN), cannot exceed $10 multiplied by the number of aided AU 

members. 


approval 

Example: A family consists of a mother, father, and two children. The father 

is excluded from the Assistance Unit (AU) AU, as he has reached the 

CalWORKs 48-month time limit. The only aided AU members are the mother 

and the two children. The total recurring special need payments for this AU 

cannot exceed $30 per month ($10 x 3 aided AU members). 

An Eligibility Worker Supervisor I (EWS I) must approve payment of recurring 

special needs. 


Recurring Special Needs – Payment Levels 

Payment chart The chart below lists the types of recurring special needs and the payment 

level for each. 

Therapeutic diets: 

Need Payment amount 

$9.00 per month 

• Diabetic diet under 2200 calories daily, 

• Bland diet, 

• Low fat/low cholesterol diet, 

• Low salt diet – sodium restricted to less than 

three grams daily, or 

• Lactose intolerance. 

Therapeutic diets: 

• Diabetic diet of 2200 or more calories daily, 

• High calorie/high protein diet, including special 

formula for infants, or 

• Lactation (breast feeding) diet. 

Special transportation need: 

• The customer is required to travel an unusual 

distance for medical treatment, or 

• The customer must travel daily for medical 

treatment. 

Special laundry service: 

Example - The customer is required to change 

bedding once daily or clothing more than once 

daily because of a medical condition. 

Housework: 

• The family caretaker is unable to do the 

cooking, laundry, household cleaning and 

similar chores, and 

• Others in the home cannot perform the duties 

listed above, without charge. 

Special telephone equipment: 

Someone in the Assistance Unit (AU) cannot use 

the telephone without special equipment due to an 

auditory impairment. 

Excessive use of utilities: 

Excessive use of utilities is required and essential 

for an AU member’s care, such as electricity 

usage for a medically necessary appliance. 

To determine excessive use of utilities, use the 

actual cost of the utilities minus the in-kind value 

for AU size. If the amount is greater than zero, the 

customer has excessive utility costs. 

$15.00 per month 

The lesser of: 

• The actual verified 

cost, or 

• Without 

documentation, 

$0.12 per mile 

traveled. 

• The actual verified 

cost, or 

• Without verification, 

$3.00 per month. 

The actual cost of the 

provider of the service. 

The actual cost of the 

service or equipment. 

• $10 multiplied by 

the aided AU 

members, or 

• Without proof of 

cost, $5.00 per 

month. 


Determining Recurring Special Needs Time Frames 

Introduction This section contains information regarding when to start and stop recurring 

special need payments. When to start the recurring special need payment 

depends on whether the customer is: 

• An applicant, or 

• A recipient. 

Applicant An applicant is eligible to receive a recurring special need payment from the 

date of application through the end of the quarter in which the verification for 

the special need expires. 

Example: A family applies for CalWORKs May 10 and requests and verifies 

the need for a lactation diet for the mother through December. The first 

payment quarter is May/June/July (Cycle 2). A recurring special need 

payment of $15 per month will be issued May through January. 

Recipient A recipient is eligible to receive a recurring special need payment from the 

first of the month in which either the need was reported or the verification 

substantiates that the need exists, whichever is later, through the end of the 

quarter in which the verification for the special need expires. 

Example 1: A customer is assigned the Jan/Feb/Mar quarter (Cycle 1). The 

customer requests a therapeutic diet in January and provides verification for 

the diet in February. The need will continue through May. A recurring 

special need payment will be authorized for February through the end of 

June. 

Example 2: A customer assigned the Apr/May/June quarter (Cycle 1) 

reports he has a recurring special need on April 10 and provides the 

verification April 15. The verification states the recurring special need will be 

needed April through August. The effective months of the recurring special 

need are April through September. September is the last month of the 

quarter in which August falls. 



Determining Recurring Special Needs Time Frames, Continued 

Example – 

verification 

provided after 

denial 

A customer assigned the Aug/Sept/Oct quarter (Cycle 2) reports she has a 

recurring special need on August 15. The Eligibility Worker (EW) requests 

the customer provide the verification within 10 days. When the customer 

fails to provide verification by the tenth day, the EW sends a Notice of Action 

(NOA) denying the request. With the September QR 7 received on October 

5, verification of a recurring special need for August through December is 

provided. The effective months of the recurring special need are October 

through January. See table below: 


QR 

Month 

BEGIN DATA SUBMIT BEGIN DATA SUBMIT 

Month August September October November December January 

Actions Special 

Verification Continue Continue End 

need 

of recurring recurring recurring recurring 

reported 

special special special special 

need need need need 

provided payment payment payment 

Request 

denied for 

failure to 

provide 

verification 

within 10 

days 

Begin 

recurring 

special 

need 

payment 


Overview 

Section 3 

Nonrecurring Special Needs 

Introduction This section contains information regarding nonrecurring special needs, with 

the exception of Homeless Assistance (HA), which has its own section in this 

Chapter. 


• ACL 03-18 

• EAS 44-211.3 

• EAS 44-211.4 



Nonrecurring Special Needs – Basics 11-16 

Nonrecurring Special Needs – Payment Requirements 11-17 


Nonrecurring Special Needs – Basics 

Introduction A nonrecurring special need payment can be made to any Assistance Unit 

(AU) that has suffered loss of or damage to their home caused by sudden 

and unusual circumstances beyond the family’s control. Examples include: 

• Fire, 

• Flood, 

• Earthquake, or 

• Inhabitability or inaccessibility of the residence. 

Eligibility To be eligible for a nonrecurring special need payment, a family must: 

• Be eligible to and receiving CalWORKs, and 

• Have $100 or less in nonexempt liquid resources (resources immediately 

available and readily converted to cash – see Liquid Resources definition 

in Applications Chapter). 

CalWORKs families with more than $100 in nonexempt liquid resources are 

not eligible to nonrecurring special need payments. 

Request A customer may request a nonrecurring special need payment at any time 

regardless of when the incident occurred if the need has not yet been met. 

Required 

verification 

The incident leading to the need for a nonrecurring special need payment 

must be verified. Verification can include: 

• Fire or police reports, 

• Letters or statements from the Red Cross or other service agency, and 

• Newspaper articles. 

Types Nonrecurring special need payments can be authorized and issued to: 


approval 

• Help repair or replace household equipment and clothing, 

• Help pay for repairs or replace damaged home, and 

• Provide interim housing for those who are homeless and do not qualify 

for Homeless Assistance (HA). 

A District Manager (DM) must approve the issuance of all nonrecurring 

special need payments. 


Nonrecurring Special Needs – Payment Requirements 

Payment 

restrictions 

Nonrecurring special needs payments will not be issued for items which: 

• Do not belong to the family, or 

• Are available to the family without cost. 

The customer is expected to accept a free item as replacement when 

possible. Repair or replacement payment will only be made when the item is 

not available to the family at no cost from any source. 

Payment limit The total amount allowed for the nonrecurring special needs payments must 

not exceed $600 per Assistant Unit (AU) for each incident of sudden and 

unusual circumstances. 

Replace or 

repair clothing 

or household 

equipment 

Damages to the 

home 

The amount of the payment for each item repaired or replaced, or to assist 

with damage to the home, shall be the actual cost, including sales tax, up to 

a total maximum not to exceed $600 per AU per incident. 

Nonrecurring special needs payments are issued for the actual cost of 

replacing the following items lost by eligible AU members, up to the 

maximums listed in the chart below: 

Item Allowable payment 

Clothing $25 per AU member 

Bedding, dishes, kitchen utensils $12 per AU member 

Cooking stove $142 

Refrigerator $190 

Space heater $73 

Double bed, including mattress $143 

Other essential furniture $50 

When the home must be repaired due to damage caused by sudden and 

unusual circumstances, a nonrecurring special needs payment may be made 

for the costs of essential repair or replacement. Payment shall be allowed for 

the following costs: 

• Moving and/or storage costs due to damage to the home, and 

• Labor and material costs for repair of the home in which the AU lives, and 

a member of the AU owns. 



Nonrecurring Special Needs – Payment Requirements, 

Continued 

Interim shelter An AU may receive a nonrecurring special needs payment for the costs of 

interim shelter when their home has been destroyed or made uninhabitable 

or inaccessible. 

If an AU is eligible to receive Homeless Assistance (HA), the AU is not 

eligible to receive a nonrecurring special need payment for interim shelter. 


Overview 

Section 4 

Homeless Assistance 

Introduction This section includes information regarding Homeless Assistance for both 

temporary and permanent shelter. 

Reference The following references are applicable to information under this topic. 

• ACL 03-18 

• ACIN I-42-03 

• EAS 44-211.5 



Homeless Assistance – Basics 11-21 

Determining Homelessness 11-24 

Determining Homelessness – Examples 11-25 

Homeless Assistance Payment Indicator (HAPI) 11-28 

Once-in-a-lifetime 11-30 

Temporary Homeless Assistance 11-32 

Homeless Management Information System (HMIS) 11-35 

Permanent Homeless Assistance 11-38 

Permanent Homeless Assistance – Arrearage Payments 11-40 

Permanent Homeless Assistance – Arrearage Payment Examples 11-43 

Permanent Homeless Assistance – Housing 11-45 

Permanent Homeless Assistance – Utilities 11-47 

Homeless Assistance and Intercounty Transfers 11-49 

Homeless Assistance Overpayments 11-50 

Returned Homeless Assistance Warrants 11-52 




Introduction Homeless Assistance (HA) provides nonrecurring special needs payments to 

homeless families. HA is available to meet an Assistance Unit’s (AU’s) 

reasonable costs of: 

Definitions – 

homeless and 

homelessness 

• Securing permanent housing, 

• Preventing eviction by payment of arrearages, or 

• Temporary shelter while the AU seeks permanent housing. 

An AU is considered homeless when it has a need for housing in a 

commercial establishment, shelter, publicly-funded transitional housing 

facility, or from a person in the business of renting properties who has a 

history of renting properties, and: 

• Lacks a fixed and regular nighttime residence; or 

• Has a primary nighttime residence that is a supervised publicly or 

privately operated shelter designed to provide temporary living 

accommodations; or 

• Is residing in a public or private place not designed for, or ordinarily used 

as, a regular sleeping accommodation for human beings; or 

• Has received a pay or quit notice to vacate current residence. 

Example: 

An otherwise eligible AU, who temporarily resides with another family, 

requests HA to obtain separate housing. The County determines the AU is 

eligible to receive HA because the AU: 

• Has a need for commercial shelter, and 

• Lacks a fixed and regular nighttime residence. 


Homeless Assistance – Basics 

Introduction Homeless Assistance (HA) payments are available to any CalWORKs 

Assistance Unit (AU) who meets the definition of homeless and meets the 

eligibility criteria. 

Eligibility To be eligible to a HA payment, a family must: 

Apparently 

eligible to 


Ineligible family 

members 

• Be eligible to and receiving CalWORKs, 

• Have $100 or less in nonexempt liquid resources (see note below), 

• Meet the definition of homeless, and 

• Have never received HA before, unless they meet a once-in-a-lifetime 

exception (see the Once-in-a-lifetime section of this Chapter for more 

information). 

Temporary HA can be issued to a family meeting all the eligibility criteria 

other than “eligible to and receiving CalWORKs” if the family is apparently 

eligible to CalWORKs. 

Note: Cash in the Electronic Benefit Transfer (EBT) account is exempt for 

consideration in the liquid resource limit determination for the payment 

quarter. Resources are evaluated once quarterly. Any money remaining at 

the beginning of the following quarter will be considered in the resource limit 


Apparent eligibility to CalWORKs exists if the information provided on the 

Statement of Facts and information otherwise known to the county indicates 

the applicant would be eligible for CalWORKs if the information on the 

Statement of Facts was verified. 

The completion of the Statement of Facts is required to determine apparent 

eligibility. 

The following family members are not eligible to receive HA: 

• Noncitizens without verification of their noncitizenship status, 

• Refugee Cash Assistance (RCA) recipients, 

• Women with no eligible child(ren) and without a verified pregnancy, 

• CalWORKs sanctioned or penalized people, 

• Timed out adults, and 

• Maximum Family Grant (MFG) children. 

See the AU/Responsible Persons Chapter of this handbook for a more 

inclusive listing of CalWORKs ineligible persons. 



Homeless Assistance – Basics, Continued 

Discontinuing a 

Homeless 

Assistance 

program 

Identifying 

homelessness 

A HA program cannot be denied in C-IV once a voucher has been issued. 

HA programs must be discontinued: 

• When the customer is no longer eligible to HA, or 

• Anytime HA benefits/vouchers have been issued. 

Note: A HA program can only be denied if benefits/vouchers were not 

issued. Auditing cannot issue payments/warrants to providers for any 

vouchers submitted for payment if the HA program has been denied. 

Eligibility Workers (EWs) must be able to identify possible homelessness in 

order to refer customers to available benefits. Information regarding a 

customer’s possible homelessness can be located in a variety of places, 

such as: 

• On the SAWS 1 application when the customer initially applies for 

CalWORKs, 

• When the customer reports a change of address and/or living 

arrangement, 

• During a conversation with the customer, and 

• On the QR 7. 

When a customer indicates he/she is or will become homeless, and wants 

HA, consider this a request for HA. 

Request A family may request HA at any time. Once the request is made, the family 

must complete a CW 42 form (Statement of Facts – Homeless Assistance) to 

apply for temporary and/or permanent HA. 

Period of 

homelessness 

HA shall only be granted for a continuous period of homelessness caused by 

the same specific circumstance. The period of homelessness begins on the 

date of the first HA payment, whether for temporary or permanent HA. The 

period of homelessness ends when the AU is issued a payment for 

permanent housing. 

If the period of homelessness is due to an exception to the once-in-a-lifetime 

limit, payments for temporary and permanent housing shall only be 

authorized for a continuous period of homelessness caused by the same 

specific circumstances. 



Homeless Assistance – Basics, Continued 

Summary of HA 

benefits 

HA issuance 

limits 

HA benefits can be summarized as follows: 

• HA payments can be made for temporary and/or permanent HA. 

• HA will pay for up to 16 consecutive days of temporary shelter and for the 

deposits necessary to secure permanent housing. 

• Permanent HA and Permanent HA arrearage payments can be issued 

whether or not temporary HA was issued. 

HA issuance limits are as follows: 

• A homeless family may receive HA once-in-a-lifetime except in certain 

circumstances. See “Once-in-a-lifetime” section in this chapter. 

• HA may only be paid for AU members. 


Determining Homelessness 

Determining 

homelessness 

Temporary and 

emergency 

housing 

In order to determine whether or not a family meets the definition of 

homeless or homelessness, an Eligibility Worker (EW) must use sound 

interviewing skills. Use the following guidelines to help determine whether 

the family is homeless: 

When the family … And … Then the family … 

Has been evicted from their Has actually vacated Is homeless. 

previous residence, 

the residence, 

Has been given a restraining Lacks a fixed and 

order, court order, Marshal’s regular nighttime 

notice, or written statement 

signed by the evictor, 

Is paying another family for 

temporary and emergency 

housing due to current 

homelessness, 

residence, 

States they will be evicted, Has a pay or quit Is considered homeless for the 

notice, 

purpose of determining 

Permanent HA Arrearage 

payments. 

States they will be evicted but 

• May sign a release of 

have nothing in writing, 

information form allowing 

the EW to call the evictor to 

verify the pending eviction. 

• Is not homeless until they 

lack a fixed and regular 

nighttime residence. 

Shares living expenses with 

Is not homeless and is ineligible 

another family on a regular 

to receive Homeless Assistance 

basis or is a roomer or 

boarder but says they need to 

move, 

(HA). 

HA can be issued to otherwise eligible families who live with another family 

on a temporary and emergency basis. This generally means the family has 

been living with others for less than 10 days and is there due to a legal 

eviction or family crisis, such as domestic violence. 

Questions to ask to determine if the family is in a temporary and emergency 

housing situation include: 

• Is there an agreement with the landlord the family may only remain 

temporarily? Is there an understanding the family will move out quickly? 

• Does the presence of the family violate the rental agreement? 

• What are the sleeping arrangements? Are they acceptable only on a 

temporary basis? 

• Is the family looking for another place to live? 

• Why did the family leave their previous residence? 


Determining Homelessness - Examples 

Introduction To determine homelessness, Eligibility Workers (EWs) must evaluate each 

family’s situation on its own merits. The examples in this section will assist in 

making a determination. 

Example 1 Situation – A family lives in their car or “on the street”. 

Resolution – A family living in their car or on the street meets the definition 

of homeless because they are without a fixed and regular nighttime 

residence. 

Example 2 Situation – A minor parent states she was kicked out of her parents’ home. 

Resolution – Follow the minor parent rules given in the Children and 

Eligibility Chapter of this handbook. Temporary Homeless Assistance (HA) 

can be issued while CPS investigates the reason the minor parent and 

child(ren) are homeless. Permanent HA cannot be issued until Child 

Protective Services (CPS) reports findings to the EW. 

Example 3 Situation – A mother has forced the father and children to leave. The 

mother will not allow the father and children to return to the home. 

Resolution – The father and children are homeless. 

Example 4 Situation – A family has been living in a motel for three weeks. They do not 

have a legal eviction notice from their former residence. 

Resolution – Although the family does not need an eviction notice after the 

fact, they will not be considered homeless until after checkout time on the 

date through which the motel room rent is paid. If rent is paid through a nonwork 

day for Human Services (HS) staff, issue enough temporary HA to 

house the family until the next HS work day. 

Example 5 Situation – A family has been living in a motel for more than a month. They 

want HA benefits because they have found a house. 

Resolution – Deny the HA request while the family still lives in the motel and 

explain the intent of the HA program. After the date through which rent is 

paid, grant HA benefits if the family says they are homeless and otherwise 

qualify for the program. 



Determining Homelessness - Examples, Continued 

Example 6 Situation – A customer applies for HA and does not have an eviction notice. 

Resolution – The County cannot require an eviction notice (including a 

Marshal’s notice) as a condition to apply for HA. However, when an eviction 

has occurred, the County may request a copy of the eviction notice as 

verification of homelessness. When the customer is unable to provide 

documentation within the first three working days after the request for HA, 

the County may accept a sworn statement by the customer. 

Example 7 Situation – A family applies for HA and has not resided in a shelter prior to 

their request for HA. 

Resolution – There is no authority in statute or regulation that allows a 

county to require families to be in a shelter for any period prior to applying for 

HA. The County cannot require a family to reside in a shelter prior to 

requesting HA. 

Example 8 Situation – A family is temporarily residing with another family. 

Resolution – An otherwise eligible AU that temporarily resides with another 

family is considered eligible to receive HA because they lack a fixed and 

regular nighttime residence. 

Example 9 Situation – A woman in a domestic violence situation voluntarily leaves her 

spouse and permanent residence with her children and becomes homeless. 

Resolution – If the Assistance Unit (AU) has received HA before and 

becomes homeless due to a domestic violence situation, the AU meets an 

exception for the once-in-a-lifetime exception and is eligible for HA. 

Example 10 Situation – A woman, who was raped in her home by a person she knew 

and lives in the same neighborhood, applies for HA. She voluntarily leaves 

her permanent residence with her children and becomes homeless. She has 

already received both Permanent and Temporary HA. 

Resolution – The AU does not meet the requirements for the once-in-alifetime 

exception for HA as it relates to domestic violence. For this exception 

to apply, the person who raped the woman would need to be the customer's 

spouse, partner, or roommate. EW should explore the exception for 

uninhabitability of the former residence (see Once-in-a-lifetime section). 



Determining Homelessness - Examples, Continued 

Example 11 Situation – A family has received a pay or quit notice. 

Resolution – An AU is eligible for Permanent HA Arrearage payments if the 

payment of the arrearages is a reasonable condition of preventing eviction, 

and the AU demonstrates the eviction is the result of a verified financial 

hardship that resulted from extraordinary circumstances beyond their control, 

and not due to other lease or rental violations. 


Homeless Assistance Payment Indicator (HAPI) 

Introduction The Homeless Assistance Payment Indicator (HAPI) allows counties to 

record Homeless Assistance (HA) issuance into a Statewide database 

accessible to all CalWORKs staff throughout the State. 

Information 

available 

through HAPI 

Obtaining HAPI 

verification 

prior to 

issuance 

Complete information regarding the HAPI records is available in the 

Statewide Automated Commuter Systems (SACS) Handbook. The HAPI 

screen shows any HA issuance a customer has received from any California 

county. HAPI inquiry details include: 

• The date HA was authorized (helps identify the beginning of the period of 

homelessness), 

• The date HA information was added to the HAPI system, 

• Which county issued the payment, 

• The types of HA authorized (see below for details), and 

• Case information: name, Social Security Number (SSN), Date of Birth 

(DOB), case number, Eligibility Worker (EW) file number, and district 

number. 

Obtain a HAPI screen print when a family applies for HA to determine when 

and where family members last received HA, if ever. 

Obtain the HA history for all adults in the family, including sanctioned, 

penalized, Intentional Program Violation (IPV), excluded, and non-needy 

caretakers. When adults are not aided due to citizenship status, do the 

research using the oldest aided child in the Assistance Unit (AU). 

Types of HA The types of HA indicated on the HAPI screen are: 

Code HA Type 

T Temporary shelter – once in a lifetime 

P Permanent shelter – once in a lifetime 

TV Temporary: violence – exception to once-in-a-lifetime limit 

PV Permanent: violence – exception to once-in-a-lifetime limit 

TM Temporary: mental or physical illness – exception to once-in-alifetime 

limit 

PM Permanent: mental or physical illness – exception to once-in-alifetime 

limit 

TU Temporary: uninhabitable dwelling – exception to once-in-alifetime 

limit 

PU Permanent: uninhabitable dwelling – exception to once-in-alifetime 

limit 

TD Temporary: declared natural disaster – exception to once-in-alifetime 

limit 

PD Permanent: declared natural disaster – exception to once-in-alifetime 

limit 



Homeless Assistance Payment Indicator (HAPI), Continued 

The search 

results 

Make the following decisions based on the results of the HAPI system 

search. For more complete instructions, refer to the section about the 

particular benefit later in this Chapter. 

If the AU … Then … 

Never received HA, Continue with the HA application process. 

Received temporary HA only, Consider eligibility for permanent HA only. 

Received permanent HA only, Continue with the application to issue 

temporary HA only if: 

Received HA before but is 

homeless for a reason that is 

an exception to the once-in-alifetime 

rule, 

Received temporary and 

permanent HA, and 

• Is not homeless due to an 

exception to the once-in-alifetime 

rule, and 

• HA was not considered 

an overpayment, 

Received temporary and 

permanent HA and is not 

homeless due to an exception 

to the once-in-a-lifetime rule, 

but the total amount of HA 

issued was determined to be 

an overpayment. 

• This is the same period of 

homelessness, and 

• The family needs temporary HA while 

they wait for the permanent housing to 

become available, and 

• The 16 consecutive-day temporary 

shelter limit has not expired. 

• Continue with the HA application 

process, and 

• Refer to the rules about issuing benefits 

based on an exception. 

Deny the HA application. 

• Continue with the HA application 

process, and 

• Refer to HA Overpayments, section of 

this Chapter. 


Once-in-a-lifetime 

Introduction Temporary and permanent Homeless Assistance (HA) payments (including 

permanent HA arrearage payments) are each limited to a once-in-a-lifetime 

period of homelessness. Assistance Units (AUs) that have received their 

once-in-a-lifetime payments will not be eligible to HA unless they meet one of 

the exceptions. 

Once-in-alifetime 

exceptions 

The exceptions to the once-in-a-lifetime limit for HA payment are as follows: 

• Whenever a state or federally declared natural disaster is the direct and 

primary cause of homelessness. 

• Limited to a maximum of one period of up to 16 consecutive calendar 

days of temporary and one payment of permanent housing assistance in 

12 months when homelessness is the result of any of the following 

exceptions: 

− Domestic violence by a spouse, partner, roommate; or 

− Former residence is uninhabitable due to sudden and unusual 

circumstances beyond the customer’s control including but not limited 

to, fire, natural catastrophe, or condemnation; or 

− A medically verified physical or mental illness, excluding alcoholism, 

drug addiction, or psychological stress. 



Once-in-a-lifetime, Continued 

Required 

verification 

When the cause of homelessness for the once-in-a-lifetime exception is for 

other than a state or federally declared natural disaster, the AU must provide 

verification of the circumstance(s), which resulted in the AU’s homelessness. 

The circumstances must be verified through a third-party governmental or 

private health and human services agency. 

Examples of required verification include: 

Cause of 

homelessness 

Verification 

Domestic violence Copies of records or reports from: 

Physical or mental 

illness 

Uninhabitability of 

the residence 

• Police departments; 

• Medical facilities; 

• Battered women’s shelters signed by an 

administrator, counselor, or designated staff 

member; or 

• Adult and Child Protective Services, Family 

Service Bureau, and Crisis Counseling Service 

agencies. 

Medical verification from the appropriate: 

• Treating physician; 

• State certified nurse; 

• Nurse practitioner; 

• Physician’s assistant; 

• Therapist; 

• Psychologist; 

• Licensed counselor; or 

• Medical or clinical personnel with access to the 

patient’s records who can verify the diagnosis. 

Written statements or copies of reports from: 

• Police departments; 

• Fire departments; 

• The Red Cross; 

• Health department; or 

• Any other agency authorized to verify the former 

residence is uninhabitable. 


Temporary Homeless Assistance 

Introduction Once Homeless Assistance (HA) eligibility has been established, temporary 

HA can be issued for homeless families who have not found permanent 

housing at the time of their request for HA. 

Qualifying 

housing 

Temporary HA will pay for temporary shelter: 

In a commercial establishment, 

In a shelter, 

In publicly funded transitional housing, and 

In shelter provided by a person in the business of renting properties who 

has a history of renting properties. 

Issuance limits When there is no cost for temporary shelter, no temporary HA benefits will be 

paid. When there is a cost for shelter, temporary HA will pay: 

$65 per day for an Assistance Unit (AU), of four or less CalWORKs 

eligible or apparently eligible persons. 

$15 per day for each additional CalWORKs eligible or apparently eligible 

person in an AU of more than four persons. 

A maximum $125 per day per AU. 

HA cost less 

than daily 

maximum 

Other issuance limits for temporary HA are: 

Issue three days of temporary HA initially. Issue more than three days 

due to office closures, if necessary. 

Subsequent temporary HA issuances may be made for up to seven days 

if the customer: 

– Has met his/her permanent search requirement, and 

– Provides verification of the amount paid for the temporary shelter for 

the previous temporary HA payment issued via Electronic Benefit 

Transfer (EBT). 

When the cost of temporary shelter is less than the daily maximum for the 

AU size, the remaining benefit for the number of days in a particular issuance 

will be paid to the family. See the Residence Chapter of this handbook for 

more information on No Address cases. 



Temporary Homeless Assistance, Continued 

Time limits Temporary HA may be issued for a maximum of 16 consecutive days. Time 

limit guidelines are as follows: 

The 16 consecutive day period begins on the first day for which a 

temporary HA payment is made. 

The AU must request all temporary HA before the end of the 16-day limit. 

If the customer does not request a payment, no HA will be issued. 

The unused days in the 16-day period cannot be saved up and used 

later. 

Temporary HA can only be issued after permanent HA when there are 

remaining temporary HA days and the family must wait for the permanent 

housing to become available. 

Issuance 

method 

Temporary HA benefits are paid by: 

EBT directly to the customer, or 

Voucher directly to the shelter, commercial establishment, transitional 

housing, or person in the business of providing shelter. 

EBT issuance Temporary HA payments are paid to the customer via EBT, using the 

issuance limits stated in the “Issuance limit” block in this section of the 

handbook. When the initial temporary HA payment is issued via EBT, the 

customer must verify that the payment was used to obtain temporary shelter 

before any subsequent temporary HA payments are issued. 

If the customer… Then the Eligibility Worker (EW) 

will… 

Provides verification of: 

Issue subsequent temporary HA 

Amount paid for temporary 

shelter, and 

payments. 

Meeting the permanent housing 

search requirement, 

Fails to provide verification of: Not issue subsequent temporary HA 

Amount paid for temporary 

shelter, or 

payments to the customer. 

Meeting the permanent housing 

search requirement, 

Note: The EW will emphasize the need to provide verification of shelter costs 

in order to receive additional temporary HA payment each time temporary HA 

is issued to the customer. 



Temporary Homeless Assistance, Continued 

Voucher 

issuance 

Processing 

time frames 

Customer 

search for 

permanent 

housing 

requirement 

Vouchers will be issued for temporary HA when the customer does not have 

an EBT account set up for cash. When paid by voucher, the housing vendor 

mails the voucher to San Bernardino County Human Services (HS) Auditing 

for payment. 

A warrant may be issued for temporary HA when the provider of the housing 

refuses to accept the voucher. All HA warrant issuances must be approved by 

a District Manager (DM). 

All temporary HA requests must be either issued or denied the same working 

day the request is made. 

Families who receive temporary HA must search for permanent housing as a 

condition of eligibility for temporary HA. The customer must have one 

face-to-face contact with the landlord of a prospective residence and complete 

at least one “walk through” of a prospective residence for each day temporary 

HA is issued to meet the housing search requirement. 

The search for housing is documented on the HA 45, Permanent Shelter 

Search Log. The HA 45 includes a release of information authorization to 

allow Eligibility Workers (EWs) to verify the validity of the information on the 

form, if necessary. 

Mailing address A family receiving temporary HA may receive their mail at the temporary 

shelter address. If the temporary shelter will not allow the family to receive 

mail there, follow the mailing instructions for “No Address” families in the 

Residence Chapter of this handbook. 

Continued 

homelessness 

When the family has exhausted their temporary HA benefits and has not 

found permanent shelter, the family may be considered a “No Address” 

family. Complete and submit a Fraud referral to the Fraud Investigations Unit 

(FIU) if the situation warrants a fraud referral. 


Homeless Management Information System (HMIS) 

Introduction The Homeless Management Information System (HMIS) is a system used to 

track the use of homeless programs, understand patterns of use, measure 

the effectiveness of homeless program, and produce an unduplicated count 

of the people using those programs. 

CAPSBC Community Action Partnership of San Bernardino County (CAPSBC) is 

responsible for administering HMIS in a manner that meets Housing and 

Urban Development (HUD) standards. 

Data sharing The Transitional Assistance Department (TAD) has agreed to provide 

CAPSBC with temporary Homeless Assistance (HA) customer information to 

be used by HMIS, which includes the customer’s: 

• Name 

• Date of birth (DOB) 

• Last four digits of the Social Security Number (SSN) 

• Zip code of the office/area where he/she is receiving temporary HA 

(location of homelessness when issued) 

Written consent In order to share customer information with CAPSBC, TAD will need to 

acquire written consent from the customer using the Client Consent/ 

Information Release Authorization form (HA 31). 

Informing the 

customer 

A temporary HA customer must understand the consent he/she is signing. In 

an effort to ensure understanding, HA Eligibility Workers (EWs) must: 

• Post the following at their work area: 

− HA 33 – Privacy Posting/Notice 

− HA 34 – Mandatory Collection Notice 

• Provide an oral explanation (see “Oral explanation” block of this 

handbook section for more information) 

HA 31 The HA 31 is used to obtain customer consent to share customer information 

with CAPSBC. It informs the customer about what: 

• He/she needs to know before signing the form, 

• Information is shared about him/her, and 

• Are his/her rights. 



Homeless Management Information System (HMIS), Continued 

HA 33 The HA 33 informs applicants of temporary HA how customer information 

may be: 

• Used, 

• Disclosed, and 

• Protected. 

Note: The EW must provide a copy of the HA 33 to the customer if he/she 

requests one. 

HA 34 The HA 34 informs applicants of temporary Homeless Assistance (HA) how 

customer information may be collected as: 

Oral 

explanation 

• Required by law, or 

• Requested from organizations which fund the San Bernardino County 

Continuum of Care (SBC CoC) program. 

All temporary HA customers must be provided with an oral explanation 

indicating their information will be entered into a computerized record 

keeping system, which includes the following: 

• What HMIS is 

• Why gather and maintain data 

• Security 

• Privacy protection 

• Customer benefits 

Note: See the next five blocks for details regarding the above items. 

What HMIS is HMIS is a web-based information system that homeless service agencies 

within SBC CoC use to capture information about the persons they serve. 

Why gather and 

maintain data 

Data collection supports improved planning and policies, including: 

• Determining whether desired outcomes were achieved, 

• Where more, or other, resources may be needed, 

• Identifying best and promising practices, and 

• Identifying factors that support or hinder achievement of outcomes. 

Security Only staff that has administrative responsibilities can look at, enter, or edit 

customer records. 

Note: TAD staff does not do any type of entry into HMIS. 



Homeless Management Information System (HMIS), Continued 

Privacy 

protection 

Customer 

benefits 

The following are privacy protection measures put into place by CAPSBC 

and SBC CoC: 

• No program level information will be released to another agency or 

individual without written consent; 

• Customers have the right not to answer any question, unless entry into a 

program requires it; 

• Customer information is stored encrypted on a central database and 

information that is transferred over the web is transferred through a 

secure connection; 

• Customers have the right to know who has added to, deleted from, or 

edited their SBC CoC HMIS record. 

Benefits for customers who participate with HMIS include: 

• Facilitation of streamlined referrals, 

• Coordinated services, 

• Unduplicated intakes, and 

• Access to essential services and housing. 

HMIS process When interviewing customers for temporary HA applications, follow the chart 

below, in addition to completing the regular HA process: 

Step Action 

1 Provide the customer with an oral explanation of HMIS. 

2 Ask the customer if he/she would like to have his/her data shared. 

If the customer… Then … 

Agrees to share data with 

CAPSBC, 

Does not agree to share data 

with CAPSBC, 

• Have the customer sign 

the HA 31, and 

• Go to Step 3. 

Go to Step 5. 

3 Image the HA 31 into C-IV. 

4 Add the Temporary HA – HMIS flag to the temporary HA case. 



Permanent Homeless Assistance 

Introduction When basic Homeless Assistance (HA) eligibility has been established, 

permanent HA may be issued for qualifying families. 

Qualifying 

housing 

Permanent HA will pay for shelter: 

In a commercial establishment 

In shelter provided by a person in the business of renting properties who 

has a history of renting properties 

In a motel only if there are cooking facilities and the total rent amount 

does not exceed the maximum allowed 

In arrearages in order to prevent eviction 

Permanent HA will not pay for the family to return to their former residence, 

but it will pay arrearages to prevent eviction of current residence. 

Shared housing Permanent HA will not be paid for shared housing unless the: 

Rental agreement has been revised to include the HA recipient family as 

well as any other family living in the home, and 

Landlord requires additional security deposits. 

Issuance rules Issuance rules for permanent HA are as follows. 

Payments must only be issued to the property owner or Property 

Management Company. 

Will pay for the deposits necessary to secure permanent housing. 

Will pay for the deposits to begin utility service when the utilities are not 

included in the rent. 

Will not pay for past due or current utility bills. 

Is issued according to the once-in-a-lifetime rule. Permanent HA may be 

issued again only when the homelessness is due to an exception to the 

once-in-a-lifetime rule. 

Can only be issued to CalWORKs recipient families or for those families 

approved to receive CalWORKs. 

Issuance 

method 

Permanent HA benefits are paid by voucher directly to the commercial 

establishment, motel, person in the business of providing shelter, or utility 

company. The vendor mails the voucher to San Bernardino County Human 

Services (HS) Auditing for payment. 

A warrant may be issued for permanent HA when the provider of the housing 

or utilities refuses to accept the voucher. All HA warrant issuances must be 

approved by a District Manager (DM). 



Permanent Homeless Assistance, Continued 

Processing 

time frames 

Internal 

Revenue 

Service (IRS) 

requirement 

Payments for permanent housing must be issued or denied within one 

working day of the time the Assistance Unit (AU) provides: 

The HA 44 – Landlord Verification and Consent form, 

Form W-9 – Request for Taxpayer Identification Number and Certification 

(when applicable; see “Internal Revenue Service (IRS) requirement” 

section below); and 

The rental agreement, or 

Credible written verification of the rental agreement from the landlord, or 

Verbal proof of the rental agreement from the landlord with the consent 

from the AU. 

Note: The Form W-9 must be submitted or the taxpayer identification 

information for the landlord must exist in the Resource Databank (RDB) prior 

to approving permanent HA when applicable. 

The Internal Revenue Service (IRS) requires government agencies report 

rent payments made to certain landlords/providers with an accumulative total 

of $600 or more during the current tax year. The following permanent HA 

payments are included in the accumulative total: 

Arrearage payments to prevent eviction, and 

Last month’s rent. 

In order to comply with this requirement, Form W-9 – Request for Taxpayer 

Identification Number and Certification must be completed by 

landlords/providers receiving permanent HA payments for rent. 

Note: HA payments made for security deposits are not considered rent 

payments and are not required to be reported. 

W-9 Form W-9 – Request for Taxpayer Identification Number and Certification is 

used by a third party who must file an information return with the Internal 

Revenue Service (IRS). The W-9 requests the taxpayer identification 

information (usually in the form of a Social Security Number (SSN) or 

Employer Identification Number (EIN) – either number is considered a 

Taxpayer Identification Number (TIN). 

If the landlord chooses to use the EIN as the TIN on the W-9, he/she must 

provide a copy of the IRS authorization letter. If the IRS authorization letter is 

not provided to confirm the EIN, the W-9 is not complete and the information 

cannot be entered into the Resource Databank (RDB). 

Note: The W-9 is located in the online TAD Forms Catalog. 



Permanent Homeless Assistance, Continued 

Tax 

Identification 

Number (TIN) 

Procedure for 

obtaining form 

W-9 

The provider’s TIN and 1099 reporting information will be added to the 

Resource Databank (RDB) for permanent Homeless Assistance providers. 

The TIN is required for landlords/providers who are not: 

Corporations, 

Limited Liability Companies (LLCs), or 

Real Estate agents. 

The landlord/provider will indicate on Form HA 44 whether he/she is a 

corporation, LLC or Real Estate agency. Landlords/providers who are not 

corporations, LLCs or Real Estate agents must complete form W-9. 

The W-9 and a return envelope is given to the customer with the HA 44 to 

provide to the landlord, and: 

If the completed 

Then the Eligibility Worker (EW) will… 

W-9 and IRS 

authorization 

letter (when 

required) is… 

Returned, Search for the provider in the RDB, and 

If the 

provider 

is … 

And the 

TIN is… 

Then… 

Listed, Listed, No action is required. 

Not listed, Complete TAD RDB 102 to request 

the RDB maintainer: 

Add the information to the RDB, 

and 

Image the Form W-9 and IRS 

authorization letter, if applicable, 

to the provider in the RDB. 

Not Listed Complete TAD RDB 102 to request 

the RDB maintainer: 

Add the information to the RDB, 

and 

Image the Form W-9 and IRS 

authorization letter, if applicable, 

to the provider in the RDB. 

Not returned, Search for the provider in the RDB, and 

If the 

provider 

is… 

And the 

TIN is… 

Then… 

Listed, Listed, Approve permanent HA payment. 

Not listed, Do not approve permanent HA. 

Not Listed Do not approve permanent HA. 

Note: For more information regarding adding/updating the RDB see TOPHB 

page 8-11. 

CWPHB #4646 (01/13) SPECIAL NEEDS 11-39.1

Permanent Homeless Assistance – Arrearage Payments 

Introduction This section includes information on permanent Homeless Assistance (HA) 

arrearage payments. 

TMHI For purposes of determining whose income should be included in the Total 

Monthly Household Income (TMHI), Eligibility Workers (EWs) must count the 

income of: 

Income 

included in 

TMHI 

TMHI 

Documentation 

• All Assistance Unit (AU) members, including Maximum Family Grant 

(MFG) children, and 

• Any other persons whose income is currently used in calculating an AU’s 

grant. This includes, but not limited to: 

− Sanctioned household members, 

− Penalized household members, and 

− Persons who are excluded by law for their undocumented non-citizen, 

drug/fleeing felon, or timed-out status. 

See Chapter 12 for more information on whose income to use. 

Income counted toward the TMHI includes earned and unearned income, 

including the CalWORKs grant. Income not counted toward the TMHI 

includes CalFresh, CalWORKs special needs payments, Supplemental 

Security Income (SSI), or State Supplementary Payment (SSP). 

The determination of the TMHI must be documented in the case Journal and 

must include: 

• All income used or not, 

• To whom each income amount/source belongs, and 

• The amounts of each income source. 



Permanent Homeless Assistance – Arrearage Payments, 

Continued 

Permanent HA 

arrearage 

payments to 

prevent 

eviction 

Permanent HA 

arrearage for 

pay or quit 

notice 

Permanent HA is available to pay up to two months of rent arrearages to 

prevent eviction. Arrearages are determined by using 80% of TMHI. 

In order for an AU to be entitled to receive permanent HA arrearage 

payments, payment of the arrearages must be a reasonable condition of 

preventing eviction. See the table below for more information: 

If… Then… 

The EW is unable to determine if 

arrearage payments will prevent 

eviction, 

Paying arrearages cannot 

prevent eviction, 

Have the customer sign a TAD 228 

Release of Authorization form to 

release the EW to contact the landlord 

for further review. 

Customer is not eligible to permanent 

HA arrearage payments. 

Example: Today is August 3 and a customer applies for permanent HA 

arrearage payments. The customer has not paid rent for June or July and 

the EW is not able to determine if arrearage payments would prevent 

eviction. The customer signs the TAD 228 and the EW contacts the landlord. 

The landlord indicates even if the customer pays the back rent, the current 

month is also owed and unless it is also paid, the eviction would proceed. In 

this situation, the customer is not eligible for arrearage payments. 

Note: Late, filing and attorney fees are not included in the two months of 

rent arrearages payment designed to prevent eviction. 

A recipient family who applies for arrearage payments due to receipt of a pay 

or quit notice must demonstrate the eviction is the result of a verified 

financial hardship (see Financial hardship section below) that resulted from 

extraordinary circumstances beyond their control, and not due to other lease 

or rental violations, breach of contract (see example section below). The 

family must be experiencing a financial crisis that could result in 

homelessness if assistance is not provided. 

Note: Customers applying for permanent HA arrearage payments at intake 

are not eligible as they must be recipients. 



Permanent Homeless Assistance – Arrearage Payments, 

Continued 

Financial 

hardship 


lease/rental 

violations 

When the AU is unable to pay for rent as a result of other necessary 

expenses/circumstances they incurred that were beyond their control and for 

which they are obligated to pay, this would be considered a financial 

hardship situation that resulted from “extraordinary circumstances beyond 

the AU’s control.” 

Examples of expenses/circumstances that might or might not place an AU in 

a financial hardship situation include, but are not limited to: 

Valid Examples of Financial 

Hardship 

• High hospital bills not covered 

by Medi-Cal 

• Car repairs 

• Funeral expenses 

• Cost gained for traveling to visit 

an ill or dying relative or to 

attend a funeral 

• Repair of household appliances 

not covered by CalWORKs nonrecurring 

special needs 

• High utility bills resulting from 

unforeseen circumstances, such 

as weather extremes 

• Loss of wages due to illness of 

self for family members 

Invalid Examples of Financial 

Hardship 

• Loss of income due to purchase 

of non-essential household 

goods, gambling debts, parties, 

or vacations 

• Failure to budget appropriately 

• Paying off regular credit card 

debt 

Note: Due to the broad and general nature of “extraordinary circumstances” 

and “financial hardship,” EWs are required to make a reasonable 

assessment of the facts and use discretion to determine if a family’s situation 

meets the standards for these conditions. 

Below are some examples of lease/rental violations, which are not all 

inclusive: 

• Bringing in animals when not allowed 

• Having more people than allowed in the home 

• Destruction of property 


Permanent Homeless Assistance – Arrearage Payment 

Examples 

Introduction To determine arrearage payments, Eligibility Workers (EWs) must evaluate 

each family’s situation on its own merits. The examples in this section will 

assist in making a determination. 

Example 1 Situation – Household has a Supplemental Security Income (SSI)/ Separate 

State Program (SSP) person who is unable to pay their portion of the rent 

arrearages. 

Resolution – The county will not pay the SSI/SSP person’s portion of the 

rent arrearages because individuals who receive SSI/SSP are not eligible to 

receive CalWORKs, and their income is never considered in determining an 

Assistant Unit’s (AUs) eligibility. The EW will treat this situation as a shared 

housing arrangement and only pay for the AU’s share of the arrearages. 

Example 2 Situation – Assume the same situation shown in Example 1. The AU will be 

evicted because they cannot come up with the SSI/SSP person’s share of 

the rent. 

Resolution – If payment of the AU’s portion of rent arrearages would not 

prevent the eviction, the county will deny the request for permanent 

Homeless Assistance (HA) rent arrearage payments. 

Example 3 Situation – An AU is eligible to receive permanent HA rent arrearage 

payments, but is not actively seeking housing. 

Resolution – The AU is not required to seek housing as they already have a 

residence. 

Example 4 Situation – An AU reported less income than what was used to determine 

the AU’s on-going benefits during the HA application process. 

Resolution –The determination of Total Monthly Household Income (TMHI) 

does not rely on income reported on the QR 7 from prior months or income 

reported on the QR 7 that was anticipated for the future quarter. The EW 

must use the current amount of income available to the AU listed on the 

CW 42 form at the time of application for HA, treat the report of decreased 

income as a voluntary mid-quarter report, and take appropriate action. 



Permanent Homeless Assistance – Arrearage Payment 

Examples, Continued 

Example 5 Situation – In a Continuing case, adding a new person with income to the 

AU results in a decrease to the grant, and he/she cannot be added to the AU 

until the beginning of the next quarter. Customer also applies for permanent 

HA mid-quarter. 

Resolution – The EW must count the income of the new person in the home 

for purposes of the Total Monthly Household Income (TMHI) if that person 

will be added to the AU, or if that person’s income will be used to help 

calculate the AU’s grant. 

Example 6 Situation – The same situation as Example 5, however adding the new 

person and his/her income makes the AU ineligible (due to no deprivation or 

excess income). 

Resolution – Regardless of whether the person being added to the AU will 

make the AU ineligible at the end of the current quarter, if the AU is eligible 

now and receiving CalWORKs at the time they apply for permanent HA, they 

are entitled to receive it if otherwise eligible. In addition, the income of the 

new person in the home would be included in the TMHI. 

Example 7 Situation – An AU is currently receiving housing assistance from the 

Housing Authority. They are several months behind on the rent and will be 

evicted. They are not able to pay their portion of the arrearages. 

Resolution – The EW would not pay permanent HA for rent arrearages in 

this situation because the payment of the AU’s portion of two month’s 

arrearages would not prevent the eviction. 


Permanent Homeless Assistance – Housing 

Introduction This section includes information on the permanent Homeless Assistance 

(HA) payment limits for housing and how to determine them. 

Housing 

issuance limits 

Issuance 

example 

Permanent HA can be paid to a family who proves they have found 

permanent housing which rents for 80% or less of the Assistance Unit’s 

(AU’s) Total Monthly Household Income (TMHI), without special needs, for 

an AU of that size. It will also pay the deposits necessary for securing 

permanent housing. The rules are: 

• Permanent HA will not pay for the first month’s rent. 

• Permanent HA can be issued to cover required occupancy fees including 

cleaning or key deposits, payments for credit checks, and final month’s 

rent. 

• The portion of the deposit representing the final month’s rent cannot 

exceed 80% of the TMHI for the AU. 

• To issue the final month’s rent, the landlord must specify this cost as a 

condition of occupancy on the HA 44, Landlord Verification and Consent, 

form. 

• Permanent HA will pay a maximum for housing deposits equal to two 

months rent. 

Note 1 : The amount for Permanent HA must not exceed two months of an 

AU’s rent, which is available to pay for the reasonable costs of security 

deposits when the deposits are a condition of securing a permanent 

residence. 

Note 2 : The HA Eligibility Worker (EW) must update the Expense Detail page 

in C-IV whenever permanent housing has been approved. 

The following example will assist in clarifying the difference between the 

allowable monthly rent and the total payable deposits. 

The father in an AU of two has gross earnings of $800 per month: 

• Calculated grant for AU (July 2007): $402 

• 80% of TMHI ($800 + $402 x 80%): $961.60 

• Maximum allowable rent: $961.60 

• Actual rent amount: $850 

• Maximum payable permanent HA: $1700 (two months actual rent) 



Permanent Homeless Assistance – Housing, Continued 

Issuance 

actions 

Approval of permanent HA payments for housing requires the following 

actions by the HA EW: 

Step Action 

1 Update the Expense Detail page in C-IV when customer reports a 

housing expense change. 

2 Review case information for QR 7 and/or Re-evaluation (RE) due 

date. 


QR 7 and/or RE is 

due in current 

month, 

RE status is “No 

Show” in 

C-IV, 


not due in current 

month, 

• Inform the customer of non-receipt of 

QR 7 and/or date of RE appointment. 

• Provide the customer with a copy of 

the QR 7 and/or RE appointment 

letter. 

• Instruct the customer to complete and 

return the QR 7 and/or attend the RE 

appointment to avoid discontinuance. 

Instruct the customer to contact his/her 

assigned CalWORKs EW to avoid 

discontinuance by rescheduling the 

missed appointment. 

Inform the customer to report his/her 

address change on the next QR 7. 

3 Run Eligibility Determination Benefit Calculation (EDBC) for the 

month of change through high end date. 

4 Communicate with the assigned CalWORKs EW regarding actions 

taken and/or communication with customer. 



Permanent Homeless Assistance – Utilities 

Introduction This section includes information on the permanent Homeless Assistance 

(HA) payments for utilities. 

Issuance limits The amount of permanent HA available for utility deposits is in addition to the 

amount available for housing deposits. 

Permanent HA will pay the actual cost to begin service for utilities including: 

• Natural gas or propane, 

• Electricity, 

• Water, and 

• Trash. 

Permanent HA cannot be issued to pay: 

• Current or overdue utility bills, 

• Telephone deposits, or 

• Cable television deposits. 

If the utility company bills for the deposit, a voucher for the deposit will be 

issued when the customer is billed. 

Note: The HA Eligibility Worker (EW) must update the Expense Detail page 

in C-IV whenever utilities have been approved. 



Permanent Homeless Assistance – Utilities, Continued 

Issuance 

actions 

Approval of permanent HA payments for utilities requires the following 

actions by the HA Eligibility Worker (EW): 

Step Action 

1 Update the Expense Detail page in C-IV when customer reports a 

utility expense change. 

2 Review case information for QR 7 and/or Re-evaluation (RE) due 

date. 



due in current 

month, 

RE status is “No 

Show” in 

C-IV, 


not due in current 

month, 

• Inform the customer of non-receipt of 

QR 7 and/or date of RE appointment. 

• Provide the customer with a copy of 

the QR 7 and/or RE appointment 

letter. 

• Instruct the customer to complete and 

return the QR 7 and/or attend the RE 

appointment to avoid discontinuance. 

Instruct the customer to contact his/her 

assigned CalWORKs EW to avoid 

discontinuance by rescheduling the 

missed appointment. 

Inform the customer to report his/her 

address change on the next QR 7. 

3 Run Eligibility Determination Benefit Calculation (EDBC) for the 

month of change through high end date. 

4 Communicate with the assigned CalWORKs EW regarding actions 

taken and/or communication with customer. 



Homeless Assistance and Intercounty Transfers 

Introduction This section includes information regarding requests for Homeless 

Assistance (HA) by families who have current active CalWORKs cases or 

CalWORKs applications in other counties. 

Responsible 

county 

Issuance 

amounts 

ICT and HA 

procedure 

In Intercounty Transfer (ICT) cases, the county where the Assistance Unit 

(AU) resides is responsible for the HA eligibility determination and issuance 

of the HA payment from the date of request. This is the county where the AU 

is physically located and intends to reside. 

When an applicant AU moves from one county to another to makes its home, 

and applies for HA in the second county, the first county is responsible for 

continuing the processing of the CalWORKs application and for initiating an 

ICT. However, the second county is responsible for issuing the HA 

payments. No permanent HA will be issued until the first county approves 


Eligibility for and the amount of HA payment are based on the Maximum Aid 

Payment (MAP) amount for the county where the AU resides. 

When a family requests HA and the CalWORKs case or application is the 

responsibility of another county, follow the steps below: 

Step Action 

1 Check Homeless Assistance Payment Indicator (HAPI) for 

previous HA issuance. 

2 Contact the county issuing CalWORKs to confirm: 

• Current eligibility or apparent eligibility to CalWORKs, 

• Recent HA issuance that may not show on HAPI, and 

• The ICT is in process, or to initiate it, if not. 

3 Journal the results of the contact with the other county. 

4 Proceed with HA eligibility determination. 


Homeless Assistance Overpayments 

Introduction Homeless Assistance (HA) received fraudulently, incorrectly, or misused will 

be identified as an overpayment and collected. This section contains 

examples to assist in determining whether or not the identification of an 

overpayment is correct. 

Overpayments 

and once-in-alifetime 

limits 

If an overpayment is identified for the entire HA issuance, the Assistance Unit 

(AU) may be eligible for HA again before 12 months have passed without an 

exception to the once-in-a-lifetime issuance limit. 

Examples Refer to the examples below to assist in determining: 

Example – EW 

error 

Example – 

Change of plan 

Example – 

Address fraud 

• Whether the HA issuance is an overpayment, and 

• When HA can be received again because the HA issuance was identified 

as an overpayment. 

Situation – The Eligibility Worker (EW) made a mistake and issued $75 per 

day in temporary HA for an AU of four instead of $65 per day. 

Resolution – The $10 per day excess payment is identified as an 

administrative error overpayment. 

Situation – A $1,200 voucher was issued for permanent housing based on 

verification the customer provided. The customer moved into another 

residence owned by the same landlord where the rent and deposits were 

less then the issued amount. 

Resolution – The amount of permanent HA issued in excess of the actual 

costs for deposits at the new residence is identified as a recipient error 

overpayment. 

Situation – Permanent HA was issued for housing and utility deposits. The 

warrants for the utility companies are returned to HSS Auditing with the 

notification, “Service not turned on.” Human Services (HS) Auditing notifies 

the EW, who makes a fraud referral. The Fraud Investigations Unit (FIU) 

investigation reveals the address is a vacant and uninhabitable residence. 

Resolution – The entire amount of permanent HA issued is identified as a 

recipient error overpayment. 



Homeless Assistance Overpayments, Continued 

Example – AU 

fraud 

Example – 

Previous HA 

overpayment 

Example – 

Permanent 

housing found 

sooner than 

expected 

Situation – HA was issued based on an AUs apparent CalWORKs eligibility. 

The EW later discovers the customer had no eligible children in the home. 

Resolution – The entire amount of HA issued is identified as a recipient 

error overpayment. 

Situation – A family fraudulently received HA nine months ago. The entire 

amount of the HA issued was identified as an overpayment. The customer is 

requesting HA again and appears to meet HA eligibility requirements. 

Resolution – Because the entire amount of the HA from the previous 

issuance has been identified as an overpayment, the family may receive HA 

again. 

Situation – Temporary HA was issued for seven days. Two days later, the 

family finds permanent housing and can move in right away. 

Resolution – The unused portion of the temporary HA is not an 

overpayment. 


Returned Homeless Assistance Warrants 

Introduction This section explains the process when a Homeless Assistance (HA) warrant 

is returned. 

Returned 

housing 

warrants 

Returned utility 

warrants 

Valid reasons for returned warrants for housing include: 

• There is a problem with the name on the warrant, 

• The incorrect amount is on the warrant, or 

• The family decided not to move into the residence. 

When a housing warrant is returned for one of the reasons above, cancel the 

returned warrant and issue another voucher with the correct information. 

Housing warrants returned for any reason, which will not be re-mailed, must 

be cancelled to avoid suspended warrants. Use the following Step/Action 

chart when a HA housing warrant is returned. 

Step Action 

1 Contact the customer to determine why the warrant was returned. 

Make a home call referral if necessary. 

2 Cancel the warrant. Reissue if appropriate. Use the instructions 

in the C-IV User Guide. 

3 Journal the actions taken and the reason(s) for such actions. 

Warrants for utility service returned because service was not turned on at the 

address must be cancelled to avoid suspended warrants. If service is turned 

on at the address later, issue another voucher for payment after determining 

the HA is being used appropriately. Use the following Step/Action chart 

when a HA warrant is returned by a utility provider. 

Step Action 

1 Contact the customer to determine why the service was not 

turned on. Make a home call referral, if necessary. 

2 Cancel the warrant. Reissue if appropriate. Use the instructions 

in the C-IV Users Guide 

3 Journal the actions taken and the reason(s) for such actions. 




CHAPTER 12 

Budgeting 

Budgeting: Overview ....................................................................................................12-1 

MBSAC and MAP: Overview........................................................................................12-2 

Minimum Basic Standard of Adequate Care (MBSAC)................................................12-3 

Maximum Aid Payments (MAP) – Nonexempt and Exempt.........................................12-4 

Exempt MAP Eligibility .................................................................................................12-5 

Exempt MAP Eligibility Determination Examples .........................................................12-6 

Eligibility to Exempt MAP Effective Dates ....................................................................12-8 

MAP Change – When to Make Change in Budget.......................................................12-9 

MAP Change – Step/Action Chart..............................................................................12-10 

MAP Change – Examples ..........................................................................................12-11 

Reasonably Anticipated Income: Overview................................................................12-15 

Reasonably Anticipated Income.................................................................................12-16 

Income Averaging ......................................................................................................12-19 

Stable Income ............................................................................................................12-23 

Fluctuating Income.....................................................................................................12-25 

Financial Eligibility Tests: Overview ...........................................................................12-30 

Financial Eligibility......................................................................................................12-31 

Applicant Financial Eligibility Test ..............................................................................12-32 

Recipient Financial Eligibility Test..............................................................................12-34 




MBSAC and MAP Chart.............................................................................................12-36 

Mandatory Mid-quarter Change Budgeting: Overview ...............................................12-40 

Mandatory Mid-quarter Changes ...............................................................................12-41 

Income Reporting Threshold (IRT).............................................................................12-42 

Address Change ........................................................................................................12-44 

Drug Felony Convictions, Fleeing Felons, and 

Parole/Probation Violations..................................................................................12-45 

County-initiated Mid-quarter Change Budgeting: Overview .......................................12-46 

County-initiated Mid-quarter Actions ..........................................................................12-47 

Budgeting County-initiated Changes..........................................................................12-48 

Budgeting County-initiated Changes – Examples......................................................12-50 

Voluntary Mid-quarter Change Budgeting: Overview.................................................12-52 

Voluntary Mid-quarter Changes .................................................................................12-53 

Voluntary Mid-quarter Changes in Income.................................................................12-55 

Examples - Voluntary Mid-quarter Changes in Income..............................................12-58 

Budgeting Mid-quarter Reports in Intake ...................................................................12-62 

Intake Mid-quarter Report Examples .........................................................................12-63 

Changes in Family Composition ................................................................................12-64 

Examples - Changes in Family Composition .............................................................12-66 

Medi-Cal Eligibility for Add Persons ...........................................................................12-69 

Mid-quarter Request for Special Need Payment........................................................12-70 

Examples - Mid-quarter Request for Special Need Payment.....................................12-71 




Third Party Information Known to the County: Overview ........................................... 12-74 

Third Party Information Known to the County ............................................................ 12-75 

Examples – Third Party Information ........................................................................... 12-76 

Multiple Mid-quarter Change Budgeting: Overview .................................................... 12-78 

Treatment of Multiple Mid-quarter Changes ............................................................... 12-79 

Examples – Multiple Mid-quarter Changes ................................................................ 12-80 

Examples – Budgeting Multiple Mid-quarter Changes ............................................... 12-83 

Annual Reporting, Income Budgeting………………………… ..……………..……….12-86.1 

Interface Between CalWORKs AR/CO and CalFresh Cases .................................. 12-86.7 

Overpayments and Underpayments: Overview ......................................................... 12-87 

Overview and Definitions ........................................................................................... 12-88 

Overpayment Identification and Responsibility .......................................................... 12-91 

Overpayment Examples ............................................................................................. 12-93 

Overpayment Procedures .......................................................................................... 12-97 

Methods of Overpayment Recoupment ................................................................... 12-101 

Computer Resources for Overpayments .................................................................. 12-104 

Underpayments ........................................................................................................ 12-105 


Overview 

Budgeting 

Introduction All CalWORKs benefits are determined using prospective budgeting and 

income averaging rules. This includes benefits calculated for an upcoming 

QR Payment Quarter and benefits recalculated due to mid-quarter changes. 

This Chapter includes information on: 

• Minimum Basic Standards of Adequate Care (MBSAC) and Maximum Aid 

Payment (MAP); 

• Reasonably anticipated income, how to determine what it is using income 

averaging, and the difference between stable and fluctuating income; 

• The financial eligibility tests, both applicant and recipient; 

• Budgeting for mandatory, County-initiated, and voluntary mid-quarter 

changes and multiple mid-quarter changes; and 

• Identifying overpayments and underpayments. 


• EAS 44-207 

• EAS 44-212 

• EAS 44-315 

• EAS 44-340 

• EAS 44-350, 44-351, and 44-352 

• EAS 89-110 



MBSAC and MAP 12-2 


Financial Eligibility Tests 12-30 

Mandatory Mid-quarter Change Budgeting 12-40 

County-initiated Mid-quarter Change Budgeting 12-46 

Voluntary Mid-quarter Change Budgeting 12-52 

Third Party Information Known to the County 12-74 

Multiple Mid-quarter Change Budgeting 12-78 

Overpayments and Underpayments 12-87 

CWPHB #4605 (04/11) BUDGETING 12-1

Overview 

Budgeting 

MBSAC and MAP 

Introduction This section covers Minimum Basic Standards of Adequate Care (MBSAC) 

and Maximum Aid Payment (MAP). Included are the differences between 

Region 1 and Region 2 amounts and Nonexempt and Exempt MAP. 


Region 1 and 

Region 2 

• EAS 44-207 

• EAS 44-212 

• EAS 44-315 

• EAS 89-110 

Counties are divided into two regions. Counties in Region 2 have MAP and 

MBSAC amounts 4.9% lower than Region 1 counties. San Bernardino County 

is a Region 2 county. 

Refer to the appropriate chart in the Charts, Tables, and Lists chapter of this 

handbook for the MAP and MBSAC amounts. The charts are also located on 

the Transitional Assistance Department’s (TAD) website at: 

http://hssnet/tad/Resources/pdfs/MAPandIRTCharts.pdf 



Minimum Basic Standard of Adequate Care (MBSAC) 12-3 

Maximum Aid Payments (MAP) – Nonexempt and Exempt 12-4 

Exempt MAP Eligibility 12-5 

Exempt MAP Eligibility Determination Examples 12-6 

Eligibility to Exempt MAP Effective Dates 12-8 

MAP Change – When to Make Change in Budget 12-9 

MAP Change – Step/Action Chart 12-10 

MAP Change - Examples 12-11 


Minimum Basic Standard of Adequate Care (MBSAC) 

Introduction The Minimum Basic Standard of Adequate Care (MBSAC) is a measure of 

neediness. It is based on the size of the applicant family. 

MBSAC The MBSAC is the amount necessary to provide an Assistance Unit (AU) 

with the following: 

• Housing; 

• Clothing; 

• Food; 

• Utilities; 

• Items for household operation, education and incidentals, recreation, 

personal needs, and insurance; and 

• Essential medical, dental, or other remedial care not otherwise provided 

at public expense. 

The amount of the MBSAC is determined by the size of the family. The 

MBSAC amounts are set by California State law and are located in the 

Charts, Tables and Lists Chapter of this handbook and on the Transitional 

Assistance Department’s (TAD) website at: 


When to use The MBSAC is used in the applicant financial eligibility test. The MBSAC is not 

used for recipient customers. 

MBSAC vs. aid 

payment levels 

The MBSAC is a measure of neediness and not the amount of cash aid a 

family may receive. CalWORKs cash aid payments are based on Maximum 

Aid Payment (MAP) levels. 


Maximum Aid Payments (MAP) – Nonexempt and Exempt 

Introduction Aid payments in California are based on one of two limit structures: 

Nonexempt vs. 

Exempt MAP 

• The Nonexempt Maximum Aid Payment (MAP) level, and 

• The Exempt Maximum Aid Payment (MAP) level. 

Before computing the grant amount, it is important the Eligibility Worker (EW) 

identify the correct maximum level to use in the budgeting process. 

Most families in California are eligible to the Nonexempt MAP. Only certain 

families are eligible to the Exempt MAP, as described in the following 

sections. Actual computation information for each level is given later in this 

Chapter. 

The amounts for Nonexempt and Exempt MAP are located in the 

Charts,Tables and Lists chapter of this handbook and also on the 

Transitional Assistance Department’s (TAD) website at: 


When to use The MAP, Nonexempt or Exempt, is used in the recipient financial eligibility 

test. This test is used for applicants who pass the applicant financial 

eligibility test and ongoing for recipients. 

Other names 

for Exempt 

MAP 

Exempt MAP 

and special 

needs 

At application, the EW will use the MAP corresponding to the Assistance 

Unit’s (AU’s) eligibility for that month. If the AU is eligible to Exempt MAP at 

application, then use Exempt MAP. Otherwise use Nonexempt MAP. 

Ongoing, the EW will use the MAP corresponding to the AU’s eligibility for 

the quarter. For Nonexempt/Exempt MAP status changes mid-quarter, see 

the Changes in MAP Status section of this Chapter. 

The County of San Bernardino has previously referred to Exempt MAP as 

SNAP MAP or Special Needs Aid Payment MAP. Other counties may refer 

to Exempt MAP families as “3P”, “3R”, or Beno families and use these as the 

aid codes or categories. 

The Exempt MAP does not include any special needs amounts as defined in 

the Special Needs Chapter of this handbook. Families eligible for the 

Exempt MAP level may also be considered for any appropriate special needs 

payments. 


Exempt MAP Eligibility 

Introduction The Exempt Maximum Aid Payment (MAP) is used for families who may 

have needs greater than those of other Assistance Units (AUs). 


parent or 

caretaker 

relative 

Exempt MAP 

eligibility 

criteria 

Situations not 

meeting 

Exempt MAP 

eligibility 

criteria 

For Exempt MAP eligibility purposes, parents are defined as follows: 

• Any parent of a child who lives in the home of the aided child; 

• Any aided stepparent of a child who lives in the home of the aided child; 

• Any parent receiving aid because of an unaided excluded child; 

• Any minor parent in the home, even if aided as an eligible child; 

• Any pregnant woman in an AU consisting of the Pregnant Woman Only 

(PWO); or 

• Each adult or parent of a child aided under Refugee Cash Assistance 

(RCA) in an RCA AU. 

For Exempt MAP eligibility purposes, caretaker relatives are defined as 

follows: 

• Any aided non-parent caretaker relative of a child who lives in the home 

of the aided child. 

• Any unaided non-parent caretaker relative of a child who lives in the 

home of the aided child. 

An AU is eligible to the Exempt MAP when one of the following conditions is 

met: 

• The non-parent caretaker relative of the aided child is unaided; or 

• All parents or aided caretaker relatives in the home receive: 

− Supplemental Security Income/State Supplemental Payments 

(SSI/SSP); 

− In-Home Supportive Services (IHSS); 

− State Disability Insurance (SDI); or 

− Temporary Worker’s Compensation (TWC) or Temporary Disability 

Indemnity (TDI). 

The following situations do not meet Exempt MAP eligibility criteria: 

• Receipt of Social Security Disability Insurance benefits (SSDI, RSDI, or 

OASDI); 

• Incapacity deprivation; 

• Welfare-to-Work (WtW) participation exemption due to incapacity; 

• WtW participation exemption due to care of another individual; or 

• A healthy adult or teen pregnancy. 


Exempt MAP Eligibility Determination Examples 

Introduction Below are a series of examples to assist the Eligibility Worker (EW) in 

making the Exempt MAP eligibility determination. 

Example 1 – 

receipt of SDI 

and SSI/SSP 

Example 2 – 

disabled 

pregnant 

woman only 

(PWO) 

Example 3 – 

receipt of 

private 

disability 

insurance 

Example 4 – 

unaided nonparent 

caretaker 

relative 

Example 5 – 

parent with 

SSI/SSP child 

Example 6 – 

SSI/SSP parent 

with child 

Example 7– 

minor parent 

A family consists of two parents and their two children with eligibility based 

on incapacity. One parent receives SDI and the second parent receives 

SSI/SSP. Since each parent receives one of the benefits specified in the 

Exempt MAP eligibility block, this family is eligible to Exempt MAP. 

A family consists of a Pregnant Woman Only (PWO). She receives SDI. 

Because the pregnant woman is the only member of her Assistance Unit 

(AU) and receives one of the benefits specified in the Exempt MAP eligibility 

block, this AU is eligible to Exempt MAP. 

An AU consists of a parent and his aided child. The parent receives private 

disability insurance benefits from his employer. Because this income is not 

one of the benefits specified in the Exempt MAP eligibility block, this AU is 

not eligible to Exempt MAP. 

An aunt receives aid for her nephew. The AU consists of the child only. This 

AU is eligible to receive Exempt MAP because the aunt is an unaided nonparent 

caretaker relative. 

An AU consists of a mother and her child. The child receives SSI/SSP. The 

mother does not receive one of the benefits specified in the Exempt MAP 

eligibility block. This AU is not eligible to Exempt MAP. 

An AU consists of a father who receives SSI/SSP and his child. This AU is 

eligible to Exempt MAP because the father receives one of the eligible 

benefits. 

An AU consists of a senior parent, her children, and her grandchild. The 17year 

old minor parent of the grandchild is one of the aided children. The 

senior parent receives SDI. This AU is not eligible to Exempt MAP because 

all parents in the AU do not meet the Exempt MAP eligibility requirements. 

The minor parent does not receive one of the eligible benefits. 



Exempt MAP Eligibility Determination Examples, Continued 

Example 8 – 

aided 

stepparent 

Example 9 – 

undocumented 

noncitizen 

parent 

Example 10 – 

receipt of IHSS 

services 

An AU consists of a father, the father’s children, and an aided stepmother. 

The stepmother is pregnant, and she is not the parent or caretaker relative of 

any of the aided children. The father receives Temporary Workers 

Compensation (TWC). This AU is not eligible to Exempt MAP because, 

while the father receives one of the eligible benefits, the stepmother does 

not. 

A family consists of a mother, father, and their mutual children. The father is 

an undocumented noncitizen. The mother receives SDI. The father is 

excluded based solely on his noncitizenship status. This family is not eligible 

to Exempt MAP. Each parent must receive one of the eligible benefits. 

While the mother does, the father does not. 

An AU consists of grandmother who is a needy caretaker relative and two 

grandchildren. The grandmother is receiving IHSS services (domestic 

services). Because the grandmother receives one of the eligible benefits, the 

AU is eligible to exempt MAP. 


Eligibility to Exempt MAP Effective Dates 

Introduction Once the determination has been made that a family meets the criteria for 

eligibility to Exempt Maximum Aid Payment (MAP), the Eligibility Worker 

(EW) must determine when the eligibility is effective. This section contains 

information regarding how to make that determination. 

Effective – 

application 

Effective – 

continuing 

CalWORKs applicant customer families meeting the criteria for Exempt MAP 

at application are eligible to Exempt MAP beginning the date of application 

(Beginning Date of Aid). Exempt MAP will be used in the budget beginning 

the application month. 

If the MAP eligibility changes during the initial QR Payment Quarter, treat 

these as mid-quarter changes and follow the rules for changes in MAP 

eligibility. 

CalWORKs Continuing program families are eligible to Exempt MAP effective 

the later of: 

• The month of report, or 

• The month the criteria to Exempt MAP are met. 

With eligibility to Exempt MAP, if eligibility exists anytime during the month, 

eligibility exists all month long. 

Example 1: Assistance Unit (AU) consists of Mom and two children. Mom 

begins receiving State Disability Insurance (SDI) in January and reports 

receipt of the SDI in February. Eligibility to Exempt MAP is effective 

February, which is the later of the month of report (February) and the month 

the criteria are met (January). 

Example 2: AU consists of Mom and one child. Mom reports in February 

she will begin receiving Temporary Worker’s Compensation (TWC) in March 

and provides her Award letter. Eligibility to Exempt MAP is effective March, 

which is the later of the month of report (February) and the month the criteria 

are met (March). 


MAP Change – When to Make Change in Budget 

Introduction A CalWORKs family may change their Maximum Aid Payment (MAP) 

eligibility from Nonexempt to Exempt MAP and from Exempt to Nonexempt 

MAP any time during the life of the case. This section will assist in the 

determination of when to make the MAP change effective in the budget. 

Change in MAP 

status 

The effective month and year of the MAP change will depend on whether or 

not the change in MAP eligibility causes an increase or decrease in benefits. 

If the change in 

MAP eligibility 

causes a(n)… 

Increase in 

benefits, 

Decrease in 

benefits, 

Then the MAP eligibility change is effective in the 

budget the first of the… 

Month in which the report of the change was made or 

criteria for that MAP were met, whichever is later. 

QR Payment Quarter based on when the information 

must be reported on the QR 7. 

• The first of the next QR Payment Quarter if the 

MAP change month is the QR Begin or Data 

Month; or 

• The first of the QR Payment Quarter following the 

next QR Payment Quarter if the MAP change 

month is the QR Submit Month. 

Note: When changing the CalWORKs benefit amount, if the customer has 

CalFresh, see the Budgeting Chapter in the CalFresh Policy Handbook to 

determine what budgeting actions to take for the CalFresh. 


MAP Change – Step/Action Chart 

Introduction A CalWORKs family may experience changes in their eligibility to Exempt 

and Nonexempt Maximum Aid Payment (MAP) any time while the 

CalWORKs program is active. This section contains a Step/Action chart to 

assist in determining when to make the MAP change effective in the 

CalWORKs budget. 

MAP change 

Step/Action 

chart 

Once an Eligibility Worker (EW) has determined a CalWORKs family meets 

criteria to Exempt MAP and when that eligibility is effective, the EW must 

then decide when to make the change in the budget. This effective date will 

depend on whether or not the change in MAP will cause an increase or 

decrease in the CalWORKs benefits. Follow the Step Action chart below to 

assist in making this determination. 

Step Action 

1 Determine whether the family meets Exempt MAP criteria. 

2 

3 

If the family… Then the family’s MAP eligibility is… 

Does not meet Exempt MAP 

criteria, 

Nonexempt. 

Meets Exempt MAP criteria, Exempt. 

Determine when the family is eligible to the new MAP determined in Step 1. 

If the family meets criteria Then the family is eligible to MAP the first 

to the new MAP… 

of the month… 

The month of report or prior, Of report. 

After the month of report, Criteria are met. 

Complete a test budget beginning the month determined in Step 2 using the new 

MAP (Exempt and Nonexempt) and any income related to it. 

If the test budget shows Then the new MAP budget change is 

the CalWORKs grant… 

effective… 

Increases, The month determined in Step 2. 

Decreases, The first of the QR Payment Quarter based 

on when the information must be reported on 

the QR 7. 

• If eligible month is QR Begin or Data 

Month, then the first of the next QR 


• If eligible month is QR Submit month, 

then the first of the QR Payment Quarter 

following the next QR Payment Quarter. 


MAP Change – Examples 

Introduction This section has a series of examples to assist in determining when to 

change the Maximum Aid Payment (MAP) level in the budget for families 

changing from one MAP to the other. 

Example 1 Situation: CalWORKs application date is August 10 (Cycle 2). Applicant 

family/Assistance Unit (AU) consists of Mom and two children. Mom gave 

birth to her youngest child in July and is receiving State Disability Insurance 

(SDI) based on the pregnancy/postpartum. SDI will end in September when 

Mom expects to return to work (hours and wages unknown). Exempt MAP 

status is met on August 10 and ends September 23. 

Action: Family meets Exempt MAP criteria based on Mom’s receipt of SDI 

from the date of application through the month SDI ends (September). 

Exempt MAP will be used in the budget beginning the month of application. 

With termination of SDI in September, the actual MAP level used in the 

budget in October is dependent upon whether the change will cause an 

increase or decrease in the CalWORKs benefits mid-quarter. In this 

situation, the change from Exempt to Nonexempt eligibility in October would 

cause a decrease in October’s benefits, so the Exempt MAP will continue to 

be used to budget the grant through the end of the quarter. 

Payment QTR QR Payment Quarter (Begin) QR Payment 

Quarter 

MONTH AUGUST SEPTEMBER OCTOBER NOVEMBER 

QR Month Begin Data Submit Begin 

MAP Elig Exempt Exempt Nonexempt Nonexempt 

MAP Level Exempt Exempt Exempt Nonexempt 

Used 

Actions Application 

Mom receiving 

SDI 

SDI ends 

Mom expects to 

return to work; 

cannot 

reasonably 

anticipate 

earnings 

Test budget 

completed using 

Nonexempt MAP 

and no income - 

decrease 



MAP Change - Examples, Continued 

Example 2 Situation: Continuing Cycle 1 CalWORKs family consisting of Mom and two 

children with no income. Mom reports on the February QR 7 received March 

5 th she began receiving SSI in February and provides the Award Letter. 

Action: Family meets Exempt MAP eligibility based on Mom’s receipt of SSI 

effective March, which is the later of the month of report (March) and the 

month criteria was met (February). The EW will complete a test budget for 

March using the Exempt MAP and an AU of 3 (with Mom) to determine if the 

CalWORKs benefits would increase or decrease. In this situation, the 

CalWORKs benefits would increase, so the change to Exempt MAP would be 

effective the first of the month of report, in this situation March 1. Mom will 

be removed from the CalWORKs AU effective the end of March. The AU 

size will change from 3 in March to 2 in April. 

Payment 

Quarter 

MONTH JAN FEB MAR APR MAY JUNE 

QR Month Begin Data Submit Begin Data Submit 

MAP Elig Nonexempt Nonexempt Exempt Exempt Exempt Exempt 

MAP Level Nonexempt Nonexempt Exempt Exempt Exempt Exempt 

Used 

Actions SSI begins – 

Exempt 

criteria met 

QR 7 

received 

SSI reported 

– Exempt 

eligible 

Test budget 

completed 

using 

Exempt 

MAP and 

with Mom – 

increase 

Change to 

Exempt 

MAP in 

budget 

Mom 

removed 

from AU the 

end of the 

month 

AU size 

decreases 

to 2 effective 

the first of 

the month 




Example 3 Situation: Same situation as Example 2 except on the February QR 7 

received March 5, Mom reports she began receiving SSI in March and 

provides her Award Letter. 

Action: The family meets Exempt MAP eligibility based on Mom’s receipt of 

SSI effective March, which is the later of the month of report (March) and the 

month the eligibility exists (March). The EW will complete a test budget for 

March using Exempt MAP and an AU of 3 (with Mom) to determine if 

CalWORKs benefits would increase or decrease. In this situation, the 

CalWORKs benefits would increase. The change to Exempt MAP in the 

budget would be effective March, the first of the month of report. Mom will be 

removed from the CalWORKs AU effective the end of June. Exempt MAP for 

2 will begin in July. 

Payment 

Quarter 

MONTH FEB MAR APR MAY JUNE JULY 

QR Month Data Submit Begin Data Submit Begin 

MAP Elig Nonexempt Exempt Exempt Exempt Exempt Exempt 

MAP Level Nonexempt Exempt Exempt Exempt Exempt Exempt 

Used 

Actions QR 7 

received 

SSI begins 

-Exempt 

criteria met 

Test 

budget 

completed 

using 

Exempt 

MAP and 

with Mom – 

increase 

Exempt 

MAP for 3 

begins in 

budget 

QR 7 on 

which SSI 

required to 

be reported 

Mom 

removed 

from AU 

effective 

the end of 

the month 

Exempt 

MAP for 2 

begins 




Example 4 Situation: Continuing Cycle 1 CalWORKs family in the April/May/June 

quarter consists of a father and two children. The father has been receiving 

Temporary Workers Compensation (TWC). The father reports on the May 

QR 7 received in June he received his final TWC payment on May 28 and 

provides verification. 

Action: Family meets Exempt MAP criteria based on the father’s receipt of 

TWC through May when eligibility ends. Exempt MAP criteria are no longer 

met beginning in June. The EW will complete a test budget for June using 

Nonexempt MAP and no TWC. Assuming the CalWORKs benefits will 

increase in June based on the test budget, the MAP level used in the budget 

for June will be Nonexempt. 

Payment 

Quarter 

MONTH APRIL MAY JUNE JULY 

QR Month Begin Data Submit Begin 

MAP Elig Exempt Exempt Nonexempt Nonexempt 

MAP Level Exempt Exempt Nonexempt Nonexempt 

Used 

Actions Last TWC 

payment received 

QR 7 received 

Father reports 

last TWC 

received in May 

Test budget 

completed using 

Nonexempt MAP 

and no TWC - 

increase 


Overview 

Budgeting 


Introduction This section covers reasonably anticipated income, what it is, and how to 

determine if income is reasonably anticipated or not. Once income is 

determined reasonably anticipated, that income must be converted into an 

average monthly amount to allow the calculation of a static (fixed) benefit for 

each month of the QR Payment Quarter. When converting to an average 

monthly amount, the Eligibility Worker (EW) must determine whether the 

income is stable or fluctuating. 


• EAS 44-207 

• EAS 44-315 




Income Averaging 12-19 

Stable Income 12-23 

Fluctuating Income 12-25 



Introduction The determination of what income can and cannot be reasonably anticipated 

is of vital importance when running EDBC (Eligibility Determination and 

Benefit Calculation). This section will assist in making that determination. 

Definition Reasonably Anticipated Income is the rule used to anticipate the household’s 


Income not 

reasonably 

anticipated 

When to make 

determination 

of reasonable 

certainty 

• Means the source, amount, and date of receipt of the income are known. 






initial or upcoming quarter, or the family/household is otherwise 

reasonably certain the income will be received within the quarter, 

AND 


When income cannot be reasonably anticipated (the amount of income or 

when the income will be received is uncertain), that portion of the family’s 

income, which cannot be reasonably anticipated, will not be counted when 

running EDBC. 

EWs are required to make a determination of what income is reasonably 

anticipated when a family: 

• First applies for CalWORKs; 

• Reports new income on the QR 7; 

• Reports on the QR 7 income is expected to change; 

• Has income that fluctuates; and 

• Makes a mid-quarter report of an income change. 

New income If the reported income is new, the EW may need to rely on information 

provided by an employer or by the income source to determine what income 

may be reasonably anticipated. 

If the amount of income, payment dates, and/or hours of work cannot be 

estimated with reasonable certainty, the EW will not use the new income 

when running EDBC. This income cannot be reasonably anticipated and will 

not be used. 




Continuing 

income 

Fluctuating 

income 

If the family is continuing to receive income used to determine current 

benefits, but expects the amount of income to change in the next QR 

Payment Quarter, the EW must attempt to find out the amount of income the 

family expects to receive. 

If the EW, with the help of the customer and/or source of income, is unable to 

determine how the income will change, only that portion of income the 

customer reasonably anticipates will be received can be used in the EDBC. 

If the family’s income fluctuates, the EW must attempt to determine what 

income can be reasonably anticipated and used in the next QR Payment 

Quarter EDBC. 

Guidelines The following guidelines can be helpful to the EW in determining what 

income can be reasonably anticipated by the family/Assistance Unit (AU). 

These guidelines include, but are not limited to, the following actions: 

• Take into account income the applicant family reports/estimates on the 

SAWS 2 as being reasonably anticipated for the beginning QR Payment 

Quarter; 

• Take into account income the recipient family reports/estimates on the 

QR 7 as being reasonably anticipated for the upcoming QR Payment 

Quarter; 

• Take into account income the recipient family reports/estimates midquarter 

as being reasonably anticipated for the current QR Payment 

Quarter; 

• If the family is unable to provide an estimate of anticipated income on the 

SAWS 2 (applicant customer) or QR 7 (recipient customer), the EW may 

contact the customer for additional information to determine what can be 

reasonably expected; 

• If the family is unable to estimate future income with the EW’s assistance, 

the EW, with authorization, may contact the employer or source of 

income; 

• If unable to obtain additional source information, the EW may take into 

account past income received by the family from the same source as an 

indicator of income that will be received in the next quarter. (For 

CalWORKs, the EW may only look back to the prior quarter for historical 

income information.) 




Documenting 

determination 

of reasonably 

anticipated 

income 

EWs will be expected to interact with the customer when determining what 

income is reasonably anticipated. For prospective budgeting purposes, the 

EW will determine whether the income is reasonably anticipated by using 

information provided by the customer together with any other available 

information. 

EWs will be responsible for documenting in the case journal how they arrived 

at the “reasonably anticipated income” amount used to calculate the 

customers’ benefits. 

Journal entries completed by EWs must provide a clear rationale explaining 

the basis of their decision regarding what income was reasonably anticipated 

and used in the EDBCs. 

Examples Example 1: A customer reports on her May QR 7 she started a new job in 

May. She reports she will be working 20 hours per week at $7.00 per hour, 

and she will be paid every other Tuesday beginning the first Tuesday in 

June. 

Because the timing and amount of income is reasonably certain, the EW 

should consider this income to be reasonably anticipated and use it in the 

EDBC for the next QR Payment Quarter. The EW will document the 

customer’s statement of expected hours and wages in the case journal to 

substantiate the estimate. 

Example 2: A customer reports he has been verbally approved for State 

Disability Insurance (SDI). He has not received an actual Award letter or 

check, and he does not know the exact start date or amount. 

Because the timing and amount of income is not known, the EW will not 

consider this income to be reasonably anticipated and will not use this 

income in the EDBC for the upcoming QR Payment Quarter. The EW will 

document in the case journal the reason(s) why the income could not be 

reasonably anticipated. 


Income Averaging 

Introduction Once the determination of what income can be reasonably anticipated is 

made, this income must be converted into an average monthly amount to 

allow the calculation of a static (fixed) benefit for each month of the QR 

Payment Quarter to be made. This section explains income averaging, 

which includes the conversion of both stable and fluctuating income into an 

average monthly amount. 

Stable income A CalWORKs applicant or recipient family has stable income when the 

household reasonably anticipates the income will continue at the same 

frequency. Stable income can vary from payment to payment as long as the 

pattern of receipt is stable throughout the QR Payment Quarter. 

Fluctuating 

income 


stable and 

fluctuating 

income 

Note: When a customer receives pay on every scheduled pay date, even 

though the amounts are different, the pattern of receipt is stable. 

Fluctuating income is income, which has different amounts and/or patterns of 

receipt for each month of the quarter. Fluctuating income includes when the 

Assistance Unit (AU)/family has any of the following: 




remaining months of the quarter due to income starting or stopping, or 

• Ongoing income that changes from month to month. 

Note: Ongoing income for which the amount changes from month to month 

should be considered stable income instead of fluctuating income if the 

pattern of receipt is stable. 

The following are examples of stable and fluctuating income: 

Stable income: Customer is approved CalWORKs effective April 18. The 

initial payment quarter is April/May/June. The customer is receiving UIB of 

$200 each week. She received her first UIB check on April 1 for $200 and 

expects to receive checks of $400 every two weeks. Because the customer 

receives payment on every scheduled pay date of the quarter, the income is 

considered stable income. 

Fluctuating income: Customer applies for CalWORKs April 18, and reports 

UIB award of $200 each week with the first check of $200 expected to be 

received on May 1. She will receive UIB of $400 every other week 

thereafter. CalWORKs is approved effective April 18. The initial payment 

quarter is April/May/June. Because the customer received zero income in 

the first month of the quarter and full month’s income the remaining months 

of the quarter, the income is considered fluctuating income for the initial 

payment quarter. 



Income Averaging, Continued 

Income 

averaging 

guidelines 

Following is a list of guidelines for income averaging: 

• The Eligibility Worker (EW) must first determine what income the 

customer reasonably expects to receive in each of the months of the 

upcoming QR Payment Quarter. 

• The EW must also determine whether the income fluctuates from month 

to month without a stable pattern of receipt or whether the income is 

stable. 

• The EW must average income the family expects to receive over a QR 

Payment Quarter and use this average monthly income figure to 

determine monthly benefits for each of the months in the QR Payment 

Quarter. 

• Income averaging will be used to estimate the beginning quarter or the 

next quarter’s benefits based on what the customer reports on the SAWS 

2 and/or QR 7. Income averaging allows EWs to establish a static 

benefit for each month of a QR Payment Quarter. 

• If the income is stable, the EW must further determine if the amount of 

pay remains the same for each payment period and whether the 

payments are received on a weekly, biweekly, or monthly basis. 

Note: Determining frequency and level of pay dictates how the EW 

averages monthly income. 




Income 

averaging 

Income averaging allows the Eligibility Worker (EW) to establish a static 

benefit for each month of the QR Payment Quarter. Income averaging is 

used to estimate the: 

• Beginning quarter’s benefits based on what the customer reports on the 

SAWS 2, at the application interview, and prior to processing; or 

• Next quarter’s benefits based on what the customer reports on the QR 7. 

Determining the frequency and level of pay dictates how the EW averages 

monthly income. If the income is stable, use the rules for converting stable 

income to a monthly average. If the income is fluctuating, use the rules for 

converting fluctuating income to a monthly average. 

Below is an overview of how to average income. 

Step Action 

1 Determine what income the customer reasonably expects to receive for 

each month of the Beginning QR Payment Quarter at application or the 

upcoming QR Payment Quarter for continuing. 

2 Determine if the income is stable or fluctuating over the QR Payment 

Quarter. 

If the income is… Then… 

Stable, Continue to Step 3. 

Fluctuating, Continue to Step 5. 

3 Determine the frequency of the pay (weekly, monthly, etc.). 

4 Convert stable income to an average monthly amount using the table 

below. 

If the frequency is… Then convert the income to a 

monthly average by… 

Weekly or biweekly (every other Multiplying the weekly or 

week), 

biweekly average by the 

appropriate conversion factor 

(4.33 for weekly and 2.167 for 

biweekly). 

Twice a month (bimonthly), Multiplying the bimonthly 

average by 2. 

Monthly, No conversion necessary. 

5 Convert fluctuating income to an average monthly amount by: 

• Adding the reasonably anticipated income for all months of the QR 

Payment Quarter, and 

• Dividing that amount by the number of months in the QR Payment 

Quarter. 

Note: Entering the income in the Income Detail pages in C-IV will complete 

these steps. Journals must be completed to justify what income was used 

and why. See the C-IV User Guide and C-IV Help Job Aids for more 

information. 




Example Customer applies for CalWORKs on July 1 for self and three children. 

Customer calls on July 17 and reports she started working on July 16, 40 

hours a week at $8.50 per hour. Her first pay date is August 4, and she is 

paid every other Monday. Customer passes the financial eligibility test 

(TAD 29) using no income in the first month. 

Based on the information provided by the customer, the EW reasonably 

anticipates the income the customer will receive for the quarter as follows: 

1. Determine reasonably anticipated income for each month of the 

payment quarter: 

Earned income for Jul: $0.00 

Earned income for Aug: $1360.00 

Earned income for Sept: $2040.00 

2. Add reasonably anticipated income for all months of the QR 

Payment quarter: 

Earned income for Jul: 0.00 

Earned income for Aug: 1360.00 

Earned income for Sept: + 2040.00 

Earned income for quarter $3400.00 

3. Divide the amount by the number of months in the QR Payment 

Quarter: 

Average monthly earned income: $3400.00 ÷ 3 = 1133.34 


Stable Income 

Introduction Income is either stable or fluctuating. This section will cover how to 

determine benefits when the family has stable income. 

Stable income A CalWORKs applicant or recipient customer family has stable income when 

the household reasonably anticipates the income will continue at the same 

frequency. Stable income can vary from payment to payment as long as the 

pattern of receipt is stable throughout the QR Payment Quarter. 

Conversion 

factors 

Calculating 

benefits using 

stable income 

Stable income received on a weekly or biweekly basis must be converted 

into a monthly total by multiplying: 

• Average weekly pay by the weekly conversion factor of 4.33, and 

• Average biweekly pay by the biweekly conversion factor of 2.167. 

When income is received weekly or biweekly and is stable, the EW must 

convert this income into a monthly total by multiplying the average weekly or 

biweekly income by the appropriate conversion factor. These conversion 

factors are: 

• 4.33 for weekly income, and 

• 2.167 for biweekly income. 

If the customer (applicant or recipient) has stable income and no other 

reasonably anticipated income, the income reported on the SAWS 2 for 

applicant customers, or the QR 7 for recipient customers, will be used in the 

Eligibility Determination and Benefit Calculation (EDBC) for the QR Payment 

Quarter. 

To calculate CalWORKs benefits for stable income using the income 

reported on the SAWS 2 for applicant customers and the QR Data Month 

income reported on the QR 7 for recipient customers, the EW will: 

Step Action 

1 Convert income to average monthly amounts. Use conversion 

factors to average weekly and biweekly amounts. 

2 Apply the applicable disregards for each income type to the income 

to determine Net Nonexempt Income (NNI). 

3 Subtract the NNI from the corresponding Maximum Aid Payment 

(MAP). The total is the benefit amount for each month in the QR 


Note: Entering the income into the Income Detail pages in C-IV, and running 

EDBC will complete these steps. Journals must be completed to justify what 

income was used and why. 



Stable Income, Continued 

Example A CalWORKs family consisting of a mother and two children receives income 

from the mother’s part-time job and the children’s Social Security income. 

The mother is paid weekly and provides the Eligibility Worker (EW) with a 

month’s worth of pay stubs. The pay stubs verify gross pay of $100, $133, 

$67, and $93. The mother states she is paid every week and her pay does 

vary from week to week. The children each receive $100 per month in Social 

Security disability based on the absent father’s disability. 

Both the mother’s and the children’s income meet the definition of stable 

income. 

1. Convert weekly income to average weekly amount: 

Weekly pay $100.00 

133.00 

67.00 

+ 93.00 

Total pay for one month = $393.00 

Number of weeks ÷ 4 

Average weekly pay = $98.25 

2. Convert average weekly pay to average monthly income: 

Average weekly pay $98.25 

Weekly conversion factor x 4.33 

Average monthly pay = $425.42 

3. Complete budget using the average monthly amounts: 

Disability-based income (SSA) $200.00 

$225 disability income disregard - 225.00 

Subtotal = - $25.00 

Earned income $425.42 

Remaining $225 disability income disregard or 

$112 Earned Income Disregard, whichever is 

less 

- 25.00 

Subtotal = $400.42 

50% Earned Income Disregard - 200.21 

Net Nonexempt Income (NNI) (dropped cents) = $200.00 

Nonexempt MAP for 3 $608.00 

NNI - 200.00 

CalWORKs grant = $408.00 

The CalWORKs grant for the QR Payment Quarter will be $408 per month. 


Fluctuating Income 

Introduction Income is either stable or fluctuating. This section will cover how to 

determine benefits when the family has fluctuating income. 

Fluctuating 

income 

Estimating 

fluctuating 

income 

Income – 

Questionable 

or unable to 

estimate 

Fluctuating income is income, which has different amounts and/or patterns of 

receipt for each month of the quarter. Fluctuating income includes when the 

Assistance Unit (AU)/family has any of the following: 




remaining months of the quarter due to income starting or stopping, or 

• Continuing income that changes from month to month. 

Note: Ongoing income for which the amount changes from month to month 

should be considered stable income instead of fluctuating income if the 

pattern of receipt is stable. 

When a CalWORKs family has or reports fluctuating income, the 

determination of whether the income is reasonably anticipated will require 

additional steps and thorough case documentation. The Eligibility Worker 

(EW) will use the customer’s income estimate if the customer is able to 

provide one and there is no conflicting information. 

If the customer information is questionable, or the customer is unable to 

estimate future income, use the steps below to determine the income. If, at 

any step, the EW has enough information to reasonably anticipate income, 

stop there, and do not continue to the next step. 

Step Action 

1 Contact the customer for additional information about anticipated 

pay and/or hours of work. 

2 Contact the source of the income regarding anticipated income 

after obtaining the customers written permission. 

3 Review the customer’s prior work patterns, if earned income, or 

other pattern of income receipt to assist in determining the income. 

This may involve asking the customer to provide available prior 

work information, as well as reviewing information in the case 

record. When reviewing a customer’s previous work patterns (for 

pay or work hours) or other previous income, the EW can only look 

back to the previous: 

• Quarter (three months) for CalWORKs for historical 

information. 

• Year (12 months) for CalFresh for historical information. 



Fluctuating Income, Continued 

Example - 

estimating 

fluctuating 

income 

Customer 

refusal to 

assist in 

providing 

information 

Estimating – 

Intake 

An Assistance Unit (AU) consists of a mother and one child. The mother is 

working part-time at a fast food restaurant, and her work hours vary from 

month to month. She reports 70 hours in the previous month, but is unable 

to estimate with any reasonable certainty how many hours she will be 

working in each month of the QR Payment Quarter. The EW contacts the 

customer, and the customer is still unable to estimate her future income. 

After obtaining the customer’s written authorization, the EW contacts the 

employer. The employer is unable to estimate with any reasonable certainty 

how many hours the customer will work. The employer thinks it may be the 

same as the previous quarter. The EW requests work hours for each of the 

previous three months and finds the customer worked 70 hours, 80 hours, 

and 75 hours in the previous three months 

Because the customer and employer do not know if the hours will remain the 

same, increase, or decrease, the best available information the EW has in 

determining what income to reasonably anticipate in determining benefits for 

the QR Payment Quarter is the information from the previous quarter. The 

EW will use the same pattern of hours worked (70, 80, and 75 hours) to 

project reasonably anticipated income for the QR Payment Quarter. 

If the customer refuses to assist in providing required information (refuses to 

sign a release to contact an employer, if such contact is necessary) or fails to 

provide information necessary to determine continuing eligibility, the EW will 

discontinue benefits at the end of the current quarter after providing 10-day 

notice. The EW will not discontinue mid-quarter based on a refusal or failure 

to cooperate or provide. 

If the customer is attempting to cooperate to the best of his/her ability, yet is 

unable to provide information that would assist the EW in projecting future 

income with reasonable certainty, the customer will not be considered as 

“failing to cooperate” and will not be discontinued for that reason. 

For an applicant customer with fluctuating income, if the customer is able to 

adequately estimate future income, the EW will use the customer’s estimate 

from the SAWS 2 and all other information reported by the customer prior to 

processing. The EW will determine the total amount of earned, unearned, or 

disability-based unearned income expected to vary for each month of the 

beginning QR Payment Quarter, based on the customer’s estimate on the 

SAWS 2. 

The EW must average the reasonably anticipated income for each of the 

three months of the beginning QR Payment Quarter to determine what 

income to use when calculating benefits for that quarter’s eligibility and 

benefits. Using the Average Income Calculation on the Income Detail page 

in C-IV will complete this action. 




Estimating – 

Continuing 

For a recipient customer with fluctuating income, if the customer is able to 

adequately estimate future income, the EW will use the customer’s estimate 

of the expected income totals from the QR 7. The EW will determine the 

total amount of earned, unearned, or disability-based unearned income 

expected to vary for each month of the upcoming QR Payment Quarter, 

based on the customer’s estimate on the QR 7. 

The EW must average the reasonably anticipated income for each of the 

three months of the upcoming QR Payment Quarter to determine what 

income to use when running EDBC for that quarter’s eligibility and benefits. 




Averaging 

fluctuating 

income 

Once the income amount and frequency has been determined, below are the 

basic income averaging steps used to determine the monthly income 

average. 

Step Action 

1 Convert income to an average monthly amount: 

If paid… Then… 

Once per Add the monthly amounts and divide by the 

month number of months. 

Twice per 

month 

• Add the two payments to get a monthly 

amount. 

• Add the monthly amounts together. 

• Divide by the number of months. 

Weekly or 

biweekly 

• Determine the pay dates including 3 rd and 5 th 

paychecks. 

• Determine the amount anticipated for each 

month. 

• Total the anticipated amounts for each month 

and divide by the number of months 

Daily or 

sporadically 

• Add the daily/sporadic amounts in the month 

to total a monthly amount 

• Calculate an average monthly amount by 

adding the monthly amounts and divide by 

the number of months. 

• Or multiply the average daily amount by the 

average number of days in a month (30). 

2 Add the averaged gross earned income received or reasonably 

anticipated to be received in each month of the QR Payment Quarter for 

which eligibility/benefits are being determined. 

3 Add the averaged gross unearned income received or reasonably 

anticipated to be received in each month of the QR Payment Quarter for 

which eligibility/benefits are being determined. 

Note: Entering the income in the Income Detail pages in C-IV as received by the 

family will complete these Steps. Journals must be completed to justify what income 

was used and why. See the C-IV User Guide and C-IV Help Job Aids for more 

information. 




Example A nonexempt AU of four is in the October/November/December quarter. 

Mom submits the QR 7 for November on December 10. On the QR 7, she 

reports she started a part-time job in November that will only last until the 

end of January, when the holiday shopping season has ended. She reports 

she will be paid $900 in January and $800 in February. One child receives 

SSA disability benefits of $100 based on an absent father’s disability. Mom’s 

aided spouse is receiving UIB of $50 per week in $100 payments every two 

weeks. 

Benefits for the January/February/March quarter are calculated based on the 

income the AU anticipates it will receive for that quarter as follows: 

1. Convert income to monthly amounts: 

Disability-based income (DBI) Jan/Feb/Mar $100 x 3 = $300 

Average Monthly DBI $300 ÷ 3 = $100 

Average Monthly UIB $100 x 2.167 = $216.70 

Earned income for Jan $900.00 

Earned income for Feb $800.00 

Earned income for Mar + $0.00 

Earned income for quarter $1,700.00 

Average monthly earned income $1,700 ÷ 3 = $566.67 

2. Complete budget using average monthly income amounts: 

Average monthly DBI $100.00 


Subtotal = - $125.00 

Average monthly earned income $566.67 

Remaining $225 disability income disregard or 

$112 Earned Income Disregard, whichever is 

less 

- 112.00 




Average monthly UIB + 216.70 

Net Nonexempt Income (NNI) (dropped cents) = $444.00 


NNI - 444.00 

CalWORKs grant = $281.00 


Overview 

Budgeting 

Financial Eligibility Tests 

Introduction The determination of financial eligibility is important in deciding whether or 

not an applicant family is, or a recipient family continues to be, eligible to 

CalWORKs. This section covers that determination. 

This section also includes a chart in determining who to include in the 

Minimum Basic Standard of Adequate Care (MBSAC) and Family and 

Assistance Unit (AU) Maximum Aid Payment (MAP) counts and whose 

income to use in the financial eligibility tests. 


• EAS 44-133 

• EAS 44-207 



Financial Eligibility 12-31 

Applicant Financial Eligibility Test 12-32 

Recipient Financial Eligibility Test 12-34 

MBSAC and MAP Chart 12-36 


Financial Eligibility 

Introduction To be eligible to CalWORKs, a family must pass both financial eligibility tests. 

The two tests are the applicant financial eligibility test and the recipient 

financial eligibility test. This section will explain what each is and when to 

use them. 

Applicant 

financial 

eligibility test 

When to use 

the applicant 

financial 


Recipient 

financial 


When to use 

the recipient 

financial 


The applicant financial eligibility test compares the applicant family’s income 

to the Minimum Basic Standard of Adequate Care (MBSAC) for that family. 

An applicant family will not be eligible to CalWORKs unless the family’s 

income, exclusive of (less) the first $90 of earned income for each employed 

person, is less than the MBSAC for that family. 

See the MBSAC and Maximum Aid Payment (MAP) section of this Chapter 

for more information on MBSAC. 

Use the applicant financial eligibility test for: 

• First time CalWORKs applicants; 

• Applicant families who have received CalWORKs within the last 12 

months (restorations); 

• Applicant families who last received cash aid more than 12 months ago 

or whose most recent application was denied (reapplications); and 

• New state arrivals who received aid in another state in the application 

month. 

The applicant financial eligibility test is for applicant families only. It will 

never be used for recipient CalWORKs families. 

The recipient financial eligibility test compares the family’s income to the 

MAP for that Assistance Unit (AU). 

The family is financially eligible for any quarter in which on the first of the 

month of the QR Payment Quarter the family’s reasonably anticipated 

income, after the needs of the family are considered, is less than the MAP for 

that AU. 

See the MBSAC and MAP section of this Chapter for more information on 

MAP, both Nonexempt and Exempt. 

Use the recipient financial eligibility test for: 

• Applicant families who pass the applicant financial eligibility test; and 

• Recipient families currently receiving CalWORKs cash aid from any 

county in California. 


Applicant Financial Eligibility Test 

Introduction The applicant financial eligibility test compares an applicant family’s income 

to the Minimum Basic Standard of Adequate Care (MBSAC) for that family. 

Steps in the 

applicant 

financial 


The following table lists the steps involved in completing the applicant 

financial eligibility test. Detailed information for each step is located in the 

subsequent pages of this section. 

Step Action 

1 Determine who is in the applicant family. 

2 Determine the number of family members whose needs are 

included in the MBSAC. 

3 Determine the MBSAC for the family plus any applicable recurring 

special needs for the family. 

4 Determine whose income to count. 

5 Determine the amount of countable net earnings by: 

• Subtracting $90 from the gross earnings of each family 

member with countable earned income; and 

• Adding the net earnings amounts together. 

6 Determine the total countable income for the family by adding the 

family’s countable unearned income to the family’s countable net 

earnings from Step 5. 

7 Compare the family’s total countable income (Step 6) with the 

MBSAC for that family. 

If the total countable 

income is… 

Equal to or greater than the 

MBSAC for the family and is 

expected to remain at that 

level if not higher, 

Equal to or greater than the 

MBSAC for the family but is 

expected to decrease in the 

next month, 

Less than the MBSAC for the 

family, 

Then… 

Deny the application. 

• Deny aid for the first 

month; and 

• Complete an applicant 

financial eligibility test for 

the second month. 

(Steps 1 through 7) 

Complete the recipient 

financial eligibility test. 

Note: Completing the appropriate Non-Financial and Financial pages and 

running EDBC (Eligibility Determination and Benefit Calculation) will 

complete the Steps above in C-IV. 



Applicant Financial Eligibility Test, Continued 

Which month’s 

income to use 

Form used for 

applicant 

financial 


Not eligible 

application 

month and 

eligible next 

month 

The income used to determine whether an applicant family passes the 

applicant financial eligibility test is either the family’s: 

• Actual income for the application month, or 

• Actual income anticipated to be received for the application month. Do 

not use conversion factors to determine this amount. 

If the applicant financial eligibility test is being completed for the second 

month because the family did not pass based on the application month’s 

income, use the income from the second month (actual or actual income 

anticipated). 

The QR 29 – Intake Financial Test is used to complete the applicant financial 

eligibility test. 

Note: In C-IV, this test is completed when EDBC is run for an applicant 

family. 

When an applicant family does not pass the applicant financial eligibility test 

in the application month, but does pass the applicant and recipient financial 

eligibility tests in the second month, the budget and benefit months of the first 

QR Payment Quarter will consist of the month immediately following the 

application month and any remaining months of that quarter. 

In C-IV, the Eligibility Worker (EW) will need to run EDBC for the month 

following to application month, as this step is not automatically completed. 

The assignment of the QR Cycle will still be based on the application month 

in these situations, so the first QR Payment Quarter will have benefits issued 

for two months only, the QR Data Month and QR Submit Month of that QR 


Example: A family applies for CalWORKs on July 14. This family is not 

financially eligible in July, but is eligible in August and ongoing. As the QR 

Cycle is based on the application date, this is a Cycle 1 family. The first QR 

Payment Quarter will consist of the payment months of August and 

September only. 

July August September 

Application date 14 - - 

Income used in 

payment 

No Yes Yes 

Payment No Yes Yes 

QR Month - Data Submit 


Recipient Financial Eligibility Test 

Introduction The recipient financial eligibility test compares a family’s income to the 

Maximum Aid Payment (MAP) for that Assistance Unit (AU). This section 

explains the process for completing the recipient financial eligibility test. 

Steps in the 

recipient 

financial 


Paid Work 

Experience 

(WEX) 

The following table lists the steps involved in completing the recipient 

financial eligibility test. Detailed information for each step can be found in 

subsequent pages of this section. 

Step Action 

1 Determine which family members are in the AU. 

2 Determine which family members to include in the Family and AU 

MAP counts. 

3 Determine which family members’ income to count. 

4 Determine countable income. 

5 Apply the appropriate income deductions. 

6 Determine net nonexempt income. 

7 Calculate the Family MAP Grant by subtracting the net 

nonexempt income from the Family MAP plus any applicable 

recurring special needs. 

8 Add any applicable recurring special needs to the AU MAP to 

calculate the AU MAP Grant. 

9 Compare the Family MAP Grant (Step 7) to the AU MAP Grant 

(Step 8). The lesser of the two is the Potential Aid Payment. 

If the Potential Aid Payment 

Then… 

is… 

Zero, The customer is not 

financially eligible to 

CalWORKs. Deny or 

discontinue as appropriate 

Greater than zero, The customer is financially 

eligible. 

Note: Completing the appropriate Non-Financial and Financial pages and 

running EDBC (Eligibility Determination and Benefit Calculation) will 

complete the Steps above in C-IV. 

Before discontinuing a CalWORKs case for being over income limits, the 

Eligibility Worker (EW) must verify if a member of the AU is enrolled in a paid 

WEX activity. Refer to Chapter 9, under the “Paid Work Experience (WEX)” 

section for more information. 



Recipient Financial Eligibility Test, Continued 

Form used for 

the recipient 

financial 


Net nonexempt 

income 

Which months’ 

income to use / 

anticipate 

Income 

disregards 

Eligibility to aid 

payment less 

than $10 

The QR 30 – CalWORKs Budget Worksheet is used to complete the 

recipient financial eligibility test and calculate the CalWORKs grant amount. 

Note: In C-IV, this test is completed when EDBC is run. 

Net Nonexempt Income (NNI) is the gross income for the AU and other 

family members (if applicable), minus all applicable income exemptions and 

income disregards. 

Recipient financial eligibility shall be determined on the basis of an average 

of all reasonably anticipated income expected to be received over a QR 

Payment Quarter. For applicant customers, this is the month of application 

and the remaining months of the beginning quarter. For recipient customers, 

this is the three months immediately following the QR Submit Month. 

The recipient financial eligibility test has three income disregards, the: 

• $225 disability income disregard, 

• $112 (or remainder of the $225, whichever is less) Earned Income 

Disregard, and 

• 50% earned income disregard. 

Note: These income disregards are allowed in C-IV when EDBC is run. 

Apply the $225 and $112 disregards as follows: 

If the total disabilitybased 

unearned income 

is… 

Then… 

Greater than $225, The difference is added to any other nonexempt 

income. 

Equal to $225, No disability-based unearned income is added to any 

other nonexempt income. 

Less than $225, The remainder of the disregard or $112 (whichever is 

less) is subtracted from any earned income. 

Zero, The $112 is applied against any earned income. 

When the recipient financial eligibility test determines the customer is eligible 

to CalWORKs, the monthly cash aid payment is calculated. If the monthly 

aid payment is less than $10, no cash aid payment will be issued for that 

month. The CalWORKs case remains open as the customer is considered 

eligible for CalWORKs. 


MBSAC and MAP Chart 

MBSAC and 

MAP chart 

Use the chart below to assist in determining who to include in the Minimum 

Basic Standard of Adequate Care (MBSAC) and Family and Assistance Unit 

(AU) Maximum Aid Payment (MAP) counts and whose income to use in the 

financial eligibility tests. The chart on this page has AU Members. 

PERSON USE INCLUDE IN INCLUDE IN INCLUDE IN 

AU MEMBERS 

Applicant eligible to 


Recipient eligible to and 

receiving CalWORKs 

INCOME? MBSAC FAMILY MAP? AU MAP? 

Alternatively Sentenced 

Person (ASP) when 

included as an essential 

person 

Child receiving 

Wraparound services 

Person with 

Immunization penalty 

Person with School 

YES YES YES YES 

Attendance penalty 

Person with Intentional 

Program Violator (IPV) 

after 12/31/1997 

MFG child with 

income/benefits from 

other than child support 

YES YES NO NO 

or SSA or other 

governmental program 

based on absent 

parent’s disability or 

retirement 

MFG child with child 

support income or 

benefits from Social 

Security Administration 

YES YES NO NO 

(SSA) or other 

governmental program 

based on absent 

parent’s disability or 

retirement 

NO YES NO NO 



MBSAC and MAP Chart, Continued 

MBSAC and 

MAP chart, 

(continued) 

The chart on this page lists Non-AU Members. 


NON-AU MEMBERS 

Undocumented 

noncitizen parents, stepparents, 

and 

siblings/children 

Unaided step-parent and 

step-siblings 

Unaided senior parent(s) 

and their other children 

Excluded father in a 

Pregnant Woman Only 


(PWO) case 

Unaided spouse of an 

aided child 

ASP when not included 

in the AU 

Unaided half-sibling 

excluded for no 

deprivation 

Potential AU Member 

determined ineligible 

prior to authorization of 


YES YES YES NO 




MBSAC and 

MAP chart, 

(continued) 

The chart on this page has Excluded Persons. 

PERSON USE INCLUDE INCLUDE IN INCLUDE IN 

EXCLUDED PERSONS 

Welfare-to-Work sanctioned 

SSN disqualified 

Failure to verify citizen or 


Refusal to assign child support 

rights 

Fleeing felon with no separate 

INCOME? IN MBSAC FAMILY MAP? AU MAP? 

income 

Probation/parole violator with 

no separate income 

IPV prior to 01/01/1998 

Felony drug convict convicted 

after 12/31/1997 with no 

separate income 

CalWORKs 48-month time 

expired adult 

Felony drug convict convicted 

after 12/31/1997 with own 


YES NO NO NO 

Fleeing felon with own 


Probation/parole violator with 

own separate income 

YES YES YES NO 




MBSAC and 

MAP chart, 

(continued) 

The chart on this page has Non-persons. 


NON-PERSONS 

SSI/SSP or CAPI 

recipient 

Foster Care child 

Non-needy caretaker 

relative 

Spouse of needy or nonneedy 


Siblings unaided due to 


age requirement 

Unrelated adult male or 

female who does not 

have a mutual child with 

parent of aided child(ren) 

Unaided, unmarried 

parent of mutual child 

unaided for no 

deprivation 

NO NO NO NO 


Overview 

Budgeting 

Mandatory Mid-quarter Change Budgeting 

Introduction This section covers mandatory mid-quarter change budgeting. Mandatory 

mid-quarter change budgeting includes those items an Assistance Unit (AU) 

must report within 10 days of the change. Mandatory mid-quarter changes 

include: 

• Income Reporting Threshold (IRT); 

• Address change; 

• Drug felony convictions; 

• Fleeing felon status; and 

• Parole/probation violations. 


• ACL 03-18 and 03-57 


• EAS 44-316.32 



Mandatory Mid-quarter Changes 12-41 

Income Reporting Threshold (IRT) 12-42 

Address Change 12-44 



12-45 


Mandatory Mid-quarter Changes 

Introduction This section contains an overview of the budgeting for the changes 

customers must report mid-quarter. Information regarding the reporting 

requirements for these changes can be found in the Reporting Chapter of 

this Handbook. 

Mandatory midquarter 

changes 

Under Quarterly Reporting, customers are required to report mandatory midquarter 

changes to the County within 10 calendar days of the date the 

change becomes known to the Assistance Unit (AU). Customers may report 

the mandatory mid-quarter change in writing or verbally, either in person or 

by phone. 

Mandatory mid-quarter changes, which must be reported within 10 days are: 

• When the family’s income exceeds the Income Reporting Threshold 

(IRT); 

• Address changes; 

• Drug felony convictions; 

• Fleeing felon status; and 

• Violations of conditions of probation or parole. 

Budgeting When a mandatory change is reported mid-quarter, the Eligibility Worker 

(EW) must take action mid-quarter, whether the reported change causes an 

increase or decrease in benefits. 

Overpayments If an action to decrease or discontinue benefits mid-quarter (end of the month 

of change) based on a mandatory mid-quarter report cannot be taken due to 

10-day notice requirements, then an overpayment must be identified for all 

excess benefits issued. 

See the Overpayments and Underpayments section of this Chapter for more 

information about overpayments. 


Income Reporting Threshold (IRT) 

Definition The Income Reporting Threshold (IRT) is the level of income, which triggers 

the need for a CalWORKs family to make a mandatory report of a change in 

income. 

Whose income 

is reported 

Report of 

income in 

excess of IRT 

The IRT is the greater of: 

• 130% of the Federal Poverty Level (FPL) for that family size, or 

• The level at which a family of that AU size becomes financially ineligible. 

The IRT is based on the Family MAP size. 

The IRT charts are located in the Charts, Tables and Lists Chapter of this 

handbook and the TAD website at: 


When a CalWORKs family has earned income or begins receiving earned 

income, the family must report to the County within 10 days when the total 

combined gross earned and unearned income of the following family 

members exceeds that family’s IRT: 

• Assistance Unit (AU) members, 

• Non-AU members, and 

• Excluded family members. 

If income in excess of the IRT is received and reported, the Eligibility Worker 

(EW) must determine if the income will continue at that level and if the AU 

remains financially eligible for CalWORKs benefits. 


reports income in 

excess of the IRT 

that… 

Will continue at that 

level, 

Is not expected to 

continue at that level (in 

excess of IRT for month 

of report only), 

And… Then the EW will… 

The customer is 

determined financially 

ineligible based on that 

income, 

Discontinue the 

CalWORKs at the end 

of the month in which 

10-day notice can be 

given. 

• Not discontinue the 


• Send a No Change 

Notice. 

Overpayments If the AU reports income in excess of the IRT, which results in ineligibility, 

and it is too late in the month to discontinue with 10-day notice, the EW must 

allow the next month’s benefits to go out. An overpayment must be identified 

for those benefits. 




Example A Nonexempt AU consists of mother and two children and is in the 

July/Aug/Sept quarter (Cycle 1). The mother works and has gross earned 

income of $1,200 per month. Benefits for that quarter have been determined 

using $1,200 earned income each month. On August 9, the customer 

reports her monthly earnings for July increased to $1,800 per month, and will 

continue at that level. 

Example – 

overpayment 

This AU would be financially ineligible and should be discontinued effective 

August 31. Computation is as follows: 

Anticipated Monthly Income $1,800.00 

$225.00 income disregard - 225.00 

Subtotal = $1,575.00 

50% earned income disregard - 787.50 

NNI (rounded down) = $787.00 


NNI - 787.00 

Financial Ineligibility $0.00 

If the AU in the above example reported the income too late to provide 

10-day notice, the EW must allow September’s benefit to go out and an 

overpayment would exist for September. 

A customer assigned to Cycle 2 (Aug/Sept/Oct) reports the receipt of income 

in excess of the IRT within 10 days of receipt, on August 28. The EW 

determines the income will continue at that level and that the customer is 

financially ineligible to CalWORKs based on the new income and should be 

discontinued effective August 31. The EW would: 

• Issue a 10-day notice informing the customer of a September 30 

CalWORKs discontinuance, and 

• Identify an overpayment for September’s CalWORKs benefits. 


Address Change 

Introduction This section contains budgeting information related to address changes. 

Information regarding reporting requirements is located in the Reporting 

Chapter of this Handbook. 


state 


County 

If a family reports moving out of state, the Eligibility Worker (EW) will 

discontinue benefits at the end of the month in which the family moved out of 

state if the family is no longer entitled to receive cash aid in California (see 

Absence from California in the Residency Chapter of this Handbook). 

If the CalWORKs benefits cannot be discontinued at the end of the month in 

which the family moved out of state due to the 10-day noticing requirements, 

the EW will: 

• Issue a 10-day notice informing the family of a CalWORKs 

discontinuance at the end of the month 10-day noticing requirements can 

be met, and 

• Identify an overpayment for all CalWORKs benefits received after the 

family moved out of state. 

When a family reports moving to another county, the EW will initiate an 

Intercounty Transfer (see ICT procedures in the Operations and Reference 

Handbook). The CalWORKs benefits will be discontinued at the end of the 

ICT period. 




Introduction This section contains budgeting information regarding what to do when a 

CalWORKs family reports an Assistance Unit (AU) member is convicted of a 

drug felony, becomes a fleeing felon, or violates a condition of parole or 

probation. 

Information regarding the reporting requirements for drug felony convictions, 

fleeing felon status, and parole/probation violations can be found in the 

Reporting Chapter of this Handbook. 

Required action AU members with felony drug convictions, fleeing felon status, and parole or 

probation violations are ineligible to CalWORKs benefits. These individuals 

become ineligible to CalWORKs at the end of the month in which the change 

occurs. 

Example: 

A CalWORKs family consists of a mother and two children with no income. 

The reporting quarter is Oct/Nov/Dec (Cycle 1). On October 16, the mother 

reports she was convicted of a drug felony on October 14. The mother 

becomes ineligible to CalWORKs effective October 31. The Eligibility Worker 

(EW) will send the a Notice of Action (NOA) informing the family of: 

• The mother’s discontinuance effective October 31, and 

• A decrease in benefits for November (mid-quarter decrease). 

Overpayments If a family reports a drug felony conviction, fleeing felon status, or violation of 

the conditions of parole or probation for one of the AU members, but it is too 

late to provide 10-day notice of the adverse action, the EW must issue the 

benefits for the next month at the previous (higher) level. 

The EW must identify an overpayment (OP) for benefits received at a higher 

level than the AU was entitled to receive when 10-day notice can not be 

provided, regardless of whether the AU reported timely or not. 

Example: 

Same example as above, except the mother reports on October 23 instead of 

October 16. The mother still becomes ineligible to CalWORKs effective 

October 31, but the EW will send a Notice of Action informing the family of: 

• The mother’s discontinuance November 30, and 

• A decrease in benefits for December. 

The EW will identify an overpayment for the excess benefits issued in 

November. 


Overview 

Budgeting 

County-initiated Mid-Quarter Change Budgeting 

Introduction The County is required to act on certain changes in eligibility status at the 

end of the month in which the change occurs and timely and adequate notice 

can be provided (10-day notice). This section covers the budgeting of those 

County-initiated changes. 


• EAS 44-316.33 

In this section This section covers the following topics: 


County-initiated Mid-quarter Actions 12-47 

Budgeting County-initiated Changes 12-48 

Budgeting County-initiated Changes - Examples 12-50 


County-initiated Mid-quarter Actions 

Introduction In addition to budgeting for mandatory and voluntary mid-quarter changes, 

the Eligibility Worker (EW) must also take action on certain changes in 

eligibility status at the end of the month in which 10-day notice can be given. 

This section gives a brief outline of those types of actions. 

Countyinitiatedmidquarter 

actions 

Changes in eligibility status which are considered County-initiated and may 

occur any time during the quarter are listed below: 

• Late submission of a QR 7 requiring a decrease in benefits for the next 

QR Payment Quarter; 

• Adult reaches the CalWORKs 48-month time limit; 

• County imposes a sanction/penalty on individual members of the 

Assistance Unit (AU); 

• County removes the sanction of an individual who corrects his/her 

Welfare-to-Work (WTW) participation problem; 

• County removes the penalty for an AU that complies with the CalWORKs 

program requirements; 

• Cal-Learn participant earns a Cal-Learn bonus or sanction; 

• Child reaches the age limit; 

• Aid is approved for a child or adult who is currently being aided in another 

AU; 

• Child is placed in Foster Care; 

• Refugee Cash Assistance (RCA) recipient reaches the eight-month RCA 

time limit; 

• Corrective Actions; 

• State Hearing decision results in mandatory changes mid-quarter; 

• Family fails to cooperate with Quality Control (QC); 

• County failure to act; and 

• An AU Member is no longer a California resident. 


Budgeting County-initiated Changes 

Introduction This section contains the time frames for when to take action for budgeting 

County-initiated mid-quarter changes. 

Required 

actions 

In situations where the decrease or discontinuance is due to a customer 

reaching the CalWORKs 48-month time limit, where the County imposes a 

sanction or financial penalty, including Intentional Program Violations (IPVs), 

or where the child reaches the age limit, the Eligibility Worker (EW) will take 

action at the end of the month in which timely notice can be provided. 

If there is insufficient time to provide a 10-day notice to reduce benefits, 

benefits must be issued at the prior, higher level. For actions relating to a 

child reaching the age limit, an adult reaching the 48-month time limits, this 

will result in an overpayment for the month(s) in which benefits could not be 

appropriately reduced in time. 

Providing bonuses to and imposing sanctions on minor parents are also 

considered County-initiated actions and will be taken mid-quarter. Imposition 

of sanction on the minor parent will be initiated mid-quarter only if timely and 

adequate notice (10-day notice) can be provided. 

Late QR 7 The County is also required to initiate mid-quarter benefit changes, if 

necessary, as the result of a late QR 7 being submitted by the customer. 

Submission of a late QR 7 may require benefits be reduced for the next QR 

Payment Quarter. However, if the EW cannot decrease benefits due to 

10-day notice requirements, then the EW must: 

Sanctions and 

penalties 

• Issue benefits for the first month of the QR Payment Quarter at the prior 

level, 

• Reduce benefits effective the first day of the next (second) month in that 

QR Payment Quarter when 10-day notice of decrease in benefits can be 

provided, and 

• Identify an overpayment for any excess CalWORKs benefits issued due 

to inability to decrease with 10-day notice. 

When the EW must impose a sanction or financial penalty on an aided 

individual in the Assistance Unit (AU): 

• A sanction or financial penalty can be imposed mid-quarter if the failure 

is a defined sanction or penalty (Welfare-to-Work sanction, child support 

penalty, immunization or school attendance penalty, IPV, etc.). 

• A mid-quarter action cannot be imposed for any failure to cooperate 

(other than with Quality Control (QC)) or failure to provide if the action 

would not be defined as a penalty or sanction (for example, failure to 

apply for unemployment benefits). 



Budgeting County-initiated Changes, Continued 

Foster Care For situations in which a child has been removed from the home and placed 

in Foster Care, timely notice is not required prior to discontinuing the child 

from the first AU. So, if the EW has time to decrease the grant at the end of 

the month of removal, the EW must do so. If the EW does not have time to 

decrease the grant at the end of the month of removal, any excess benefits 

received in the first AU for that child, after the month of removal, must be 

identified as an overpayment. 

Applied in 

another AU 

In situations where an individual has applied for aid in another AU, cash aid 

in the second AU cannot be approved until the individual has been 

discontinued from the first AU (to prevent duplicate aid from being issued). 

This discontinuance is done mid-quarter. If the individual is a child, the EW 

will need to determine which caretaker relative has care and control in order 

to take action in either case. 

In the situation where the second AU applies for aid for the only eligible child 

of the first AU, the EW will discontinue the first AU (now consisting of only 

one or two adults and no eligible child) at the end of the month of the second 

AU’s application, and add the child to the second AU the first of the month 

following that application. If no aid is requested by the second AU during the 

first AU’s QR Payment Quarter, the first AU will not be discontinued until the 

end of the quarter, and no overpayment will be identified. 


Budgeting County-initiated Changes - Examples 

Introduction This section contains a series of examples to assist in budgeting Countyinitiated 

mid-quarter changes. 

Example – 

48-month time 

limit 

Example – 

WTW sanction 

Example – 

Cal-Learn 

bonus 

Mom and her two children are receiving CalWORKs cash aid and are in the 

July/August/September quarter (Cycle 1). Mom will receive 48 months of 

CalWORKs as of July 31 and must be discontinued from the Assistance Unit 

(AU). 

The County initiates action to discontinue the mother effective July 31 

(mid-quarter) and transfer to a Safety Net aid code. This results in a Countyinitiated 

mid-quarter decrease in CalWORKs to the remaining AU members 

beginning August. 

Father and his child are receiving CalWORKs and are in the Jun/Jul/Aug 

quarter (Cycle 3). On July 10, the father was found not in compliance with 

Welfare-to-Work (WTW) program requirements. 

The County initiates action to impose the WTW sanction effective July 31. 

This results in a mid-quarter decrease in CalWORKs to the AU effective 

August. 

Same situation as previous example, except minor daughter turns in a 

January report card showing satisfactory progress and becomes eligible for a 

$100 Cal-Learn bonus. 

The County initiates a Cal-Learn bonus for February. The March CalWORKs 

benefit will return to the quarterly grant level less the Cal-Learn bonus. 



Budgeting County-initiated Changes - Examples, Continued 

Example - Child 

moved from 

one AU to 

another 

An AU in the Aug/Sept/Oct quarter (Cycle 2) consists of a mother and her 

two children, a son and daughter. On September 10, the paternal 

grandmother of the son applies for CalWORKs for her grandson. The 

Eligibility Worker (EW) verifies the grandmother has care and control of her 

grandson and has since September 5. The effective dates of change are as 

follows: 

Quarter Payment Quarter – First AU 

QR Month BEGIN DATA SUBMIT 

Month August September October 

AU Size 3 

Mother and 

2 children 

3 

Mother and 

2 children 

Actions Discontinue son 

effective 

September 30 

Send notice 

decreasing aid 

effective 

October 1 

2 

Mother and 

1 child 

Quarter Payment Quarter – Second AU 

QR Month BEGIN DATA SUBMIT 

Month September October November 

AU Size 0 2 

Grandmother and 

Actions Grandmother 

applies for aid for 

herself and 

grandson. 

grandson 

Approve aid for 

grandmother and 

grandson 

2 

Grandmother and 

Grandson. 

The grandson will be added to the grandmother’s case effective October 1. 


Overview 

Budgeting 

Voluntary Mid-quarter Change Budgeting 

Introduction This section covers voluntary mid-quarter change budgeting. Customers 

may voluntarily report changes in income and circumstances any time during 

the quarter. This section explains how and when to act on those changes. 


• EAS 44-316.31 

In this section This section contains the follows topics: 


Voluntary Mid-quarter Changes 12-53 

Voluntary Mid-quarter Changes in Income 12-55 

Examples – Voluntary Mid-quarter Changes in Income 12-58 

Budgeting Mid-quarter Reports in Intake 12-62 

Intake Mid-quarter Report Examples 12-63 

Changes in Family Composition 12-64 

Examples – Changes in Family Composition 12-66 

Medi-Cal Eligibility for Add Persons 12-69 

Mid-quarter Request for Special Need Payment 12-70 

Examples – Mid-quarter Request for Special Need Payment 12-71 


Voluntary Mid-quarter Changes 

Introduction Customers may voluntarily report changes in income and circumstances any 

time during the quarter. This section explains the budgeting for those 

changes. 

Voluntary 

mid-quarter 

changes 

Mid-quarter 

decreases 

Required 

verification 


of change - 

increase 

The County will only take action mid-quarter on those voluntarily reported 

changes that result in an increase in benefits. Examples of reported 

changes that might increase benefits include, but are not limited to, the 

following: 

• When the family’s income increases or decreases; 

• When someone moves into or out of the home; 

• When an Assistance Unit (AU) requests the discontinuance of existing 

AU members; 

• When an AU member becomes pregnant; 

• When an AU requests recurring special needs; and 

• When a teen become pregnant or gives birth and meets Cal-Learn 

requirements. 

See the Reporting Chapter of this Handbook for more information about 

Voluntary Mid-quarter Reports. 

CalWORKs benefits may not be decreased in the middle of a quarter as the 

result of voluntarily reported changes. The Eligibility Worker (EW) may not 

take action mid-quarter to initiate the decrease unless the change is one, 

which must be mandatorily reported or is County-initiated. The decrease 

must be suppressed and “held over” for action until the next quarter when the 

EW is determining eligibility and benefit levels for that quarter using the 

information reported on the QR 7. 

When a customer voluntarily reports a decrease in income or a new 

household member, the EW must request verification immediately. A new 

SAWS 2 or CW 8A must be completed to add the new household member. 

Action to increase the CalWORKs benefits based on the voluntarily reported 

change is based on when the change was reported, not when the change 

actually occurred. The effective date of the increase in benefits is as follows: 

If the increase is due to… Then the change is effective… 

Decreased income, The first of the month in which the 

change is reported or occurred, 

whichever is later. 

Addition of a new AU member, The first of the month following the 

report of the change. 



Voluntary Mid-quarter Changes, Continued 

Held over 

actions 


of change – 

decrease or 

ineligibility 

If the customer voluntarily reports a change mid-quarter that would decrease 

benefits or make an AU ineligible, the EW must not act on the information 

during the current quarter. The EW will send a Notice of Action (NOA) 

informing the AU the voluntarily reported information did not increase their 

benefits and remind the customer to report this information on their next 

QR 7. 

If the circumstances of the voluntary report of information are still applicable 

in the QR Data Month, the customer must report this information on the 

QR 7. 

When a customer voluntarily reports a change mid-quarter (outside of the 

QR 7) that would decrease benefits or make an AU ineligible, the effective 

date of change is based on when that information is required to be reported 

on the QR 7. 

The effective date of the decrease in benefits is as follows: 

If the change is 

reported in the… 

QR Begin or Data 

Month, 

QR Submit Month, 

And the change has 

occurred… 

Since the last QR 7 

Data Month, 

In the QR Submit 

Month, 

Prior to the QR Submit 

Month, 

Then the change is 

effective the first of 

the… 


Quarter. 


following the QR 7 on 

which the change is 

required to be reported 

(in three months). 


Quarter (next month). 


Voluntary Mid-quarter Changes in Income 

Introduction Voluntarily reported mid-quarter changes in income require the Eligibility 

Worker (EW) to take action on that change. This section includes what those 

required actions are and the effective date(s) of change. 

Income 

Reporting 


Verification 

requirements 

Required 

actions – 

income 

decrease 

Voluntarily reported changes in income do not include mandatory reports of 

income exceeding the Income Reporting Threshold (IRT). Required actions 

and budgeting for IRT reports can be found in the Mandatory Mid-quarter 

Change Budgeting section of this Chapter. 

When a customer voluntarily reports a decrease in income, the EW must: 

• Request verification of the change immediately allowing the customer 10 

days to provide, and 

• Not act to increase benefits until the verification is received. 

If the customer fails to provide the verification of decrease in income within 

10 days, the EW will send the customer a No Change Notice due to 

nonreceipt of verification. If the customer subsequently provides the 

verification, this will be treated as a new report. 

If the customer fails to provide verification within 10 days, and the EW fails to 

send a No Change Notice due to failure to provide, the request is still open. 

Sending a No Change Notice closes the request. 

Voluntary mid-quarter reports of income increases do not require verification. 

Once verification of the change in income is provided, the EW must 

determine the result of the income change on benefits by completing a 

budget (running EDBC). The County can only take action mid-quarter on 

those voluntarily reported income changes, which increase benefits. 



Voluntary Mid-quarter Changes in Income, Continued 

Budgeting To determine whether the voluntarily reported income change results in 

increased benefits mid-quarter, the EW must recalculate benefits for the 

current and remaining months of the quarter using the new income the AU 

reasonably expects to receive. 

If the AU anticipates income will be different in each of the remaining months 

of the quarter and knows with reasonable certainty what the amount would 

be for each month, the EW will average the new income over the month in 

which the change is reported and the remaining months in the quarter. 

If the reported change in income results in an increase in benefits when 

benefits have been recalculated, the EW will act to increase the benefits 

within 10 days of receiving the required verification and provide adequate 

notice of the increase to the customer. 

Note: If the customer also receives CalFresh, the EW must determine 

whether the reported income change also changes CalFresh. See the 

Budgeting Chapter in the CalFresh Policy Handbook for information. 



Voluntary Mid-quarter Changes in Income, Continued 

Step/Action 

chart for 

recalculation of 

benefits 

When recalculating the current quarter’s benefits based on reports of 

decreased or terminated income, the EW will use: 

• Actual income for the month of report or month of change, whichever is 

later, and 

• Reasonably anticipated income for the remaining month(s) of the quarter. 

Use the Step/Action chart below for recalculation of benefits. 

Step Action 

1 Add: 

• Actual gross monthly earned income for the month the 

decrease or loss of income is reported; and 

• Any additional gross monthly earned income the Assistance 

Unit (AU) reasonably anticipates for the current and remaining 

months of the quarter. 

2 Determine the new average monthly gross earned income for the 

current quarter by dividing the total amount from Step 1 by the 

number of months equal to the current and remaining months of 

the quarter. 

3 Add: 

• Actual Disability-based Income (DBI) for the month the 

decrease or loss of income is reported; and 

• Any DBI the AU reasonably anticipated for the current and 

remaining months of the quarter. 

4 Determine the new average DBI for the quarter by dividing the 

total of the amount from Step 3 by the number of months equal to 

the current and remaining months of the quarter. 

5 Add: 

• Actual unearned income for the month the decrease or loss of 

income is reported; and 

• Any unearned income the AU reasonably anticipates for the 

current and remaining months of the quarter. 

6 Determine the average monthly gross unearned income for the 

quarter by dividing the total of the amount from Step 5 by the 

number of months equal to the current and remaining months of 

the quarter. 

7 Apply all the applicable income disregards for each income type 

to the new average gross income amounts to calculate an 

average Net Nonexempt Income (NNI) for each month. 

8 Recalculate benefits for the quarter by subtracting the newly 

averaged NNI from the applicable Maximum Aid Payment (MAP) 

amount for CalWORKs. 

Note: Completing the appropriate Income Detail page(s) and running EDBC 

will complete the above Steps in C-IV. 


Examples – Voluntary Mid-quarter Changes in Income 

Introduction This section has a series of examples of voluntary mid-quarter changes in 

income. Use the examples to assist in completing recalculation of benefits. 

Example – loss 

of job in QR 

Begin Month 

Situation: A Nonexempt Assistance Unit (AU) of a mother and two children 

is receiving CalWORKs in the amount of $64. The CalWORKs grant is 

based on the mother having earned income of $1200 per month. This Cycle 

1 family is currently in the April/May/June quarter. On April 5, the mother 

reports she lost her job the day before. She states she will only receive one 

paycheck in April for $600, and she anticipates no additional income. 

Action: The Eligibility Worker (EW) immediately requests verification of the 

job loss, and the customer provides it on April 10. The EW uses the new 

income to recalculate benefits for April, as well as the remaining months of 

the current quarter as follows: 

1. Recalculation of Averaged Income: 

Earned income for April (actual) $600.00 

Earned income for May (anticipated) 0.00 

Earned income for June (anticipated) + 0.00 


Reaveraged monthly earned income $600 ÷ 3 = $200.00 

2. Recalculate CalWORKs using average monthly income amounts: 

Reaveraged monthly earned income $200.00 

$112 Earned Income Disregard - 112.00 

Subtotal = $ 88.00 


NNI = $ 44.00 


NNI - 44.00 

New CalWORKs grant for April, May, and June = $564.00 

3. Calculate supplement for April: 

New CalWORKs grant for April $564.00 

Previous grant issued for April - 64.00 

Supplement for April $500.00 

The customer is eligible to $564 per month for April, May, and June. Issue a 

supplemental payment for April and increase the May and June benefits. 



Examples – Voluntary Mid-quarter Changes in Income, 

Continued 


of job in QR 

Data Month 

Situation: Using the same situation as the previous example, except the 

mother reports on May 5 (second month of the quarter) she lost her job and 

will only receive one paycheck in May for $600 and no income in June. 

Action: The EW immediately requests verification of the job loss, and the 

customer provides it on May 12. The EW uses the new income to 

recalculate benefits for May, as well as the remaining month of the current 

quarter as follows: 


Earned income for May (actual/anticipated) $600.00 









NNI = $94.00 


NNI - 94.00 

New CalWORKs grant for May and June = $514.00 

3. Calculate supplement for May: 

New CalWORKs grant for May $514.00 

Previous grant issued for May - 64.00 

Supplement for May $450.00 

The customer is eligible to $514 per month for May and June. There is no 

change to April’s benefits. Issue a supplemental payment for May and 

increase the June benefits. 

Note: If the customer calls the EW in June to report zero income for June, 

the EW will not recalculate June. The EW will send a No Change Notice. 

The zero income for June has already been taken into consideration when 

the recalculation of May and June benefits was completed. 




Continued 


of hours of 

employment 


is receiving CalWORKs of $64. The CalWORKs grant is based on the 

mother having earned income of $1200 per month. This Cycle 1 family is 

currently in the April/May/June quarter. On May 5, the mother reports her 

hours decreased by 50%. She states she will receive $600 in May and $600 

in June. 

Action: The EW immediately requests verification of the earnings decrease, 

and the customer provides it May 10. The EW uses the new income to 

recalculate benefits for May and June as follows: 


Earned income for May (actual/anticipated) $ 600.00 



Reaveraged monthly earned income $1,200 ÷ 2 = $600.00 






NNI = $244.00 


NNI - 244.00 

New CalWORKs grant for May and June = $364.00 

3. Calculate supplement for May: 

New CalWORKs grant for May $364.00 

Previous grant issued for May - 64.00 

Supplement for May $300.00 

The customer is eligible to $364 per month for May and June. There is no 

change to April’s benefits. Issue a supplemental payment for May and 

increase the June benefits. 




Continued 

Example – 

increase in 

earnings 


is receiving CalWORKs of $64. The CalWORKs grant is based on the 

mother having earned income of $1200 per month. This Cycle 1 family is 

currently in the April/May/June quarter. On May 5, the mother reports she 

received a raise and will receive $1,500 in May and $1,500 in June. 

Action: The EW does not require verification of the earnings increase. The 

EW uses the new income to recalculate benefits for May, as well as June as 

follows: 


Earned income for May (actual/anticipated) $1,500.00 

Earned income for June (anticipated) + 1,500.00 


Reaveraged monthly earned income $3,000 ÷ 2 = $1,500.00 


Reaveraged monthly earned income $1,500.00 

$112 earned income disregard - 112.00 

Subtotal = $1,388.00 


NNI = $694.00 


NNI - 694.00 

New CalWORKs grant for May, and June = $ 0.00 

Since the increase in income causes a decrease in the customer’s 

CalWORKs, the EW will “hold over” this action. The EW will send the 

customer a No Change Notice. Assuming the customer reports this same 

information on the May QR 7, the EW will take the action to decrease the 

CalWORKs effective July 1. 


Budgeting Mid-quarter Reports in Intake 

Introduction This section contains information regarding mid-quarter changes occurring 

while the case remains in Intake. 

Intake midquarter 

reports 

When a case is in intake, the Intake Eligibility Worker (EW) is responsible for 

all mid-quarter changes (those changes occurring and reported after the 

application has been approved but prior to the case going to the Continuing 

EW) reported for that case. Follow the chart below if a customer reports a 

change in income or household size while the case is still assigned to the 

intake EW. 

Note: Any changes reported prior to the approval of the application are not 

mid-quarter reports and must be acted upon prior to processing the 

application. 

If the change reported 

results in a… 

Then… 

Decrease in benefits, • Journal the change and the action held over 

for the Continuing EW to review with the next 

QR 7. 

• Set a task for the Continuing EW to follow up. 

Increase in benefits, • Take the appropriate action, such as lower 

the income, add a person to the Assistance 

Unit (AU), or discontinue the person with 

income, etc. 

• Run Eligibility Determination and Benefit 

Calculation (EDBC) for the remaining months 

of the quarter through high date to issue the 

correct supplemental benefits. 

• Send a change in benefit Notice of Action 

(NOA) notifying the AU of the change and 

grant increase. 

• Journal change and actions taken. 


Intake Mid-quarter Report Examples 

Introduction This section contains information regarding examples that show when and 

how to take action on a mid-quarter reported change while the case remains 

in Intake. 

Example 1 Situation – A customer with three children applies for aid on 2/2 and 

provides all necessary verifications. The customer reports Unemployment 

Insurance Benefits (UIB) stopped 1/31. The Assistance Unit (AU) is 

determined to be eligible and the case is processed on 2/5; however, the 

case remains in intake. 

Customer calls on 2/7 to report UIB has been extended and will not be 

stopping as originally reported at application. 

Action – Since this mid-quarter report results in a decrease in benefits: 

• The action is held over for the upcoming quarter because the case was 

processed using the reasonably anticipate income reported at 

application. 

• Set a task for the Continuing Eligibility Worker (EW) to follow up. 

• Journal the mid-quarter change, how it resulted in a decrease of benefits, 

and that action was held over for the following quarter. 

Example 2 Situation – Same situation as shown in Example 1 above. 

The customer calls 2/7 to report her 17 year-old daughter has moved into the 

home and has no income or resources. 

Action: Since this mid-quarter report results in an increase in benefits due to 

an increase in household size with no additional income: 

• Re-run Eligibility Determination and Benefit Calculation (EDBC) for March 

through high date with a household size of five (5). 

• Journal the mid-quarter change in household size and action taken to 

increase benefits mid-quarter. 


Changes in Family Composition 

Introduction Voluntarily reported mid-quarter changes in family composition require the 

Eligibility Worker (EW) to take action on that change. This section includes 

the budgeting for those changes and their related effective date(s) of change. 

Steps for add 

person budget 

Information specific to the actions required for an add person application can 

be located in the Applications Chapter of this Handbook. 

Following is a description of the steps EWs are required to take when a new 

person is reported in the home. 

Step Action 

1 Review eligibility for the new person to determine if the person 

should be mandatorily included as part of the Assistance Unit 

(AU), and whether or not that person’s income will be considered 

in the CalWORKs Eligibility Determination and Benefit Calculation 

(EDBC). 

2 Run a test EDBC to determine if adding the person and his/her 

income would result in an increase or decrease in the AU’s 

benefits. 

When running the test EDBC to determine if benefits would 

increase or decrease, use the new person’s reasonably 

anticipated income for the month following the month of report. 

If benefits 

will… 

Then… 

Increase, Add the new person the first of the month 

following the month of report. 

Decrease, • Hold the action until it is required to be 

reported on the QR 7, and 

• Send a No Change Notice. 



Changes in Family Composition, Continued 

Voluntary 

requests to 

discontinue an 

entire AU or 

person 

Reports of 

death 

Reports of 

receipt of SSI 

Any time during the QR Payment Quarter the customer may request 

CalWORKs be discontinued for the entire Assistance Unit (AU), an optional 

person, or any individual AU member who is no longer in the home. 

If an individual requests discontinuance from an existing AU, the County shall 

discontinue the individual even when the individual’s request results in a 

decrease in CalWORKs for the remaining AU members. 

If an individual AU member who has left the home requests a 

discontinuance, but the AU has not voluntarily reported the departure, the 

individual’s request for discontinuance takes precedence over the AU’s 

decision not to make this voluntary mid-quarter report. 

The County will not presume a mid-quarter report of an individual leaving the 

home is a voluntary request for discontinuance of that AU member. The 

County will verify with the AU if the AU is seeking to discontinuance that 

individual, and shall inform the AU that such discontinuance will result in 

decreased cash aid to the remaining AU members. 

Use the table below to determine when to discontinue CalWORKs based on 

a voluntary request for discontinuance. 

If the voluntary request for 

Then the County shall 

discontinuance is made… discontinue CalWORKs… 

Verbally, At the end of the month in which 

timely and adequate (10 day) notice 

can be provided. 

In writing, At the end of the month in which 

adequate notice can be provided. 

A voluntary mid-quarter report of the death of an AU member will be treated 

as a mid-quarter request for the discontinuance of that person. The 

deceased will be discontinued mid-quarter with 10-day notice. 

If the death is reported on the QR 7 and not mid-quarter, no overpayment will 

exist. 

A voluntary report of the receipt of SSI by an AU member does not require 

mid-quarter action. The person receiving SSI will be discontinued at the end 

of the current quarter. 

Example: An AU consists of mom and two children. Mom reports receipt of 

SSI for herself on January 15. The quarter is January/February/March. Mom 

is discontinued at the end of the current quarter (March). 


Examples – Changes in Family Composition 

Introduction This section has a series of examples of voluntary mid-quarter changes in 

family composition. Use these examples to assist in completing recalculation 

of benefits. 

Example – new 

person causes 

increase 

Situation: A Nonexempt Assistance Unit (AU) consists of a mother and one 

child with no income currently receiving CalWORKs of $490 per month. The 

current quarter is July/August/September (Cycle 1). The mother voluntarily 

reports on August 10 the father moved into the home that month and has no 

income. 

Action: Assuming the father met all eligibility requirements, the Eligibility 

Worker (EW) would establish eligibility for the father effective September 1. 

The test budget is completed as follows: 

1. Recalculate benefits for September: 

Average monthly disability-based income $ 0.00 


Subtotal = - $225.00 

Average monthly earned income $ 0.00 




NNI = $ 0.00 


NNI - 0.00 

New CalWORKs grant for September = $608.00 

2. Calculate supplement for September: 

New CalWORKs grant for September $608.00 

Previous grant issued for September - 490.00 

Supplement for September $118.00 

This family is eligible to a supplement of $118 for September. 

Note: If the mother had waited to report the father moving in until the August 

QR 7 (received in September), the father would be added to CalWORKs the 

first of October (the first of the month following report). 



Examples – Changes in Family Composition, Continued 


person causes 

decrease 

Situation: A Nonexempt Assistance Unit (AU) consists of a mother and two 

children with no income currently receiving CalWORKs of $661 per month. 

The current quarter is August/September/October (Cycle 2). The mother 

voluntarily reports on August 10 the father moved into the home that month 

and receives Unemployment Insurance Benefits (UIB) of $200 biweekly. 

Action: Assuming the father met all other eligibility requirements, the EW 

would complete a test budget as follows: 

1. Convert UIB into monthly amount: 

Average monthly UIB $200 x 2.167 = 433.40 

2. Complete test budget for September: 

Disability-based income September (anticipated) $ 0.00 

Earned income for September (anticipated) 0.00 

Unearned income for September – UIB (anticipated) + 433.40 

NNI (rounded down) $433.00 


NNI - 433.00 

CalWORKs grant (test) $355.00 

Since the addition of the father causes a decrease in the CalWORKs grant 

($661 per month to $355 per month), the action to add the father would be 

“held over” until review of the information on the next QR 7. The EW would 

send a No Change Notice. Assuming the customer reports this same 

information on the September QR 7, the father would be added to 

CalWORKs November 1. 

Report in Submit Month: Given the same situation as above, except the 

mother reports on October 10 the father moved in that month, the father 

would be added to CalWORKs February 1. The report of the father in the 

home is not required until the December QR 7, due in January. 



Examples – Changes in Family Composition, Continued 


person causes 

ineligibility 


child. Mother receives UIB of $100 biweekly. Current CalWORKs grant is 

$273 per month. The current quarter is September/October/November 

(Cycle 3). The mother voluntarily reports on October 10 the father moved 

into the home that month. He works and receives $300 weekly in earned 

income. 

Action: Assuming the father met all other eligibility requirements, the EW 

would complete a test budget as follows: 

1. Convert earned and unearned income to monthly amounts: 

Average monthly earned income $300 x 4.33 = $1299.00 

Average monthly unearned income (UIB) $100 x 2.167 = $216.70 

2. Complete test budget for November: 

Disability-based income November (anticipated) $ 0.00 


Subtotal - $225.00 

Earned income for November (anticipated) $1,299.00 


Subtotal $1,187.00 


Subtotal $ 593.50 

Unearned income for November – UIB (anticipated) + 216.70 

NNI (dropped cents) $ 810.00 


NNI - 810.00 

CalWORKs grant (test) $ 0.00 

Addition of the father and his income causes ineligibility to CalWORKs for the 

entire AU. The EW would send a No Change Notice. Assuming the 

customer reports this same information on the October QR 7, the EW would 

discontinue CalWORKs effective November 30 with adequate and timely 

notice. 


Medi-Cal Eligibility for Add Persons 

Introduction Under Quarterly Reporting, a new member will only be added to an existing 

Assistance Unit (AU) as of the first of the month following the reported 

change or at the beginning of a quarter, depending on the circumstances. 

However, Medi-Cal eligibility for the new AU member based on the link to 

cash aid will be established for the month the new person joined the AU, 

provided eligibility has been verified. This section gives an overview for 

when to add the person to Medi-Cal. Specific information can be located in 

the Medi-Cal Chapter of this Handbook. 

Beginning date 

of aid – 

Medi-Cal for 

add person 

Financial 

eligibility 

If adding the new person to the AU would not make the family ineligible to 

CalWORKs, cash-linked Medi-Cal eligibility shall be established as follows: 

If the person moving into the 

home was… 

Reported timely on the QR 7 or by 

the extended filing date for that 

QR 7, 

Then cash-linked Medi-Cal is 

effective beginning the 

month the… 

Individual moved into the home. 

Timely and voluntarily reported, Individual moved into the home. 

Not timely reported, County received the report. 

Exception: When the AU does not report the birth of a newborn timely (on 

the first QR 7 following the birth), cash-linked Medi-Cal for the newborn 

begins the month following the child’s birth after eligibility has been 

established and all verification has been provided. 

To be eligible to cash-linked Medi-Cal, in addition to meeting all non-financial 

eligibility requirements, add persons must also be financially eligible to 

CalWORKs for those months. To determine financial eligibility the Eligibility 

Worker (EW) must run a test budget for each month the add person may be 

eligible to Medi-Cal, beginning the first month listed in the table above and 

ending the month prior to the month the person is added to CalWORKs. 

Example Situation: A family is in the June/July/August quarter (Cycle 3). On the July 

QR 7 received August 5, the family reports Dad moved into the home on 

June 14. 

Action: Assuming Dad was determined eligible to CalWORKs, his beginning 

date of aid for Medi-Cal would be June 1. The move was reported timely (on 

the first QR 7 following the move). 


Mid-quarter Request for Special Need Payment 

Introduction A customer may voluntarily request a special need payment any time during 

the quarter. Requests for special need payments include those for: 




• Nonrecurring special needs (including Homeless Assistance), and 

• Pregnancy Special Needs (PSN). 

This section will cover the budgeting for mid-quarter requests for recurring 

and pregnancy special needs. Information regarding eligibility, verification, 

and payment limits can be found in the Special Needs Chapter. 

The Eligibility Worker (EW) will treat a request for a recurring or PSN 

payment as a voluntary report resulting in increased benefits (once verified). 

The effective dates of change for recurring and pregnancy special need 

payments are as follows: 

• Recurring special needs: The effective date of the special need 

payment is the first of the month of the request, once the required 

verification has been provided. 

• PSN: The effective date of the special need payment is the first of the 

month in which the verification of pregnancy is received. 

Additional information regarding the actual start and stop dates can be found 

in the Special Needs Chapter. 


Examples – Mid-quarter Request for Special Need Payment 

Introduction This section has a series of examples of voluntary mid-quarter requests for 

special need payments, both recurring and pregnancy. Use these examples 

to assist in completing the budget. 

Example 1 – 

PSN request 

with no income 


child with no income and is currently receiving CalWORKs of $533 per 

month. The current quarter is November/December/January (Cycle 2). The 

mother calls the Eligibility Worker (EW) December 5 to report she is 

pregnant. 

Action: The EW immediately requests medical verification of pregnancy, 

which the customer provides on December 13. Since Pregnancy Special 

Need (PSN) payments are effective the first of the month verification of 

pregnancy is received, the EW would start the PSN payments in December. 

The recalculation for December and January benefits follows: 

1. Recalculate December and January benefits: 

Disability-based income (anticipated) $ 0.00 

Earned income for (anticipated) 0.00 

Unearned income (anticipated) + 0.00 

NNI (rounded down) $ 0.00 


Special Needs (PSN) + 47.00 

Subtotal $580.00 

NNI - 0.00 

CalWORKs grant $580.00 

2. Calculate supplement for December: 

New CalWORKs grant for December $580.00 

Previous grant issued for December - 533.00 

Supplement for December $ 47.00 

The family is eligible to CalWORKs of $580 for December and January. The 

EW will issue a $47 supplement for December and increase January 

benefits. 



Examples – Mid-quarter Request for Special Need Payment, 

Continued 

Example – PSN 

request with 

income 

Situation: A Nonexempt Assistance Unit (AU) consists of a mother, father, 

and two children. The family is currently receiving CalWORKs of $240 per 

month based on the father’s earnings of $250 per week. The current quarter 

is March/April/May (Cycle 3). The mother calls the EW on March 15 to report 

she is pregnant. 

Action: The EW immediately requests medical verification of pregnancy, 

which the customer provides on March 20. The EW would start the PSN 

payments in March. The recalculation for March, April, and May benefits 

follows: 

1. Convert earned income to monthly amount: 

Average monthly earned income $250 x 4.33 = $1,082.50 

2. Recalculate March, April, and May benefits: 



Subtotal - $225.00 

Earned income (anticipated) $1,082.50 






NNI (rounded down) $ 485.00 


Special Needs (PSN) + 47.00 


NNI - 485.00 


3. Calculate supplement for March: 

New CalWORKs grant for March $287.00 

Previous grant issued for March - 240.00 

Supplement for March $ 47.00 

The family is eligible to CalWORKs of $287 per month beginning March. 

Issue a $47 supplement for March and increase April and May benefits. 



Examples – Mid-quarter Request for Special Need Payment, 

Continued 

Example 3 – 

recurring 

special need 

request 

Situation: A Nonexempt Assistance Unit (AU) consists of a mother and two 

children. The family is currently receiving CalWORKs of $228 per month 

based on the mother’s UIB of $200 received biweekly. The current quarter is 

April/May/June (Cycle1). The mother calls the EW on April 9 to report both 

of her children are diabetic and need special diets. 

Action: The EW immediately requests medical verification of the special 

diets, which the customer provides on April 16. The verification provides a 

diet for less than 2,200 calories per day for the oldest child and 2,200 

calories or more per day for the youngest child. The EW would authorize 

monthly recurring special need payments of $9.00 and $15.00 for the 

children (oldest and youngest respectively) beginning in April. The 

recalculation of April, May, and June benefits follows: 

1. Convert unearned income to monthly amount: 

Average monthly unearned income (UIB) $200 x 2.167 = $433.40 

2. Recalculate April, May, and June benefits: 


Earned income (anticipated) 0.00 


NNI (rounded down) $433.00 


Special Needs (Therapeutic diets) + 24.00 


NNI - 433.00 


3. Calculate supplements for April and May: 

New CalWORKs grant for April and May $252.00 

Previous grant issued for April and May - 228.00 

Supplement for April and May $ 24.00 

The family is eligible to CalWORKs of $228 per month beginning in April. 

Issue $24 supplements for April and May and increase the June benefits. 


Overview 

Budgeting 

Third Party Information Known to the County 

Introduction This section covers the actions required when third party information 

becomes known to the County. 

Reference The following references are applicable to information under this topic: 

• ACL 03-18 




Third Party Information Known to the County 12-75 

Examples – Third Party Information 12-76 


Third Party Information Known to the County 

Introduction Under certain circumstances, information will be “known to the County” or will 

be provided to the County through a third party. This section covers the 

actions required for this information. 

Use of third 

party 

information 

Conflicting 

information 

Required 

actions 

The Eligibility Worker (EW) will use third party information to: 

• Calculate an overpayment when the information received is obtained 

after benefits have been issued, such as in the case of Income and 

Eligibility Systems (IEVS) matches; and 

• Take prospective action to change benefits mid-quarter or at the 

beginning of a quarter if the County learns the customer failed to 

accurately report changes on a mandatory mid-quarter report or on the 

QR 7. 

When third party reports provide information that conflicts with what the 

Assistance Unit (AU) reported, the EW will: 

• Contact the customer to indicate eligibility information is in question, 

• Give the customer the opportunity to verify the correct circumstances 

before the County takes action to reduce or terminate benefits, and 

• Ensure information reported on the customer’s QR 7 is consistent with 

other information known to the County and, if not, the EW will attempt to 

resolve the discrepancy. 

All third party information received by or known to the County must be acted 

on in accordance with Quarterly Reporting rules. If a change is required to 

be reported by the customer mid-quarter (mandatory reports), then the EW 

must: 

• Take action to verify the information, and 

• Take action on the information, once verified. 

If a change is not required to be reported mid-quarter (voluntary reports), 

such as a change in family composition, the EW may use the third party 

information as ancillary information to ensure the QR 7 submitted by the 

customer is consistent with other information known to the County. If the 

information on that QR 7 is not consistent with what has already been 

reported or is being reported through a third party, the EW must attempt to 

resolve the discrepancy. 

While third party information may be useful to the County and EW, under 

some circumstances the information will not always result in any action being 

taken. The EW will not take mid-quarter action based on third party 

information regarding changes an AU is not required to report during the 

quarter. 


Examples – Third Party Information 

Introduction This section gives examples of types of third party information. It also 

includes what actions to take and when to take them when third party 

information is received. 


types of reports 

Example – WtW 

ES reports 

customer has 

new job 

Example – 

request for CC 

in case with no 

income 

Examples of information, which may be received from a third party include, 

but are not limited to: 

• Employment Services Specialist (ESS) has been notified the customer 

has started a job; 

• A Child Care Eligibility Worker (EW) has received a request for Child 

Care payments in a case where no earned income has been reported; 

• An anonymous source reports information about the Assistance Unit (AU) 

to the County; 

• An asset match shows interest income for a bank account that has never 

been reported; 

• A Cal-Learn Case Manager notifies the County of a minor who becomes 

pregnant or gives birth; or 

• Information received on an IEVS (Income and Earnings Verification 

System) Applicant Abstract (410) or PVS 40. 

The EW will take no action on the above reports unless the information 

conflicts with what the customer should already have reported. 

Situation: A CalWORKs family consisting of mother and one child is in the 

Jan/Feb/Mar quarter (Cycle 1). The mother contacts her ES to report a new 

job beginning January 15. 

Action: Unless the income from the new job exceeds the Income Reporting 

Threshold (IRT), the customer is not required to report the new job until the 

February QR 7 (due in March). Once the February QR 7 is received, the EW 

will compare information from the ES to what the customer reports to ensure 

it is consistent. If not consistent, the EW will attempt to resolve the 

discrepancy. 

Situation: A CalWORKs family consisting of mother and one child is in the 

Feb/Mar/Apr quarter (Cycle 2). The mother requests Child Care from her 

Child Care EW for work hours. Previously, Child Care had been issued for 

Job Club hours only. 

Action: Unless the income from the new job exceeds the IRT, the customer 

is not required to report the new job until the March QR 7 (due in April). 

Once the March QR 7 is received, the EW will compare information from the 

Child Care EW to what the customer reports to ensure it is consistent. If not 

consistent, the EW will attempt to resolve the discrepancy. 



Examples – Third Party Information, Continued 


resources 

Example – 

second parent 

moves in 

Example – 

income over 

IRT 

Situation: A CalWORKs family is in the May/June/July quarter (Cycle 2). 

The County receives information from a third party this family acquired a new 

car in July. 

Action: The EW will take no action on this information at this point. The EW 

will wait until the family voluntarily reports the information mid-quarter or 

reports it on their September QR 7 (due in October), whichever occurs first, 

to take action. If the family fails to report the new car on their September 

QR 7, the EW will attempt to resolve the discrepancy. The report of the 

vehicle is not a mandatory report and as such is not required to be reported 

until the QR 7. 

Situation: A CalWORKs family consisting of a father and two children is in 

the Dec/Jan/Feb quarter (Cycle 3). The County receives information from a 

third party the children’s mother moved into the home at Christmas time. 

Action: The EW will take no action on this information at this point. The EW 

will wait until the family voluntarily reports the information mid-quarter or on 

their January QR 7 (due in February), whichever occurs first, to take action. 

If the family fails to report the mother moving in on their January QR 7, the 

EW will attempt to resolve the discrepancy. The report of the change in 

family composition is not a mandatory report and as such is not required to 

be reported until the QR 7. 

Situation: A CalWORKs family consisting of a mother, father, and two 

children is in the April/May/June quarter (Cycle 1). The County receives 

information from a third party in June the father is working and making 

$2,500 per month. 

Action: The EW must take action to verify this information. $2,500 per 

month in earnings by this family is income over the IRT, making this a 

mandatory report. The EW will not wait to see if this information is reported 

on the August QR 7 (due in September) to take any action. 


Overview 

Budgeting 

Multiple Mid-quarter Change Budgeting 

Introduction This section covers budgeting multiple mid-quarter changes, whether all 

mandatory, County-initiated, voluntary, or any combination of the three. The 

Reporting requirements for mandatory and voluntary changes can be located 

in the Reporting Chapter of this Handbook. 


• EAS 44-315 and 44-316 



Treatment of Multiple Mid-quarter Changes 12-79 

Examples – Multiple Mid-quarter Changes 12-80 

Examples – Budgeting Multiple Mid-quarter Changes 12-83 


Treatment of Multiple Mid-quarter Changes 

Introduction Customers may experience multiple changes in their circumstances during a 

QR Payment Quarter. Eligibility Workers (EWs) are required to act on those 

changes in accordance with the Quarterly Reporting rules for mandatory and 

voluntary customer reports, County-initiated actions, and third party reports. 

Actions 

required 

When a customer reports multiple mid-quarter changes, the EW is required 

to act on each change separately, using the rule unique to that type of 

change. The EW must not combine the different circumstances to effect a 

change in benefits resulting from the combined changes. 

Actions on multiple mid-quarter reports will be taken individually and 

sequentially as reported. 

Rules When the customer reports multiple changes within a quarter, the following 

rules apply: 

• Do not decrease benefits mid-quarter unless the decrease is the result of 

a mandatory report or County-initiated action, and 

• Only act on “third party report” changes if the customer was required to 

report the change. 

The EW must determine if the multiple changes are two or more separate 

and independent changes or if they are part of one change. 

If the change meets the 

requirements of… 

Then… 

A mandatory report, • Take action immediately with adequate 

and timely notice (10 days), 

• Identify any related overpayment or 

underpayment. 

A voluntary report, • Take action immediately if the change 

causes an increase in benefits, or 

• Hold the action until the next payment 

quarter if the change causes a 

decrease in benefits or ineligibility. 

A County-initiated change, • Take action immediately with adequate 

and timely notice (10 days), and 

• Identify any related overpayment or 

underpayment. 

Third party information, Follow the rules related to whether the 

information meets the requirements of a 

mandatory or voluntary report. 

Note: See related sections in this Chapter for the budgeting rules for these 

types of reports. 


Examples – Multiple Mid-quarter Changes 

Introduction This section has a series of examples of multiple mid-quarter changes and 

the budgeting actions involved. 

Example 1 – 

two voluntary 

reports (add 

person and 

new income) 

with application 

approved 

Example 2 – 

two voluntary 

reports (add 

person and 

new income) 

with application 

pending 

Situation: A family is in the January/February/March quarter (Cycle 1). 

Mom reports Dad in the home on February 5. Dad has no income. On 

March 20, Dad starts working, but the income does not exceed the Income 

Reporting Threshold (IRT). 

Actions: 

1. First Action: The Eligibility Worker (EW) will take action to add Dad to 

the Assistance Unit (AU) mid-quarter effective March 1, as it causes an 

increase in the grant. 

2. Second Action: The EW will not consider Dad’s income until it is 

required to be reported on the May QR 7 (due in June). Dad’s income 

will be included in the budget for the July/August/September payment 

quarter. 

Situation: A family is in the January/February/March quarter (Cycle 1). 

Mom reports Dad in the home February 5. Dad has no income. Dad begins 

working on February 12. 

Action: If the add person application is still pending when the report of the 

new income is received, the EW must use Dad’s income and treat it as part 

of the voluntary report to add Dad and not a separate incident. 

• If adding Dad and his income would result in an increase in benefits to 

the AU, the EW will add Dad and his income to the AU effective March 1, 

the first of the month following the report. 

• If adding Dad and his income would result in a decrease in benefits to the 

AU, the EW will: 

− “Hold over” this action and not act to add Dad to the AU until April 1 

(first of the next QR Payment Quarter) after the AU reports Dad and 

his income on the February QR 7, submitted in March, and 

− Add Dad to cash-linked Medi-Cal effective February 1. 

• If adding Dad and his income would result in financial ineligibility, the EW 

will not add him to the AU. The entire AU will be discontinued effective 

March 31, after the AU reports Dad and his income on the February 

QR 7, submitted in March. 



Examples – Multiple Mid-quarter Changes, Continued 

Example 3 – 

two voluntary 

reports (add 

person and 

decrease in 

income) 

Example 4 – 

two voluntary 

reports (income 

increase and 

decrease) 

Example 5 – 

two Countyinitiated 

changes (age 

requirements 

and school 

attendance) 

Situation: A family is in the May/June/July quarter (Cycle 2). Dad moves 

into the home on May 10, and he has income. Mom contacts the County on 

May 15 to report Dad moved in. Mom contacts the County again on May 20 

to report a decrease in her earnings 

Actions: The EW will not act on both changes at the same time. The EW 

must act on each change separately and according to the sequence in which 

the changes occurred. Following general QR rules, the EW would act only to 

increase benefits, not to decrease benefits. 

1. First Action: In this scenario, the EW would not act to decrease benefits 

based on adding Dad and his income to the AU, but would “hold over” 

this action and add Dad to cash-linked Medi-Cal. 

2. Second Action: The EW would act to increase benefits based on 

Mom’s decrease in income. The EW will not reevaluate the net result by 

trying to add Dad and his income again when increasing the grant base 

on Mom’s decreased income. 

Situation: A family is in the June/July/August quarter (Cycle 3). The 

customer contacts the EW in August to report Mom’s earnings decreased 

and Dad’s increased (not IRT). 

Actions: The EW will not evaluate the net result of the two changes. Each 

change must be acted on separately and in the sequence of occurrence. 

1. First Action: The EW will act to increase benefits based on Mom’s 

decreased income. 

2. Second Action: The EW will not act to decrease benefits based on 

Dad’s increased income. The EW will “hold over” the action based on the 

increase income until it is reported on the October QR 7 (due in 

November). 

Situation: A family consisting of Mom and two children are in the 

June/July/August quarter (Cycle 3). The older child is 18 and will graduate in 

June, per the case record. On July 3, the EW receives verification the 

younger child (14) has missed 20 or more days of school and is not attending 

regularly. 

Actions: Both changes in eligibility status are considered County-initiated. 

The EW will evaluate and act on each change separately and in the 

sequence of occurrence. 

1. First Action: Based on the June age change, the older child will be 

discontinued from CalWORKs effective June 30, causing a decrease in 

the July and August grants. 

2. Second Action: Based on the information received July 3, a school 

attendance penalty will be imposed effective August 1, causing a 

decrease in the August grant. 



Examples – Multiple Mid-quarter Changes, Continued 

Example 6 – 

voluntary and 

mandatory 

report 

Situation: A family consisting of a mother, father, and two children are in the 

May/June/July quarter (Cycle 2). On May 10, the mother contacts the 

County to report she was convicted of a drug felony on that date. On June 5, 

the mother contacts the County to report the father started a job on June 1. 

Actions: Both changes are acted on individually and in the sequence of 

occurrence. The net result of the changes will not be evaluated mid-quarter. 

1. First Action: The change in drug felony status is a mandatory report. 

The mother will be discontinued from CalWORKs effective May 31, 

causing a decrease in the June and July grants. 

2. Second Action: The change in income is a voluntary report and will 

either be effective June 1 or August 1, based on whether it causes an 

increase or decrease in the grant. 


Examples – Budgeting Multiple Mid-quarter Changes 

Introduction This section contains two examples of budgeting multiple mid-quarter 

changes. 

Example 1 – 

voluntary 

report and 

Countyinitiated 

change 

Situation: A Nonexempt Assistance Unit (AU) consisting of a mother and 

two children is receiving CalWORKs of $64 based on the mother’s earned 

income of $1200 per month. This Cycle 1 family is currently in the 

April/May/June quarter. 

• On April 5, the mother reports she lost her job the day before. She states 

she will only receive one paycheck in April for $600, and she anticipates 

no additional income after that. 

• On May 10, the Eligibility Worker (EW) receives verification the customer 

is not cooperating with the Department of Child Support Services 

(DCSS). 

First Action: Based on the April 5 report, the EW immediately requests 

verification of the job loss, and the customer provides it within 10 days. The 

EW uses the new income to recalculate benefits for April, as well as the 

remaining months of the current quarter as follows: 


Earned income for April (actual) $600.00 

Earned income for May (anticipated) 0.00 









NNI = $ 44.00 


NNI - 44.00 

New CalWORKs grant for April, May, and June = $564.00 

3. Calculate supplement for April: 

New CalWORKs grant for April $564.00 

Previous grant issued for April - 64.00 

Supplement for April $500.00 

The customer is eligible to $608 per month for April, May, and June. Issue a 

supplemental payment for April and increase May and June benefits. 



Examples – Budgeting Multiple Mid-quarter Changes, Continued 

Example 1 – 

voluntary 

report and 

Countyinitiated 

change 

(continued) 

Example 2 – 

increase and 

decrease in 

income 

Second Action: Based on the information received May 10, the EW will 

take action on the second reported change and impose the Child Support 

penalty effective June 1 and will recalculate benefits for June using the 

averaged income calculated in the first action as follows: 


Re-averaged monthly earned income $200.00 




NNI = $ 44.00 


NNI - 44.00 


25% Child Support penalty (rounded down) - 141.00 

CalWORKs grant (rounded down) = $423.00 

The customer is eligible to $423 for June. The EW will impose the penalty 

effective June 1 and decrease June’s benefits. 

Situation: A family consisting of Mom, Dad, and two children is in the 

June/July/August quarter (Cycle 3). The family receives a CalWORKs grant 

of $415 of based on Mom’s earnings of $300 per month and Dad’s earnings 

of $100 per week. The customer contacts the EW in August to report 

effective August: 

• Mom’s earnings decreased to $200 per month, and 

• Dad’s increased to $150 per week. 

The EW will not evaluate the net result of the two changes. Each 

change must be acted on separately and in the sequence of 

occurrence. 




Example 2 – 

increase and 

decrease in 

income 

(continued) 

First Action: Based on the August report of Mom’s earnings decrease, the 

EW immediately requests verification, and the customer provides it within 10 

days. The EW uses Mom’s new income, and Dad’s previously budgeted 

income ($100 per week), to recalculate August benefits as follows: 

1. Recalculation of Averaged Income (Mom): 

Earned income for August (actual) + $200.00 



2. Convert earnings into monthly amount (Dad): 

Average monthly earnings (Dad) $100 x 4.33 = $433.00 


Reaveraged monthly earned income (Mom) $200.00 

Average monthly earnings (Dad) + 433.00 

Total earned income = $633.00 




NNI = $260.00 


NNI - 260.00 

New CalWORKs grant for August = $465.00 

4. Calculate supplement for August: 

New CalWORKs grant for August $465.00 

Previous grant issued for August - 415.00 

Supplement for August $ 50.00 




Example 2 – 

increase and 

decrease in 

income 

(continued) 

Second Action: Based on the August report of Dad’s earnings increase, the 

EW will use Dad’s increased earnings and Mom’s earnings prior to the 

reported changes ($300 per month) to recalculate August benefits as follows: 

5. Calculation of Averaged Income (Mom): 

Earned income for August (anticipated) + $300.00 



6. Convert earnings into monthly amount (Dad): 

Average monthly earnings (Dad) $150 x 4.33 = $649.50 


Reaveraged monthly earned income (Mom) $300.00 

Average monthly earnings (Dad) + 649.50 

Total earned income = $949.50 




NNI (rounded down) = $418.00 


NNI - 418.00 

CalWORKs grant for July and August = $307.00 

8. Compare August grants: 

Previous grant issued for August $415.00 

New CalWORKs grant for August (1 st Action) $465.00 

New CalWORKs grant for August (2 nd Action) $307.00 

The EW will compare the three different grants calculated for August and: 

1. Issue the largest. As such, the customer is eligible to $465 for August. 

The EW will issue a supplemental payment of $50 for August benefits. 

2. Using Dad’s new income causes a decrease in the grant. Therefore, the 

EW will “hold over” this action until it is reported on the family’s October 

QR 7 (due in November). 


Annual Reporting, Income Budgeting 

Introduction This section contains information regarding budgeting income for Annual 

Reporting (AR) cases. 

Prospective 

budgeting 

Prospective budgeting is used when determining continuing benefits for AR 

cases. Income the customer anticipates, with reasonable certainty, to be 

received in the upcoming annual period will be budgeted. Current income 

information obtained at application or Re-Evaluation/Recertification (RE/RC) 

and any reasonably anticipated changes in income will be used as an 

indicator of the income that will be available to the customer for the AR period. 

Income changes that the customer anticipates within the upcoming year are 

treated differently in CalWORKs and CalFresh: 

CalWORKs – Income changes, including income starting/stopping, can be 

budgeted for the upcoming RE/RC period. 

CalFresh – Income changes that are mandated to be reported must be 

reported within 10 days from the change and will be budgeted as 

appropriate. 

Example: In January, an intake Annual Reporting/Child Only (AR/CO) 

customer reports he/she is working a temporary job and expects the job to 

end in March. Both the customer and the Eligibility Worker (EW) agree that 

the income is reasonably anticipated. Therefore, the income is used in the 

CalWORKs budget for January through March. In CalFresh, the income will 

be used beginning in January, but the income cannot be stopped until the 

customer reports the change. Customers must be advised to report all 

changes in income within 10 days of the occurrence (per Change Reporting 

(CR) requirements). 

Note: Refer to the CalFresh Policy Handbook (CFPHB) regarding required 

action when the customer fails to report a mandatory change of income 

stopping within 10 days of the change occurring. 


CWPHB #4653 (05/13) BUDGETING 12-86.1

Annual Reporting, Income Budgeting, Continued 

Reasonably 

anticipated 

income 

Income 

averaging 

Income is reasonably anticipated when the customer and the EW determine it 

is reasonably certain that the customer will receive a specified amount of 

monthly income in the AR/CO period. If either the amount of income or date it 

will be received is uncertain, the portion of the Assistance Unit’s (AU’s) income 

that is uncertain shall not be counted. 

Additionally, customers are not required to report an exact amount of 

anticipated monthly income for each month of the AR/CO period. CalWORKs 

customers are required to provide information about current income and any 

anticipated changes in the following RE period. CalFresh customers are 

required to report changes to income within 10 days of the occurrence (per CR 

requirements). The income reported on the SAWS 2 will be considered 

reasonably anticipated and will be used in the budget calculation unless the 

customer reports that he/she anticipates a change in the upcoming AR/CO 

period for CalWORKs. Anticipated income shall only be considered 

reasonably anticipated if the EW determines that the: 

Customer verified the income has been or will be approved or authorized 

within the upcoming AR/CO period or he/she is otherwise reasonably 

certain the income will be received within the AR/CO period. 

Anticipated amount of the income is known and verified, or the customer is 

otherwise reasonably certain of the amount of the income. 

Start date of the income is known and verified, or the customer is 

otherwise reasonably certain of the start date of the income. 

If a customer anticipates receipt of new income in the upcoming AR/CO 

period, but does not have reasonable certainty of the dates and amounts 

expected to be received, this income cannot be considered reasonably 

anticipated and, therefore, will not be used in determining the benefits for the 

upcoming AR/CO period. If new income exceeds the Income Reporting 

Threshold (IRT) mid-year, then the customer must report the income and 

benefits will be discontinued or recalculated as required. 

Note: EWs must Journal how income was determined. 

Unlike Quarterly Reporting (QR), income is not averaged over the next 

12-month period (see the “Prospective budgeting exception” block in this 

section of the handbook for more information regarding income averaging in 

AR/CO cases). When income fluctuates, income must be budgeted in the 

months it is anticipated to be received, and a full grant allowed in the months 

in which the customer anticipates receiving no income. 


CWPHB #4653 (05/13) BUDGETING 12-86.2


Income 

budgeting 

examples 

Prospective 

budgeting 

exception 

Examples of budgeting income in AR/CO cases with CalFresh follow: 

Example 1: A mother of two applies for CalWORKs and CalFresh in 

November and has no income for November; however, she anticipates income 

(and provides verification) from a job (not by contract or self-employment) she 

is due to begin in December. She expects to receive $245 each week 

beginning in December and ending in April. The weekly amount is converted 

to a monthly amount using the conversion factor of 4.33 and budgeted for the 

months of December through April only. For CalFresh, budget the income as 

anticipated, but the customer must report when the income ends. 

Example 2: A customer with an AR/CO case receiving CalFresh benefits 

completes the RE/RC. The customer reports income that fluctuates from 

month to month but agrees that she generally gets $300 per month. In this 

instance, the $300 income can be reasonably anticipated for the following 

RE/RC period in both the CalWORKs and CalFresh programs. 

CalFresh households with a CalWORKs AR/CO case receiving income for a 

period of time shorter than one year either by contract or self-employment are 

exempt from prospective budgeting. The income shall be averaged over the 

12-month period for both CalFresh and CalWORKs AR/CO cases, provided 

the income is not received on an hourly or piecework basis. 

For AR/CO cases not in receipt of CalFresh benefits, the contract/ 

self-employment income will be calculated using prospective budgeting and 

reasonably anticipated income rules and is not averaged over the RE period. 

Example: An AR/CO customer receiving CalFresh is employed by contract at 

a school cafeteria from the middle of September through the middle of June. 

During the July RE/RC, she reports her job ended in the middle of June. The 

EW looks at the case record for prior work information and determines the 

customer always has a break in employment during the summer months. The 

EW clarifies with the customer that her job will resume in September. The 

income which the customer anticipates to receive in September through June 

is added together and then averaged over the 12-month AR/CO period, 

August through July, for both the CalWORKs and CalFresh programs. 


CWPHB #4653 (05/13) BUDGETING 12-86.3


Income 

Reporting 



AR/CO IRT 

Customers must be informed of their IRT: 

At application, 

At each RE/RC, and 

When their IRT changes. 

The AR 2 – Reporting Changes For Cash Aid and CalFresh will be used to 

notify AR/CO customers of their IRT. 

Customers must report within 10 days when the total combined earned and 

unearned income exceeds the IRT, even if the income is received mid-year. 

The IRT for AR/CO CalWORKs cases is the amount of income likely to render 

the recipient ineligible for CalWORKs benefits (see “CalWORKs AR/CO IRT” 

block). 

AR/CO cases with income over the IRT will result in discontinuance of the 

CalWORKs program at the end of the month with timely and adequate notice. 

The CalWORKs AR/CO IRT is the level likely to render an AU ineligible for 

CalWORKs benefits as listed in the following chart: 

Family Maximum Aid 

Payment (MAP) 



Non-Exempt 



Exempt 

0 $113 $113 

1 $712 $780 

2 $1,092 $1,212 

3 $1,328 $1,474 

4 $1,562 $1,730 

5 $1,762 $1,958 

6 $1,964 $2,182 

7 $2,144 $2,386 

8 $2,330 $2,590 

9 $2,508 $2,792 

10 

or more 

$2,684 $2,990 

Note: AR/CO cases discontinued for over IRT will be evaluated for 

Transitional CalFresh (TCF) per established policy when appropriate. 


CWPHB #4653 (05/13) BUDGETING 12-86.4


Excess IRT 

examples 

Procedure for 

discontinuing 


when over IRT 

Following are examples of AR/CO cases exceeding the IRT: 

Example 1: A customer with a CalWORKs AR/CO case reports mid-year and 

verifies income over IRT. The income is expected to continue. The EW 

determines the case is ineligible for CalWORKs. The AR/CO case is given 

10-day notice for the discontinuance. 

Example 2: A customer with an AR/CO and CalFresh case reports and 

verifies income over IRT for the current month only. The income will not 

continue and will be below the IRT the following month. The EW will not take 

any action on the CalWORKs case other than to provide the AU with a 

No-Change Notice of Action (NOA). The EW must take action on the 

CalFresh case because any information reported from a CR household must 

be acted on. 

When the CalWORKs program is ineligible for being over the IRT, the EW will 

take the following action to discontinue the program: 

Step Action 

1 Navigate to the Negative Action Detail page in C-IV, and for the 

appropriate benefit month: 

If the AU… Then… 

Receives CalFresh, Select the Run EDBC for 

this program box for the 

CalFresh program, and 

Complete the Negative 

Action Detail for the 

CalWORKs using Negative 

Action Reason of 

Transferred Income. 

Go to Step 2. 

Note: C-IV will auto-test for 

TCF when the CalFresh and 

CalWORKs Eligibility 

Determination and Benefit 

Calculations (EDBCs) are run 

together. 

Does not receive CalFresh, Go to Step 2. 

2 Override the CalWORKs EDBC Program Configuration for each 

person with: 

Role Reason = Over IRT, and 

Status Reason = Over IRT. 

3 Run, Accept and Save the EDBC. 

4 Send a manual NOA (NA 200A) to the customer. 



CWPHB #4653 (05/13) BUDGETING 12-86.5


Overpayment CalWORKs Overpayments (OPs) will be established based on the following: 

Customer failure to report any mandatorily required information, 

County error, 

Customer late reporting, and 

Inability to issue correct benefits due to insufficient time to issue a 10-day 

notice. 

Note: Refer to the CFPHB for instructions regarding CalFresh overissuances. 

CWPHB #4653 (05/13) BUDGETING 12-86.6

Interface Between CalWORKs AR/CO and CalFresh Cases 

Interface 

between 


AR/CO and 

CalFresh 

cases 

Action must be taken on all mandatorily reported changes; however, as a 

reminder, while CalFresh Change Reporting (CR) rules have additional 

reporting requirements, if the change is not required to be reported for the 

CalWORKs Annual Reporting/Child Only (AR/CO) case, this information will 

be treated as a voluntary report in CalWORKs and the Eligibility Worker (EW) 

may not decrease or discontinue the CalWORKs grant/case mid-year. EWs 

may only act on reports in CalWORKs if the report results in an increase to the 

grant. Additionally, because the Assistance Unit (AU)/household reported the 

change to comply with CalFresh CR rules, if the EW is not taking action to 

change the CalWORKs grant, the EW must send a No-Change Notice of 

Action (NOA) to the customer. 


reports a change midyear 

in… 


$100 or less, 


of $50 or less, or 

Income source, 

Note: For CalFresh, 

income must be 

verified when the 

above income changes 

are reported. 


$100 or less, 


of $50 or less, or 

Income source 

Note: For CalFresh, 

income must be 

verified when the 

above income changes 

are reported. 

And the income 

is… 

Under the 


Income 

Reporting 

Threshold (IRT), 

Under the 


Over the 


Then the report is… 

Voluntary for both CalWORKs and 

CalFresh. For: 


results in a(n): 

– Decrease to the grant, 


– Increase to the grant, 


appropriate. 

CalFresh: 

– Budget and change the 

income for the appropriate 

months, and 

– Send a NOA. 

Voluntary for CalWORKs and 

mandatory for CalFresh. For: 


results in a(n) 

– Decrease to the grant, 


– Increase to the grant, 


appropriate. 

CalFresh: 

– Budget and change the 

income for the appropriate 

months, and 

– Send a NOA. 

Mandatory for both 


The EW will send a10-day 

notice for discontinuance of 

CalWORKs and CalFresh to 

the customer. 


CWPHB #4653 (05/13) BUDGETING 12-86.7


Continued 


the impact of 

CalFresh 

mandatory 

mid-year 

report on 


AR/CO cases 

Following are examples of processing a mid-year report that is mandatory for 

CalFresh and voluntary for CalWORKs: 


a mandated report of an increase in earned income of $150 (not exceeding 

the CalWORKs IRT). The EW will take action to adjust the household’s 

CalFresh allotment only. Because the change in income is not over the AU’s 

IRT, this will be treated as a voluntary mid-year report for CalWORKs and the 

grant will not be changed. The EW will issue a No-Change NOA for 

CalWORKs and send a DFA 377.5 to the customer. 


a CalFresh mandatory report that the household received an increase in 

unearned income of $100. The change in income does not exceed the 

CalWORKs IRT. The EW will take action to adjust the household’s CalFresh 

allotment, as per Change Reporting (CR) rules. The change in income is 

treated as a voluntary report for the AR/CO case and the CalWORKs grant will 

be unchanged. A No-Change NOA for CalWORKs will be sent to the 

customer. 

Example 3: A customer with a CalWORKs AR/CO case with CalFresh 

reports mid-year her current job ended because she became employed at a 

higher paying job (income still under the IRT). For CalWORKs, each change 

must be acted on separately and sequentially. The EW will terminate the 

income from the previous job and issue a supplement. Because the income 

from the new job does not exceed the IRT, no action is taken on the new 

income. For CalFresh, changing jobs/new source of income is a mandatory 

report. If the change results n a decrease in benefits, the EW will send timely 

and adequate notice informing the customer of the decrease in CalFresh 

benefits effective the first of the following month. 


CWPHB #4653 (05/13) BUDGETING 12-86.8


Continued 

Income report 

affects 

CalFresh case 

only 

When an income change affects the CalFresh case but not the CalWORKs 

AR/CO case, EWs will take the following action: 

Step Action 

1 Complete a manual budget using the appropriate CalFresh Budget 

Worksheet or the online CalWORKs/CalFresh budget to determine 

the new CalFresh benefit amount. 

2 Run CalFresh EDBC through high end date, and 

Override the EDBC to issue correct benefits, 

Ensure the Reporting Type is Change Reporting, and 

Accept and Save the EDBC. 

3 Send a: 

NOA to the customer informing of the new CalFresh benefit 

amount, and 

No-change NOA for the CalWORKs grant. 

4 Image the manual budget into C-IV. 


CWPHB #4653 (05/13) BUDGETING 12-86.9

Overview 

Budgeting 

Overpayments and Underpayments 

Overview This section covers the budgeting of overpayments and underpayments, and 

creating and activating a recovery account. 

Reference The following references are applicable to the information under this section: 

All County Letter (ACL): 12-02 and 12-23 

Eligibility and Assistance Standards (EAS): 44-340, 44-350, 44-351 and 

44-352 



Overview and Definitions 12-88 

Overpayment Identification and Responsibility 12-91 

Overpayment Examples 12-93 

Overpayment Procedures 12-97 

Methods of Overpayment Recoupment 12-101 

Computer Resources for Overpayments 12-104 

Underpayments 12-105 


Overview and Definitions 

Policy The County is responsible for identifying, calculating, and collecting all 

CalWORKs cash aid overpayments. Overpayments must be put into grant 

adjustment quickly so they can be collected in full. 

The Eligibility Worker (EW) is responsible for: 

• Identifying overpayments, 

• Documenting the overpayments in case journals, and 

• Creating and activating Recovery Accounts. 

Definitions Activated Recovery Account: A recovery account that has been changed 

from pending to active status and is collected in C-IV. 

Administrative Error Overpayment: An overpayment caused by an error 

by the County, when the County possessed all information necessary to 

make a correct aid payment determination. 

Aid Payment: The amount of CalWORKs cash aid issued to the 

customer/Assistance Unit (AU). 

Balancing: The recovery of all or a portion of an overpayment by applying it 

against a payable underpayment. 

Date of Discovery: The date the county has all information necessary to 

establish and create the overpayment. 

Demand for Repayment: The notification to a customer or former customer 

an overpayment occurred and must be repaid. 

Discrepancies: Include but are not limited to differences in current 

customer information, previous customer information, and/or documented 

third party information. 

Excess Property Overpayment: Occurs when an AU has resources in 

excess of the resource limit on the first day of the quarter. If it is determined 

the customer received CalWORKs in “good faith”, the amount of the 

overpayment is the amount of excess resources or CalWORKs cash aid 

received, whichever is less. 

Grant Adjustment: The recovery of an overpayment by reducing the aid 

payment to a currently eligible customer/AU. 



Overview and Definitions, Continued 

Definitions 

(continued) 

Month of Discovery: The month the County obtained, or could have 

obtained, by taking prompt action, information sufficient to support a 

determination both an overpayment occurred and the amount of such 

overpayment. This is not necessarily the month the overpayment amount is 

calculated. 

Overpayment (OP): The amount of the aid payment the AU has received to 

which it was not eligible. An overpayment may be all or a portion of an aid 

payment including, but not limited to, an Immediate Need payment, a special 

need payment, or Aid Paid Pending (APP) a State Hearing. 

Recipient Error Overpayment: An overpayment caused by the AU’s failure 

to report or meet conditions of eligibility after being notified of their reporting 

responsibilities and the need to meet eligibility conditions. Also included are 

Aid Paid Pending (APP) overpayments due to a State hearing request. 

Recovery: The method of recouping the overpayment. Recovery methods 

include grant adjustment, balancing, voluntary cash repayment, and tax 

intercept. 

Recovery Account: An account set up to recover an overpayment, 

overissuance, Child Care overpayment, or to track a Child Care Levy, Child 

Support Recovery Account, or Foster Care Trust Fund Account. 

Responsible Party: A member of the AU other than an adult or 

emancipated minor who was a minor in the AU at the time an overpayment 

occurred. 

Note: In a two-parent AU, both parents are responsible parties. 

Snowballing Overpayments: When the aid payment is recalculated due to 

a new overpayment and the amount being adjusted for a prior overpayment 

is added to the new overpayment rather than added back to the balance 

owing for the prior overpayment. 

Uncollectible Overpayments: Overpayments which are nonfraudulent and 

totaling less than $35 are uncollectible. 

Underpayment (UP): The amount of aid payment the AU is eligible to and 

has not received. 



Overview and Definitions, Continued 

Definitions 

(continued) 

Unlocatable: Means either of the following: 

• The County is unable to determine the physical whereabouts of the 

caretaker relative; or 

• The County is able to locate the caretaker relative, but unable to execute 

legal process to collect. 

Voluntary Cash Recovery: A voluntary cash repayment made to the 

County by a customer who has incurred an overpayment. 

Voluntary Aid Payment Offset: A voluntary repayment made to the County 

by a customer foregoing all or a portion of their aid payment. 


Overpayment Identification and Responsibility 

Introduction This section includes the overpayment identification process. The Eligibility 

Worker (EW) is responsible for identifying overpayments, creating and 

activating recovery accounts. 

Identifying an 

overpayment 

Late reporting 

overpayments 

When 

overpayments 

will not be 

identified 

Eligibility 

Worker (EW) 

overpayment 


An overpayment occurs when the Assistance Unit (AU) receives more cash 

aid than it is entitled to receive. Overpayments can be the result of, but are 

not limited to, the following: 

• Customer failure to report accurately and completely; 

• County error; 

• Customer late reporting; 

• County inability to issue the correct grant due to the 10-day notice 

requirement when the customer reported timely, completely, and 

accurately; 

• EW failure to act; and 

• Aid Paid Pending (APP) issued due to a State hearing request when the 

County’s position is upheld. 

“Late reporting” applies to the timing of mandatory mid-quarter reports, as 

well as the timing of the submission of the QR 7. For both of these reporting 

requirements, the EW will identify an overpayment when the customer 

received a grant amount to which they were not entitled under Quarterly 

Reporting rules, regardless of whether or not the customer reported timely. 

No overpayment or underpayment will be identified when actual income 

received during a quarter differs from the amount of income reasonably 

anticipated, as long as the customer met his or her mandatory reporting 

obligations completely and accurately. 

No reconciling based on actual income will be done so long as the 

requirement to report completely and accurately is met and the EW averaged 

and issued the benefits correctly based on his/her determination of 

reasonable anticipated income. 

The EW is responsible for: 

• Identifying overpayments; 

• Calculating the amount of the overpayment and any related CalFresh 

overissuance by running EDBC (Eligibility Determination and Benefit 

Calculation); 

• Creating and activating a recovery account in C-IV; 

• Generating the overpayment Notice of Action (NOA); and 

• Documenting the overpayment/recovery account in the case journal. 



Overpayment Identification and Responsibility, Continued 

Eligibility 

Worker (EW) 

responsibility - 

other 

The EW is responsible for all the cases in his/her assigned workload, 

including the overpayment and recovery account. The EW will: 

Perform all routine eligibility functions for all cases, including those with 

overpayments. 

Ensure the income and deduction(s) are correct. 

Ensure the Family and AU person counts are correct. 

Clarify any missing or conflicting information. 

Identify the overpayment. 

Create and activate the recovery account. 

Generate, print and send the overpayment notice to the customer. 

Document the recovery account in the case journal. 

Research the case record and respond to any questions the customer 

may have regarding the overpayment. This includes the balance, 

calculation, and recovery methods. 

The EW will not refer the customer to the Quality Review Specialist (QRS) 

when a customer has questions regarding an overpayment. The EW is 

responsible for all customer program questions. 

Timeframe It is county policy that EWs must create and activate recovery accounts for 

all overpayments by the end of the month in which the benefits were issued. 

Questions 

regarding 

complex 

recovery 

accounts 

Example: Late QR 7 with income processed on April 26th. An overpayment is 

identified for May. Set a Task to create and activate a recovery account by 

May 31 st . The Task should state: Recovery Account Month/Year, i.e.05/2007. 

There are some instances when the EW is unable to complete an 

overpayment action due to the complexity of the action. Some examples of 

these complex actions include, but are not limited to: 

Unresolved IEVS discrepancies, 

On-going overpayment and new overpayment identified for the same 

month, and 

Recovery account created in error and adjustments are being collected. 

QRS staff is available to assist EWs with resolving complex recovery account 

issues, voiding recovery accounts and to answer questions. When 

assistance is required for voiding recovery accounts, the Eligibility Worker 

Supervisor I (EWS I) will refer the issue to the Quality Review Unit (QRU) via 

e-mail to the Recovery Account Inbox in Outlook. Either the EWS I or the 

Eligibility Worker III (EW III) may e-mail the QRU regarding all other complex 

recovery account issues. 

Note: EWs must not contact the QRU directly regarding recovery account 

issues. 



Overpayment Identification and Responsibility, Continued 

Contacting 

QRU via the 

Recovery 

Account 

Inbox 

When requesting assistance from the QRU via the Recovery Account Inbox, 

case information regarding the question or assistance needed must be 

e-mailed as an attachment to comply with Personally Identifiable 

Information (PII) requirements. The Subject Line of the e-mail must identify 

whether the request is regarding: 

Recovery Account Question, 

Void Request: 

– Only EWS Is are to e-mail requests to void recovery accounts to the 

QRU, as the request must be reviewed to ensure voiding the recovery 

account is appropriate. 

– The following must be included in the e-mail: 

Recovery account(s) number, and 

Specific reason for the void (such as rescinding discontinuance, 

incorrect income used, etc.), or 

Assistance with Complex Budgets – Include the following: 

– Recovery account number(s), and 

– Specific reason for the complexity. 

CWPHB #4648 (02/13) BUDGETING 12-92.1

Overpayment Examples 

Introduction This section contains a series of overpayment examples to assist in the 

identification of overpayments. 

Example 1 – 

late mandatory 

mid-quarter 

report 

Example 2 – 

late QR 7 

Situation: A family consisting of Mom and two children is in the 

April/May/June quarter (Cycle 1). Mom is convicted of a drug felony on April 

25 and reports the conviction on April 26. 

Action: The report is considered timely, because it was made within 10 

days. The Eligibility Worker (EW) is unable to decrease CalWORKs benefits 

for May due to insufficient time to provide 10-day notice. The EW must: 

Issue May benefits in the same amount issued in April; 

Take action to decrease benefits effective June 1; 

Identify an Administrative Error overpayment for the mother’s portion of 

the May grant; and 

Create and activate the recovery account in C-IV for the overpayment. 


Situation: A family consisting of Mom and one child is in the May/June/July 

quarter (Cycle 2). The customer turns in her QR 7 on July 25. She reports 

starting a new job in June and indicates she will receive $1,000 in earnings 

each month. 

Action: The EW is unable to reduce CalWORKs benefits for the 

August/September/October payment quarter effective August 1 due to 

inability to provide 10-day notice of the decrease. The EW must: 

Issue August benefits without using the reported earnings; 

Take action to decrease benefits effective September 1; 

Identify a Late QR 7 overpayment for the excess portion of the August 

grant; 

Set a task to run the August EDBC after the benefits have been issued, 

and; 





Overpayment Examples, Continued 

Example 3 – 

failure to report 

income 

Example 4 – 

Eligibility 

Worker (EW) 

failure to act 

Situation: In the January/February/March 2005 quarter (Cycle 1), the 

County determined through an IEVS match an Assistance Unit (AU) had 

income that exceeded the Income Reporting Threshold (IRT) early in April 

2004 (April 5). The quarter in which the income was received was 

April/May/June 2004. The AU is still receiving the same level of income in 

the current quarter and has never reported the income in a mid-quarter 

report, on any QR 7 submitted, or during any Re-Evaluation (RE). 

Action: The EW determines the AU should have reported this change by 

April 15, and should have been discontinued due to financial ineligibility 

effective April 30. The EW will: 

Discontinue the CalWORKs as soon as possible with 10-day notice; 

Identify a Recipient Error overpayment for all CalWORKs benefits 

received beginning May 2004 through discontinuance; and 



Situation: A family consisting of Mom, Dad, and two children is in the 

May/June/July quarter (Cycle 2). On the June QR 7 submitted on July 5, the 

AU reports Dad started a job on June 10. The income is expected to 

continue at the same level in the next QR Payment Quarter and does not 

exceed the IRT. The EW failed to use the newly reported income to 

determine benefits for the next QR Payment Quarter 

(August/September/October). 

Action: If using the income to calculate the CalWORKs benefits would have 

resulted in a lower grant, the EW must: 

Take action to decrease benefits as soon as possible with 10-day notice, 

Identify an Administrative Error overpayment for the amount of all 

CalWORKs benefits the AU was not entitled to receive beginning 

August 1, and 






Example 5 – 

voluntary 

report, failure 

to report 

Example 6 – 

excess 

property 

Example 7 – 

loss of 

deprivation 

Situation: A family consisting of Mom (with no income) and two children is 

in the April/May/June quarter (Cycle 1). Dad moves into the home on April 

16. Dad is full-time employed, and the AU never reports he is in the home. 

In December of that year, the QR finds out Dad is in the home and has been 

there since April 16. 

Action: Because deprivation ceases to exist (assuming Mom is not 

disabled), the AU is not eligible to CalWORKs. The AU was not required to 

report Dad in the home until June, when the May QR 7 was due. The EW 

must: 

Take action to discontinue CalWORKs as soon as possible with 10-day 

notice, 


received beginning July 1, 



Situation: A family consisting of Mom, Dad, and one child is assigned to 

Cycle 3. The family reports on the July QR 7 (June/July/August quarter) they 

have not acquired any new property since their last QR 7. In September, 

Dad wins a car, but sells the car for fair market value in early October to pay 

past-due medical bills. The family reports these facts on the October QR 7. 

Action: The EW determines the family is property eligible for the 

December/January/February quarter based on the October QR 7 submitted 

in November. The EW will not identify an excess property overpayment for 

any months of the September/October/November quarter, because the EW 

correctly determined property eligibility for that quarter based on the July 

QR 7 (submitted in August), and the family was not required to report 

property changes as a mid-quarter report. The EW will Journal the action 

taken. 

Situation: A family consisting of a mother and child are aided based on 

absent parent deprivation and are assigned to Cycle 1. On the May QR 7 

(April/May/June quarter) due in June, the mother reports no one had moved 

in or out of the home since the last QR 7 (February) was submitted. In July, 

the father of the aided child moves into the home and is full-time employed. 

The mother reports this on the August QR 7 submitted in September. 

Action: Based on the August QR 7, the EW determines no deprivation 

exists and discontinues benefits effective September 30. The EW does not 

identify an overpayment for any months of the July/August/September 

quarter because the family was not required to report the addition to the 

home until the August QR 7. Deprivation was established based on the May 

QR 7 for the July/August/September quarter. The EW will Journal the action 

taken. 




Example 8 – 


excess 

property 

Example 9 – 


excess 

property 

Example 10 – 

actual and 

reasonably 

anticipated 

income differ 

Situation: A family is in the January/February/March quarter (Cycle 1). In 

January, the family receives a $3,000 inheritance. In February, the family 

still has $2,800 of the inheritance. The family does not report the $2,800 on 

the February QR 7, submitted on March 10. The County finds out about the 

resource from an Asset Match in December, contacts the family and learns 

they still have the money in a bank account and it is now over $3,000. 

Action: The family should have reported on the February QR 7 they 

received the inheritance and still had $2,800 left in February. Had the EW 

known about the resource, the EW would have discontinued the CalWORKs 

effective March 31. The EW will: 

Discontinue CalWORKs as soon as possible with 10-day notice. 


beginning April 1, and 



Situation: Same as above, except the family spends all the money on 

Christmas gifts in November. The County learns about the property in March 

of the following year. 

Action: The family should have reported on the February QR 7 they 

received the inheritance. Had the EW know about the resource, the 

CalWORKs would have been discontinued effective March 31 for excess 

property. Additionally, the family should have reported on the November 

QR 7 they spent the money. The family would be property eligible for 

CalWORKs again beginning December 1. The EW will: 

Identify an overpayment for all CalWORKs benefits received from April 1 

through November 30, 



Situation: A family is in the July/August/September quarter (Cycle 1). The 

parent is part-time employed and correctly and accurately reports this 

information on the August QR 7 received in September. The EW determines 

benefits for the October/November/December quarter based on this 

information. In October, the parent unexpectedly obtains another part-time 

job (not in excess of IRT), so the parent’s actual income for the 

October/November/December quarter is different from the reasonably 

anticipated income the EW used to determine benefits for that quarter. 

Action: Because the income from the second part-time job was not 

anticipated, the EW correctly determined the October/November/December 

benefits based on income that was reasonably anticipated at that time. The 

EW will not identify an overpayment for the October/November/December 

quarter based on the difference between actual and reasonably anticipated 

income. The EW will Journal action taken. 


Overpayment Procedures 

Overview An overpayment may be identified at any time, including: 

Newly 

identified 

overpayment – 

open case 

When processing a: 

QR 7, 

Re-Evaluation (RE), 

Mid-quarter report/change, 

During any review of the case record, 

By request of the Appeals Unit, or 

When information is received via the IEVS 410. 

When a potential overpayment has been identified and requires more 

information or clarification, the Eligibility Worker (EW) will contact the 

customer. The EW will clarify any missing or conflicting information. 

An unworked QR 7 does not automatically indicate an overpayment. The 

EW must complete a budget to determine whether an overpayment exists. 

When the EW identifies a new overpayment on an open case, the following 

actions will be taken: 

Step Action 

1 Identify the overpayment from available information including: 

QR 7s, 

Income and Eligibility Verification System (IEVS), 

Customer interviews, 

Complaints, 

Case reviews, etc. 

2 Obtain all information necessary to calculate the overpayment and 

resolve any discrepancies. 

3 Update the C-IV data screens for the change which caused the 

overpayment, such as, increased income or newly acquired 

property. 

4 Run Eligibility Determination and Benefit Calculation (EDBC) for 

each month of the overpayment. 

5 Create and activate the recovery account (see C-IV User Guide). 

6 Complete and send the customer the appropriate Notice of 

Action (NOA). 

7 Journal the following: 

Cause of the overpayment, 

Date(s) involved, and 

Action(s) taken. 



Overpayment Procedures, Continued 

Overpayments 

under $35 

On-going 


No new 

overpayment is 

identified 

Overpayments which are nonfraudulent (administrative error) and totaling 

less than $35 are non-collectible. When activating recovery accounts in C- 

IV, the EW must select “Uncollectible” as the status and “Cash-Under $35- 

AE” as the status reason (see C-IV User Guide). 

Example 1: 

Customer submits the June QR 7 on July 5. Customer reports the receipt of 

self employment income in June. The income is expected to continue at the 

same level in the next QR Payment Quarter and does not exceed the IRT. 

The EW processes the QR 7 on July 30. An Administrative Error 

overpayment of $33 for the month of August is identified. Because the 

overpayment is nonfraudulent and totals less than $35, it is not a collectible 

overpayment. 

Example 2: 

Customer submits the June QR 7 on July 5. Customer reports the receipt of 

self employment income in June. The income is expected to continue at the 

same level in the next QR Payment Quarter and does not exceed the IRT. 

The EW failed to use the newly reported income to determine benefits for the 

next QR Payment Quarter (August/September/October). On October 10, the 

EW recalculates the CalWORKs grants for August, September and October. 

The customer is overpaid $33 for each of the three months resulting in an 

overpayment totaling $99. Because the overpayment is nonfraudulent and 

totals more than $35, it is a collectible overpayment. 

If a program has an on-going overpayment, continue with all existing 

overpayment adjustments. Refer the case to the Quality Review Unit (QRU) 

if changes occur that would impact any months of the overpayment(s) or the 

months of adjustments. 




Aid Paid 

Pending (APP) 

ordered on an 

overpayment 

On-going O/P 

and new O/P 

identified for 

same month(s) 

When a hearing is filed on an overpayment and Aid Paid Pending (APP) is 

ordered, the Appeals Specialist: 

Sends an APP order e-mail to the Quality Review Unit (QRU), and 

Notifies the EW of the APP order via an e-mail and Task. 

When the APP order is received prior to the Main Payroll cut-off date in C-IV, 

the following is completed: 


1 The Quality Review Specialist (QRS): 

Suspends the recovery account, and 

Re-runs EDBC to stop the overpayment adjustment. 

2 The EW sends the APP NOA to the customer. 

When the APP order is received after the Main Payroll cut-off date in C-IV, 



1 The QRS: 

Issues the overpayment adjustment back to the recipient, and 

Stops future adjustments on the recovery account . 

2 The EW sends the APP NOA to the customer. 

Use the following chart when a customer has an on-going overpayment, 

regardless of whether or not the overpayment is in adjustment, and a new 

overpayment is identified for the same month(s): 

Step Action 

1 Update the C-IV data screens for the change(s) causing the 

overpayment. 

2 Run EDBC to reflect the overpayment. 

3 Create and activate the Recovery Account (See C-IV User 

Guide). 

4 The Eligibility Worker Supervisor I (EWS I) will refer the program 

to QRU for further action. 

Note: If the two overpayments have separate causes, one agency caused 

and the other client caused, two recovery accounts must be created and 

activated. A separate NOA must be sent to the customer for each recovery 

account. 




Overpayment 

computed in 

error 

Newly 

identified 


discontinued 

program 

Discontinued 

case with an 

overpayment 

balance owing 

If the EW computes an overpayment and creates a recovery account in error, 


The EWS I will refer the case to the QRU to void recovery account via the 

Recovery Account Inbox. 

QRU will notify the EW via e-mail when the void action is completed, and 

EW will create a correct recovery Account. 

Note: Void requests must include the recovery account number and specific 

reason for the void, such as rescinding discontinuance, incorrect income 

used, etc. Do not use “Created in error”. 

Use the following table when an overpayment is identified on a discontinued 

program: 

Step Action 

1 Complete the discontinuance action if the case has not been 

discontinued. 

2 Obtain all information necessary to calculate the overpayment and 

resolve any discrepancies. 

3 Update the data screens for change causing the overpayment, 

such as, increased income or newly acquired property. 

4 Run EDBC for each month of the overpayment. 

5 Create and activate the recovery account (See C-IV User Guide). 

6 Complete and send the customer the appropriate NOA. 

7 Journal the following: 

Cause of the overpayment, 

Date(s) involved, and 

Action(s) taken. 

When the EW discontinues a case, which has an overpayment balance 

owing, he/she will take the following actions: 

Step Action 

1 Complete the discontinuance action. 

An overpayment demand notice is generated and is sent to 

the customer’s last address when the case discontinues. 

2 Notify the receiving county of the amount of the overpayment 

balance owing on the TAD 215 (ICT Overpayment Adjustment 

Notification), if the discontinuance is due to an Inter-County 

Transfer (ICT). 

3 Follow existing district policies for sending the program file (if a 

physical file) to closed files. 

CWPHB #4636 (08/12) BUDGETING 12-100

Methods of Overpayment Recoupment 

Introduction Overpayments may be recouped through grant adjustment (including 

voluntary aid payment offset), balancing, voluntary cash repayment, or tax 

intercept. This section explains what each is and the priority order of 

recoupment. 

Priority order of 

recoupment for 

responsible 

parties 

Overpayments shall be recouped in the following order: 

Caretaker relative recipient (includes parents) when the caretaker relative 

was a member of the Assistance Unit (AU) at the time of the 

overpayment. The County will continue to seek recovery from the 

caretaker relative even when he/she: 

– Moves to another AU, or 

– Is no longer on aid. 

Other members of the original AU (see exceptions below) after all efforts 

to collect from the caretaker relative have been exhausted, and the 

caretaker relative recipient: 

– Dies and the County cannot collect the entire unpaid balance from the 

caretaker relative’s estate, 

– Is unlocatable, or 

– Has the overpayment discharged in bankruptcy. 

Exceptions: Overpayments will not be recouped from the following: 

Adults and emancipated minors who were minors in the AU at the time 

the overpayment occurred, and 

Minors who become a member of a new AU when the overpayment 

occurred while the minor was a member of the previous AU. 

Note: In C-IV, all AU members are selected as responsible parties when an 

overpayment recovery account is established. C-IV Batch process will 

remove the minors as responsible parties when they turn 18. Staff must 

remove emancipated minors as responsible parties when the emancipation 

status is reported. 


CWPHB #4636 (08/12) BUDGETING 12-101

Methods of Overpayment Recoupment, Continued 

Grant 

adjustment 

Voluntary aid 

payment offset 

An overpayment may be recovered by grant adjustment. Overpayment 

adjustments are deducted monthly from the CalWORKs grant. The 

overpayment grant adjustment amounts are: 

Administrative Error overpayments – 5% of the AU Maximum Aid 

Payment (MAP) rounded down to the next lowest dollar; and 

All other overpayments – 10% of the AU MAP rounded down to the next 

lowest dollar. 

The customer may designate a monthly adjustment amount higher than the 

percentages listed above; however, he/she may not designate a monthly 

amount lower than the percentages listed. 

The amount to be adjusted is the lesser of the: 

Overpayment balance, 

Maximum adjustment amount, or 

Current aid payment. 

The AU can request a “voluntary aid payment offset” in an amount greater 

than the regulations allow (see “Grant adjustment” block above). If the AU 

makes such a request, the Eligibility Worker (EW) will: 

Journal the reason for the request and amount to be adjusted (a written 

agreement is not required), and 

Request that the Eligibility Worker Supervisor I (EWS I) refer the case to 

the Quality Review Unit (QRU) for further action. 

At any time, the AU can request the adjustment be reduced to the amount 

allowed by regulation. 

Balancing An overpayment may be recouped in full or in part by applying an 

underpayment due for a previous month against the overpayment. A current 

calendar month’s underpayment/supplement may not be used to recoup an 

overpayment. 

Example: Today is August 7 th . The customer was overpaid $350 in March 

and then underpaid $150 for July and $150 for August. 

The July underpayment of $150 can be used to offset (balance) the $350 

overpayment leaving a new balance of $200. 

The $150 supplemental for August must be issued to the customer since 

August is the current month. 


CWPHB #4636 (08/12) BUDGETING 12-102

Methods of Overpayment Recoupment, Continued 

Voluntary cash 

repayment 

A customer or former customer may choose to repay the overpayment 

directly to the County. If the customer or former customer offers to repay all 

or a portion of an overpayment, the customer’s agreement to voluntarily 

repay shall: 

Be in writing, and 

Clearly indicate to the customer or former customer the repayment is 

voluntary. 

The customer or former customer is not required to fulfill any voluntary 

agreement he/she enters into and may suspend payments he/she has 

agreed to make at any time. 

The customer will receive a Promissory Note (An Agreement to Reimburse) 

when a recovery account is established. If the form is signed by the customer 

and returned to the district office, the EW will image as appropriate. 

Electronic Benefit Transfer (EBT) Releases for either cash or CalFresh, 

received in the district offices, are forwarded to Human Services (HS) 

Auditing/Collections, mail code 0914. 

Payment may be made by cash, check, or money order and turned in to the 

district office or sent to HS Auditing/Collections. Only authorized clerical staff 

can accept negotiables such as cash, checks, and money orders. 

Tax intercepts Uncollected overpayments may be subject to Federal or State tax intercept 

when the prior AU member from whom recovery is being sought is not 

currently receiving CalWORKs. 

If a customer believes his/her taxes were intercepted in error, the EW will 

refer him/her to the Tax Intercept Coordinator at HS Auditing/Collections. 

CWPHB #4636 (08/12) BUDGETING 12-103

Computer Resources for Overpayments 

Introduction Computer resources are available to the Eligibility Worker (EW) to assist in 

identifying and reviewing current overpayment information. These resources 

are discussed in this section. 

MEDS-ORI – 

MEDS Alert 

The MEDS-ORI MEDS Alert is generated when a case with an overpayment 

is discontinued and the Assistance Unit (AU) subsequently reapplies for 

CalWORKs. MEDS generates an alert to the new county of eligibility and the 

old/previous county where the case was discontinued. 

C-IV EWs create and view Recovery Accounts in C-IV. Refer to the C-IV User 

Guide and Overpayments Job Aid for more information. 

CWPHB #4605 (04/11) BUDGETING 12-104

Underpayments 

Introduction Underpayments occur when the customer receives less cash aid than the 

amount to which he/she is entitled in any given month(s). This section 

covers underpayment guidelines and procedures. 

Guidelines The Eligibility Worker (EW) is responsible to take appropriate action to issue 

an underpayment once it has been identified. This includes issuing 

underpayments/supplements to families not currently receiving CalWORKs. 

When 

underpayments 

will not be 

identified 

Underpayment 

procedure 

The following guidelines apply for underpayments: 

• An underpayment for the current month must be issued in full. 

• Underpayments for prior months will first be used to balance any existing 

overpayments. The remainder of the underpayments, if any, will then be 

issued to the family. Do not delay in issuing the current month 

underpayment/supplement because of an existing overpayment. 

• At no time are the underpayment supplements issued for prior months 

treated as income or as resources in the month of receipt. 

No overpayment or underpayment will be identified when actual income 

received during a quarter differs from the amount of income reasonably 

anticipated, as long as the customer met his or her mandatory reporting 

obligations completely and accurately. 

No reconciling based on actual income will be done so long as the 

requirement to report completely and accurately is met, and the EW 

averaged and issued the benefits correctly based on his/her determination of 

reasonable anticipated income. 

The EW will take the following actions when an underpayment is identified: 

Step Action 

1 Determine the correct aid payment for the month(s) in question. 

2 • Compare the correct aid payment to the amount actually paid 


• If the amount the customer received is less than the correct 

aid payment for that month, an underpayment exists. 

3 Issue the underpayment supplement for the current calendar 

month. 

4 Complete and send the customer the appropriate Notice of Action 

(NOA). 

5 Narrate in the case journal the: 

• Reason for the underpayment, 

• Month(s) involved, and 

• Action(s) taken. 

CWPHB #4605 (04/11) BUDGETING 12-105



CHAPTER 13 

Benefit Issuance 

Overview ......................................................................................................13-1 

Electronic Benefit Transfer (EBT): Overview...............................................13-2 

Electronic Benefit Transfer: General Information ........................................13-4 

Terms and Definitions ..................................................................................13-7 

Intake Process ...........................................................................................13-10 

EBT Host-to-Host .......................................................................................13-12 

Cash Withdrawal at an Automated Teller Machine (ATM) .........................13-14 

Cash Withdrawals at a Point-of-Sale (POS) Terminal................................13-15 

Elimination of Electronic Benefit Transfer (EBT) 

Cash Access at Certain Businesses...................................................13-16 

Electronic Benefit Transfer (EBT) Card......................................................13-17 

Card Problems ...........................................................................................13-20 

Returned Electronic Benefit Transfer (EBT) Cards ....................................13-21 

Cross-County Printing of EBT Cards..........................................................13-23 

Electronic Benefit Transfer (EBT) Cardholders ..........................................13-24 

Payee Changes..........................................................................................13-25 

Designating an Electronic Benefit Transfer (EBT) 

Authorized Representative (AR) .........................................................13-27 

Unlinked Benefits .......................................................................................13-29 

Electronic Benefit Transfer (EBT) Program Exemption..............................13-30 

Request for State Hearing/Appeal .............................................................13-33 




Electronic Benefit Transfer (EBT) Inactive, Dormant, and 

Expunged Accounts: General Information ......................................... 13-34 

Inactive Accounts ....................................................................................... 13-35 

Dormant Accounts ..................................................................................... 13-36 

Expunged Accounts ................................................................................... 13-38 

Resource and Residence Determinations ................................................. 13-39 

Direct Deposit: Overview .......................................................................... 13-40 

Direct Deposit: General Information .......................................................... 13-41 

Direct Deposit: Definitions ......................................................................... 13-42 

Direct Deposit: What to tell the Customer ................................................. 13-43 

Direct Deposit: Process ............................................................................ 13-46 

Rejected Deposits ...................................................................................... 13-48 

Verifying Direct Deposit ............................................................................. 13-50 

Direct Deposit: System Errors ................................................................... 13-51 

Direct Deposit: Miscellaneous ................................................................... 13-52 

Warrants: Overview .................................................................................. 13-59 

Stop Payments ........................................................................................... 13-60 

Counter Warrants and Priority Mail-out Warrants ...................................... 13-63 

Returned Warrants ..................................................................................... 13-66 

Warrant Pick-up ......................................................................................... 13-67 

Emergency Grocery Assistance: Overview ............................................... 13-69 

Emergency Grocery Assistance ................................................................. 13-70 


Overview 

Benefit Issuance 

Introduction CalWORKs cash aid benefits are made available to each customer on one of 

the first three days of the month for which the benefits are intended. Benefits 

are issued via Electronic Benefit Transfer (EBT), Direct Deposit, and on 

exception basis only, via warrant. This Chapter contains information and 

instructions regarding special benefit issuance items such as: 

Electronic Benefit Transfer (EBT) 

EBT Host-to-Host 

Direct Deposit 

Vendor payments 

Warrants 

Emergency grocery assistance 

EBT Overview The on-line Electronic Benefit Transfer (EBT) System stores data used to 

control the issuance of CalWORKs, CalFresh, and Refugee Cash Assistance 

(RCA) benefits. Benefits will be issued from a Point-of-Sale (POS) terminal, 

Automated Teller Machine (ATM), or other electronic fund transfer device. 

The customer uses an assigned reusable plastic debit card to access EBT. 

The EBT card is called the Golden State Advantage card. 

The EBT Host-to-Host is the interface process, which replaced the multiple 

daily batch runs. It allows EBT accounts, rush and cancelled EBT benefits to 

be processed in real time. Routine benefits are processed in the nightly 

batch. The Eligibility Worker completes these actions through C-IV. 


ACL #03-18, 00-24, and 86-07 

MPP 16-000, 16-100, 16-200, 16-300, 16-400, 16-500, 16-600, 16-700, 

and 16-800 

EAS 42-203.2 

EAS 44-300, 44-302, 44-303, 44-304, 44-305, and 44-307 

General Relief Policy Handbook (GRPHB) 

In this chapter This Chapter contains the following topics: 


Electronic Benefit Transfer (EBT) 13-2 

EBT Host-to-Host 13-12 

Direct Deposit 13-40 

Warrants 13-59 

Emergency Grocery Assistance 13-69 

CWPHB #4641 (08/12) BENEFIT ISSUANCE 13-1

Overview 

Electronic Benefit Transfer (EBT) 

Introduction This section contains information regarding the overview of Electronic Benefit 


EBT The on-line EBT System stores data used to control the issuance of 

CalWORKs, CalFresh, and Refugee Cash Assistance (RCA) benefits. 

Benefits will be issued from a Point-of-Sale (POS) terminal, Automated Teller 

Machine (ATM), or other electronic fund transfer device. The customer uses 

an assigned reusable plastic debit card to access EBT. The EBT card is 

called the Golden State Advantage card. 

EBT Host-to- 

Host (H2H) 

EBT H2H 

functionality 

The EBT Host-to-Host is the interface process which replaced the multiple 

daily batch runs. This interface process allows EBT accounts, rush and 

cancelled EBT benefits to be processed in real time. Routine benefits will 

continue to be processed in the nightly batch. The Eligibility Worker (EW) 

will complete certain actions through the C-IV system that were previously 

completed by the fiscal and/or clerical staff via the Administrative Terminal. 

EBT H2H functionality in C-IV is supported by the following: 

• Once EDBC is accepted and saved, the benefit information is sent 

automatically to the EBT Vendor via Host-to-Host. 

• All EBT issuance automatically stores account numbers upon being 

created. 

• If a rush issuance does not successfully interface with the EBT Vendor, 

C-IV displays an informational message on the EDBC List page that the 

issuance will be resubmitted to the EBT Vendor during the nightly batch. 

• EBT is set as the default issuance method. 

• If there is no current account when running EDBC, C-IV will prompt the 

EW the EBT account has not been set up. The EW has the option to add 

the EBT account or run EDBC without setting up the EBT account. 


• MPP 16-000, 16-100, 16-200, 16-300, 16-400, 16-500, 16-600, 16-700, 

and 16-800 

• EAS 42-203.2 






Electronic Benefit Transfer: General Information 13-4 

Terms and Definitions 13-7 

Intake Process 13-10 

EBT Host-to-Host 13-12 

Cash Withdrawal at an Automated Teller Machine (ATM) 13-14 

Cash Withdrawals at a Point-of-Sale (POS) Terminal 13-15 

Elimination of Electronic Benefit Transfer (EBT) Cash Access 13-16 

at Certain Businesses 

Electronic Benefit Transfer (EBT) Card 13-17 

Card Problems 13-20 

Returned Electronic Benefit Transfer (EBT) Cards 13-21 

Cross-County Printing of EBT Cards 13-23 

Electronic Benefit Transfer (EBT) Cardholders 13-24 

Payee Changes 13-25 

Designating an Electronic Benefit Transfer (EBT) Authorized 13-27 

Representative (AR) 

Unlinked Benefits 13-29 

Electronic Benefit Transfer (EBT) Program Exemption 13-30 

Request for State Hearing/Appeal 13-33 

Electronic Benefit Transfer (EBT) Inactive, Dormant, and 13-34 

Expunged Accounts: General Information 

Inactive Accounts 13-35 

Dormant Accounts 13-36 

Expunged Accounts 13-38 

Resource and Residence Determinations 13-39 

Direct Deposit Overview 13-40 

Direct Deposit General Information 13-41 

Direct Deposit Definitions 13-42 

Direct Deposit What to tell the Customer 13-43 

Direct Deposit Process 13-46 

Rejected Deposits 13-48 

Verifying Direct Deposit 13-50 

Direct Deposit System Errors 13-51 

Direct Deposit Miscellaneous 13-52 

Vendor Payments Overview 13-56 

Vendor Payments 13-57 

Warrants: Overview 13-59 

Stop Payments 13-60 

Counter Warrants and Priority Mail-out Warrants 13-63 

Returned Warrants 13-66 

Warrant Pick-up 13-67 

Emergency Grocery Assistance: Overview 13-69 



Electronic Benefit Transfer: General Information 

Introduction This section contains general information regarding Electronic Benefit 


How are 

benefits 

issued? 

The on-line Electronic Benefit Transfer (EBT) System stores data used to 

control the issuance of CalWORKs, CalFresh, and RCA benefits. Benefits 

are issued from a Point of Sale (POS) terminal, ATM, or other electronic fund 

transfer device. The customer uses an assigned reusable plastic debit card 

to access their benefits. 

Benefit data The customer’s CalFresh, CalWORKs, and Refugee Cash Assistance (RCA) 

benefit information is electronically loaded each month from C-IV to a central 

computer account. A magnetic-strip plastic card is used to access the 

customer’s account in lieu of issuing CalFresh coupons or issuing cash 

warrants. The cardholder accesses CalFresh benefits by swiping the EBT 

card through a POS terminal at a grocery retailer for a purchase transaction 

or accesses his/her Cash benefits account at an ATM. 

EBT Vendor 

customer 

service 

EW customer 

service 

The EBT Vendor provides customer service 24 hours a day, 7 days a week. 

The toll free customer service number is 1-877-328-9677. Cardholders can 

call Customer Service to: 

• Report lost, stolen, or damaged cards 

• Verify the account balance 

• Change PIN 

Customers can also access the EBT website at www.ebt.ca.gov. This site is 

available in English and Spanish. At this website the customer can: 

• Check food and cash benefit balances, 

• See their EBT card use history, and 

• Find places to use their EBT card. 

Using C-IV screens the Eligibility Worker (EW) is able to: 

• Reactivate expunged or dormant accounts and 

• Answer customer’s questions relating to their accounts. 



Electronic Benefit Transfer: General Information, Continued 


benefits 

Benefit 

adjustments for 

EBT system 

errors 

Regular monthly benefits for ongoing customers are available on a staggered 

issuance based on the last digit of the case number. Staggered issuance is 

based on the first three calendar days of the month for CalWORKs 

customers. Customers cannot access regularly scheduled benefits until 

his/her scheduled “stagger” day each month. See the table below for cash 

stagger days. 

If the last digit of the Then the availability date 

case number is … is calendar day … 

1, 2, or 3, 1 

4, 5, 6, or 7, 2 

8, 9, or 0, 3 

Benefit adjustment for EBT System errors is the process where a debit or 

credit is applied to an EBT account to correct an error identified in the 

settlement process. A customer or a retailer may initiate a benefit 

adjustment request. 

A customer-initiated benefit adjustment: 

• Must be requested within 90 calendar days of the original error 

transaction. 

• Is investigated by the EBT Contractor who renders a decision and, if 

applicable, moves funds into the customer’s account. 

• May be appealed through the state hearing process if denied. 

A retailer-initiated benefit adjustment: 

• Must be requested within 15 calendar days of the original error 

transaction. 

• Is investigated by the EBT Contractor who provides a claim activity report 

to the county. 

• Requires the Eligibility Worker (EW) to send a NOA to the customer 

within two days of receipt of the claim activity report. 

• Is suspended until a hearing decision is rendered if the customer 

requests a state hearing within 15 calendar days from the date of the 

notice. 

Access method EBT is a method where CalWORKs customers receive and access his/her 

benefits. It does not affect eligibility to CalWORKs. 

Additional 

access 

methods 

Direct Deposit and cash warrants are the other methods for issuing 

CalWORKs benefits. Cash warrants will be used on an exception basis only. 



Electronic Benefit Transfer: General Information, Continued 

Direct deposit 

and EBT 

Inter-county 

transfers out 

Expunged 

accounts 

Direct Deposit is the most convenient way for cash customers to receive their 

benefits; it also saves the County money. If the customer requests the 

County stop his/her Direct Deposit, the customer’s cash benefits will be 

issued through the EBT system unless an exemption is requested and 

approved. 

When a customer informs the EW of an out-of-county move, the EW will 

inform the customer that the EBT account remains open and any benefits 

remaining in the account will be available through any terminal displaying the 

Quest logo, which is available statewide. Benefits in the EBT account may 

not be converted to a warrant. Customers concerned about access to Quest 

terminals should be informed to withdraw all their funds from the EBT 

account before leaving the County. 

Expunged cash benefits are benefits returned to the department after 365 

days of inactivity in the cash EBT account. When a customer contacts the 

department to request the replacement (reactivation) of an expunged cash 

benefit, the EW will have the responsibility to research and reactivate the 

account to reissue those benefits. 

Note: Expunged CalFresh benefits are not replaceable. 

Overpayments No changes have been made to CalWORKs overpayments. Cash aid 

recoupment for a customer will continue through a reduction in cash aid. 

EBT accounts 

in C-IV 

EBT noticing 

guidelines8 

C-IV automatically adds both cash and CalFresh to every EBT account, even 

if the case has only cash or CalFresh. C-IV does not set up the EBT 

account; the EW must set up the account. An inactive EBT account of a 

cash or CalFresh will not impact benefit issuance for the active program. 

The following guidelines apply to sending Notices of Action (NOAs) for EBT 

accounts that have reached an aged status: 

• When an EBT balance exists (i.e., one cent or more) for cash benefits, a 

timely Notice of Action (NOA), M16-120A, must be sent to the EBT 

cardholder in the month prior to the account benefits becoming dormant. 

• A NOA is not required to be sent for an aged cash account with a zero 

balance. 

• A NOA is not required to be sent prior to account benefits reaching an 

inactive status, or when account benefits have been expunged. 

• After an account has become dormant, counties have the option of 

sending the M16-120B or TEMP NA 1232 to inform the cardholder that 

benefits will be removed if they have not been used for 365 days. 


Terms and Definitions 

Introduction This section contains information regarding terms for the Electronic Benefit 

Terminal (EBT) system. 

Terms and 

definitions 

Administrative Terminal: A PC-based software application that provides 

real-time, on-line access to the EBT system. 

Aged Accounts: EBT accounts that are inactive, dormant or expunged. 

Authorized Representative (AR): The person designated to obtain and use 

benefits. The AR will receive an EBT card to access the cash benefit 

account. 

Automated Response Unit (ARU): Automated phone system that accepts 

data from touch-tone telephones and responds with synthesized voice 

commands and information. The ARU is used to provide balance information 

or to authorize manual transactions. 

Automated Teller Machine (ATM): Unattended terminal from which one or 

more cash EBT and/or banking transactions can be performed, including 

balance inquiries and cash withdrawals. 

Availability Date: A date assigned to every customer’s benefit issuance that 

determines the date on which that benefit is to be accessible to the 

cardholder. 

Balance Inquiry: A non-financial transaction that permits the cardholder to 

obtain the current balance of the customer’s account. 

Batch Interface: Various records are transmitted to the EBT system daily to 

set up accounts. 

Business Day: Any day the Federal Reserve Bank of New York is open for 

business. 

Calculated Net Benefit Issuance: The total issuance by availability date 

minus any returns 

Cardholder: An individual who has been issued and authorized to use an 

EBT card. Cardholder can be the customer or other designated individual. 

Cash Withdrawal Transactions: A transaction in which a cardholder 

obtains cash at a POS or ATM location without also making a purchase. 

Designated Alternate Cardholder (DACH): An individual designated by the 

head of the household/payee to receive an EBT card and PIN to access cash 

benefits. This individual is not a member of the AU/household. 

Dormant Status: When the EBT account has no debit activity by the 

cardholder for 180 days. 



Terms and Definitions, Continued 

Terms and 

definitions, 

continued 

Electronic Benefit Transfer (EBT): The electronic transfer of government 

funds to individuals through the use of card technology and ATMs, POS, and 

other terminals. 

EBT Card: A plastic debit card that bears the QUEST Mark and can be used 

to effect EBT transactions. 

EBT Host: The central account management component of the EBT 

system. It is the computer system used for processing cardholder 

transactions, maintaining transaction histories, performing account 

reconciliation, and conducting settlement. 

EBT Host-to-Host: The Interface process, which allows EBT accounts, rush 

and cancelled EBT benefits to update in real time. 

Eligibility System Interface: The mechanism by which data is shared 

between the County eligibility systems and the EBT system. 

Expunged Status: The removal of cash or CalFresh benefits from the EBT 

Host after a 365-day period with no debit activity. Cash benefits are returned 

to the County. 

Host-to-host Interface: A real-time transaction based link between the EBT 

system and a County or consortia host system. 

Inactive Status: When the EBT account has no debit activity by the 

cardholder for 135 days. 

Interoperable Transaction: The use of an EBT card issued by one EBT 

project area or state at a terminal of a different EBT project area or state. 

EBT Vendor: Provider of EBT Services. 

Lock/Unlock: 

• Lock – customers are allowed four attempts to enter the correct PIN 

when using their EBT card. After the fourth incorrect PIN entry, the 

system deactivates the card. 

• Unlock – cardholders contact the County to unlock their PIN. 

Note: This action is taken using the administrative terminal. 

Magnetic Strip: A strip of magnetic tape affixed on the reverse side of the 

EBT card that contains the encoded Primary Account Number (PAN). 

Non-settling Transactions: Benefits returned to the County. They include 

expungements, repayments and coupon conversions. 




Terms and 

definitions, 

continued 

Personal Identification Number (PIN): A four-digit number issued to or 

selected by a cardholder. 

Point of Sale (POS): The equipment at a retail location used to transact an 

electronic debit of a customer account and credit the retailer account when a 

purchase is made. 

Primary Account Number (PAN): The account number that identifies the 

issuer and the cardholder. The PAN is fully displayed and encoded on the 

magnetic stripe of the EBT card. 

Receipt: A paper record of a transaction that took place at the POS, 

containing at a minimum the date, merchant name and location, primary 

account number, type of account accessed, amount, reference number, and 

an action code. A receipt also contains the balance remaining in the 

account. 

Reconciliation: The daily process of balancing the EBT system and 

resolving any discrepancies in the various internal and external accounts. 

Reject: A record that has a missing data element in the record, which is sent 

by the County to the EBT Contractor. 

Settlement: The process by which retailers are reimbursed on a daily basis 

for authorized benefits they have redeemed during the most recently 

completed transaction day. 

Statused: Deactivated. 

Surcharge: A fee added to a transaction by an acquirer, terminal operator 

or merchant for a transaction initiated at a POS. 

Unlinked Benefits: Benefits which are placed in the EBT Contractor’s 

pending file by the County’s eligibility system because they cannot be 

matched to an active customer’s account. 


Intake Process 

Introduction This section contains information regarding the Intake process for Electronic 

Benefit Transfer (EBT). 

Video 

presentation 

Customers will view the EBT informational video during the orientation or 

intake process. 

Direct deposit During the interview, the EW will inform the customer of the Direct Deposit 

alternative to cash EBT. Direct Deposit is received on the 1 st of the month 

and is not subject to cash stagger issuance. 

Immediate 

Need 

Application 

processing 

If the customer chooses Direct Deposit, the EW will give the customer the 

HSS 27 – Direct Deposit Request Form to be completed and returned to the 

EW. These forms are available in English and Spanish. 

If the customer is eligible for Immediate Need, the EW shall arrange for Overthe-Counter 

(OTC) issuance of the EBT card and PIN. 

For normal processing of applications, the EW shall advise the customer the 

Golden State Advantage (EBT) card, with instructions for usage, will be 

mailed to his/her address. The PIN will arrive separately in the mail a few 

days after the EBT card. 



Intake Process, Continued 

No Address 

customers 

For customers who have no address or do not have a regular mailing 

address and use a district office address for their mail, the EW must advise 

the customer the: 

• EBT card and PIN must be issued OTC, and 

• Customer’s mail must be picked up every few days. 

Note: When setting up an EBT account in C-IV for No Address customers, 

use the option of “Pick-up” instead of “Mail”. EBT cards for No Address 

customers should not be mailed to district offices for customer pick-up; they 

must be issued OTC. 


EBT Host-to-Host 

EBT Host-to- 

Host 

EBT Account 

List Page 

EBT Account 

Detail page 

EBT Card Detail 

page 

The EBT Host-to-Host is the interface process, which replaced the multiple 

daily batch runs. It allows EBT accounts, rush and cancelled EBT benefits to 

be processed in real time. Routine benefits are processed in the nightly 

batch. The EW completes certain actions through the C-IV system that were 

previously completed by Office Assistant (OA) staff via the Administrative 

Terminal. 

The EBT Account List page lists all accounts linked to a case including those 

hidden on a case. All accounts are listed in order of effective dates with the 

newest account at the top of the list. The EW will be able to view the 

Account Detail page via the Account number hyperlink. 

The EBT Account Detail page has a view, create and manual create mode. 

In View Mode the EW can: 

• View the current and historical information related to an EBT account and 

all related cards. 

• Reactivate an EBT account by sending a request to the EBT Vendor. 

This button only displays if the account is in Dormant or Expunged status. 

Note: Cash expungements tied to the Expunged Account type are sent to 

the EBT Vendor during nightly batch. 

In the Create mode the EW can create a new EBT account along with a 

primary card. 

In Manual create mode the EW can: 

• Search and retrieve information from the EBT Vendor, and 

• Add the account and all card information tied to the account into C-IV. 

The existing EBT Card Assignment Detail page has been renamed to EBT 

Card Detail page and modified to have a View, Edit and Create mode. 

In the View mode the EW is able to view: 

• Current and historical information related to the card, 

• Statuses of updates to the EBT Vendor and demographic changes for the 

card, 

• EBT account via the account number hyperlink, and 

• Cancel and reissue the current card and create a new card. 

Note: This button is displayed when the card is in issued/cancelled status. 

In Edit mode the EW will be able to: 

• Modify the card access type and status to issue or cancel, and 

• Save card changes to the EBT Vendor. 

In Create mode the EW will be able to create a secondary card by specifying: 

• Cardholder and cardholder’s age, and 

• Access type and delivery method. 



EBT Host-to-Host, Continued 

EBT Account 

Search page 

EBT 

Transaction 

Search page 

Issuance Detail 

page 

Issuance 

Method Detail 

page 

The EBT Account Search page allows searches to be made by: 

• Account number 

• Card number 

• Cardholder name, or 

• SSN 

Note: The results returned will contain information retrieved from the EBT 

Vendor. Searches will be returned with Account number, Card number, 

Case number and Person to make the results more restrictive. If items exist 

in C-IV hyperlinks are available. 

The EBT Transaction Search allows the EW to review transactions posted 

against the account by specifying a “From” date and up to 90 days of online 

history. The EW will be able to: 

• Search the EBT Vendor for all transactions within the specified date 

range and account type and 

• View the detailed information of the transactions selected in the EBT 

Card Transaction Detail page. 

All EBT issuances store the Account Number upon being created. A column 

has been added to the Issuance Detail page to show the EBT Account to 

which benefits were assigned. 

The Issuance Method Detail defaults to EBT when adding a CalFresh to a 

case. The Issuance Method page includes the ability to activate an EBT 

Account when the EBT Issuance Method, is selected and when an EBT 

Account does not exist. If the Issuance Method is EBT, the system will 

display the high dated EBT Account. 

EBT Validation When running EDBC for CalWORKs, CalFresh, Immediate Need or Refugee 

Cash Assistance (RCA), a validation will display if no current EBT account 

exists for the case. The validation does not prevent the worker from 

accepting and saving EDBC. 

Unsuccessful 

Rush Issuance 

Note: When the EDBC is accepted and saved, the benefit information for the 

EBT Account is sent to the EBT Vendor via Host-to-Host. 

If a rush issuance is not successfully submitted to the EBT Vendor, C-IV will 

display an informational message on the EDBC List page indicating the 

issuance will be submitted to the EBT Vendor during the nightly batch. 


Cash Withdrawal at an Automated Teller Machine (ATM) 

Introduction This section contains information regarding cash withdrawal at an Automated 

Teller Machine (ATM). 

Background CalWORKs and Refugee Cash Assistance (RCA) customers are able to 

withdraw their cash benefits from participating QUEST® ATMs located 

throughout California and in most other States. The total amount of cash the 

customer elects to withdraw is deducted from his/her available balance in 

their cash Electronic Benefit Transfer (EBT) account. The EBT Vendor does 

not impose a maximum amount the customer can withdraw at one time. The 

customer can withdraw an amount up to the maximum limit set by the ATM 

itself. All participating ATMs will allow cash withdrawal of $200.00 or more in 

one transaction, and many have a withdrawal limit of $500.00 or more per 

transaction. 

ATM locations The California Department of Social Services (CDSS) provides a monthly 

updated report of Automated Teller Machines (ATMs) in San Bernardino 

County, listed by city. 

ATM surcharge Many ATMs charge a surcharge for cash withdrawal transactions. 

EBT – ATM 

listing for San 

Bernardino 

County 

For example, a bank may impose a surcharge on a transaction made at its 

ATMs using any debit card other than the card issued by the bank. Other 

ATMs may not be owned by a bank and may surcharge all transactions at 

that ATM. When an ATM’s policy is to charge a surcharge, the surcharge will 

be deducted from the customers cash EBT account. There are some ATMs 

that do not charge a surcharge. If there are insufficient funds to cover all 

charges, the EBT system will deny the transaction. 

A list of ATMs that accept the Golden State Advantage EBT card will be 

distributed to all TAD district offices. This list is used so customers will know 

where they can access their cash benefits. The listing is in alphabetical 

order by city. 

Note: Customers can access their cash benefits anywhere the QUEST logo 

is displayed. 

Transaction fee After a customer has four cash withdrawal transactions in one calendar 

month at any ATM location, the customer will incur a transaction fee of $0.80 

(eighty cents) for each additional ATM cash withdrawal transaction in the 

month. A transaction fee is not incurred when cash is received with the 

purchase of merchandise through a Point of Sale (POS) terminal. 


Cash Withdrawals at a Point-of-Sale (POS) Terminal 

Introduction This section contains information regarding cash benefit withdrawals at a 

Point of Sale (POS) terminal. 

Background CalWORKs and Refugee Cash Assistance (RCA) customers are able to use 

their EBT card at participating QUEST® retailers located throughout 

California and in most other States, to purchase merchandise through the 

retailer’s POS terminal. Also, many of these retailers allow the customer to 

receive cash back. The total amount of merchandise and cash the customer 

elects to receive is deducted from the customer’s available balance in their 

cash EBT account. 

POS locations The California Department of Social Services (CDSS) provides a monthly 

updated report of merchants who use Point of Sale (POS) terminals and 

provide cash back in San Bernardino County, listed by city. 

POS surcharge Most retail merchants do not charge a fee for purchase transactions. 

However, some do, such as gas stations and restaurants. If the merchant 

charges a fee it will be deducted from the customer’s cash EBT account. 

The balance in the cash EBT account must be sufficient to cover the full 

amount of the transaction, which could include: the amount of the purchase, 

the amount of the cash to be withdrawn and the surcharge. If there are 

insufficient funds to cover all charges, the EBT system will deny the 

transaction. 

EBT – POS 

terminal listing 

for San 

Bernardino 

County 

A list of POS terminals that accept the Golden State Advantage EBT card will 

be distributed to all TAD district offices. This list is used so customers will 

know where they can access their cash benefits. The listing is in 

alphabetical order by city. 

Note: Customers can access their cash benefits anywhere the QUEST logo 

is displayed. 

Transaction fee After a customer has four cash withdrawal transactions in one calendar 

month at any POS location, the customer will incur transaction fee of $0.80 

(eighty cents) for each additional POS cash withdrawal transaction in the 

month. A transaction fee is not incurred when cash is received with the 

purchase of merchandise through a POS terminal. 


Elimination of Electronic Benefit Transfer (EBT) Cash Access 

at Certain Businesses 

Introduction This section contains a list of businesses whose Electronic Benefit Transfer 

(EBT) cash access at Automated Teller Machines (ATMs) or Point-of-Sale 

(POS) devices has been deactivated. 

Background The California Department of Social Services (CDSS) instructed California’s 

EBT service provider, Affiliated Computer Services, Inc. (ACS), to deactivate 

EBT access to ATMs located in gambling and adult establishments. These 

actions were taken to reinforce the intent of the CalWORKs Program, which 

is to help families meet their basic needs of food, clothing and shelter. The 

Department has identified locations that are inconsistent with this intent. 

List of affected 

businesses 

ACS has deactivated EBT cash access at ATMs and POS devices located in 

liquor stores not authorized by the United States Department of Agriculture 

Food and Nutrition Services (USDA-FNS) to accept CalFresh benefits as well 

as the following types of businesses: 

Bail Bonds 

Bingo halls 

Cannabis shops 

Cruise ships 

Gun/Ammunition stores 

Night clubs/Saloons/Taverns 

Psychic readers 

Race tracks 

Smoking shops 

Spa/Massage salons 

Tattoo/Piercing shops 

Locations Customers can obtain a list of ATMs for cash access in their zip code from 

the EBT website: www.ebt.ca.gov. 


Electronic Benefit Transfer (EBT) Card 

Introduction This section contains information regarding the Electronic Benefit Transfer 

(EBT) card. 

Background Electronic Benefit Transfer (EBT) is the automated delivery, redemption, and 

reconciliation of the CalFresh and CalWORKs benefits. It provides 

customers electronic access to CalFresh and cash benefits through the use 

of EBT cards at point-of-sale (POS) devices and automated teller machines 

(ATMs). 

Golden State 

Advantage card 

What is on the 

front of the 

card 

A magnetic-stripe plastic card is used to access the customer’s account in 

lieu of issuing cash warrants to purchase goods or services. 

The following features will be included on the front of the EBT card: 

• A four-color print 

• Printed: 

− The cardholder’s name 

− The cardholder’s Primary Account Number (PAN). The PAN will be 

unique for each card issued. 

• The CalWORKs/CalFresh case number below the name 

• A hologram 

• Fine-line printing below the hologram and containing a repetitive “ebt” 

Note: The CalWORKs/CalFresh case number includes the County number. 

Applicants will need a new EBT card even if they had a previous EBT 

account in another county or state. 



Electronic Benefit Transfer (EBT) Card, Continued 

What is on the 

back of the 

card 

How the card 

works 

The following features will be included on the back of the card: 

• A tamper-evident signature panel 

• The Quest® mark in the lower left-hand corner 

• The Customer Service toll-free number for reporting a lost or stolen card 

• The Retailer Assistance toll-free number so retailers may obtain manual 

voucher approvals 

• The TTY toll-free number so the hearing and speech impaired can use 

the telecommunications relay service 

• A return address for the EBT Vendor 

• Instructions that the Personal Identification Number (PIN) should not be 

written on the card 

• A statement of non-discrimination 

The cardholder will access the benefit account by swiping the EBT card 

through a Point of Sale (POS) terminal or Automated Teller Machine (ATM) 

and then enter a PIN. The EBT card number can also be manually keyed 

into a POS device when necessary. The following is a general description of 

the steps of a transaction: 

Step Action 

1 Connect on-line to the central processor database. 

2 Verify the validity of the: 

• PIN, 

• Card number, and 

• Amount of available benefits in an EBT account. 

3 Obtain authorization for each purchase. 

4 Initiate the debiting of the customer’s account and the crediting of 

the retailer’s account. 

5 Send the transaction information to the central processor for 

maintenance after the transaction has been completed. 



Electronic Benefit Transfer (EBT) Card, Continued 

Transaction 

authorizations 

ATM 

transaction 

fees 

POS 

transaction 

fees 

Retailers 

accepting EBT 

EBT transactions are authorized only if: 

• The transaction is initiated through a valid terminal, third party processor 

or network, 

• The retailer has a valid Food and Nutrition Services (FNS) authorization 

number (for CalFresh transactions), 

• The card authentication value is verified, 

• The card status is “active”, 

• The cardholder’s PIN is verified, and 

• There are sufficient funds in the account to cover the amount of purchase 

or cash withdrawal and any fees or surcharges that are the cardholder’s 

responsibility. 

If any condition is not met, the transaction is denied. The transaction 

response includes the reason for denial. When the denial is due to 

insufficient funds the transaction response includes the available balance. 

The EBT Vendor will not charge cardholders a transaction fee for the first 

four CalWORKs cash-only withdrawal transactions at ATMs per case per 

calendar month. After the first four withdrawals, the cardholder will be 

charged a .80-cent fee per ATM transaction. If a cardholder chooses to 

make a cash withdrawal at locations that impose additional surcharges, 

those charges are the customer’s responsibility and are deducted from the 

customer’s cash account. 

Cardholders may make an unlimited amount of cash purchases, including 

purchases with cash back, at retailers with point of sale (POS) devices with 

no charge from the EBT Vendor. POS operators may charge their own fees 

based upon store policy. California state law states EBT cardholders cannot 

be charged any transaction fees in excess of what state law allows or more 

than other customers are customarily charged. Therefore, if debit card 

customers are being surcharged $1.00 for conducting debit transactions at a 

POS device then EBT customers cannot be surcharged more than $1.00 at 

that same device for cash withdrawal transaction. 

Note: POS operators may never charge transaction fees on CalFresh 

purchases. 

The Quest® Mark is the sign on store doors, check-out lanes, ATMs and 

POS machines that tell customers an EBT card can be used at that store or 

machine. There are special pictures on the Quest® sign that tell what 

benefits can be used. 


Card Problems 

Introduction This section contains information regarding problems with the Electronic 

Benefit Transfer (EBT) card. 

Reporting lost, 

stolen or 

damaged cards 

Replacement 

cards 

Replacement 

timeframes 

PIN selection, 

change and 

unlock 

Cardholders can call the EBT Vendor Automated Response Unit (ARU) to 

report lost, stolen or damaged cards at 1-877-328-9677, a 24-hour-per day 

toll-free number. When a cardholder contacts the EBT Vendor, the EBT 

Vendor will immediately deactivate the card and will inform the cardholder to 

contact the County if a new card is needed. 

The EW can create a new EBT card, for mail out only if needed, via the EBT 

Card Detail page by selecting the reissue button. This cancels the current 

card and creates a new card. The button displays only when the card is in 

Issued or Cancelled status. 

California state law requires replacement EBT cards be provided within three 

(3) business days following a cardholder’s request for a replacement. 

The cardholder is allowed to select and change the PIN whenever he/she 

deems necessary. The cardholder may choose to change the PIN either 

through the EBT Vendor ARU at 1-877-328-9677or at the district office using 

the CAPS device. 

After four consecutive invalid PIN attempts in one day, the system will lock 

the card. If the cardholder requests to have the PIN unlocked the action will 

be taken through the administrative terminal by the EW. The caller must 

provide at least two verifiable items of information related to the primary 

cardholder’s demographics available through the administrative terminal, 

such as: 

• Name, 

• Address, 

• Social Security Number, or 

• Date of birth. 

Unless the customer contacts the EW or ARU to have the PIN unlocked 

earlier the PIN will automatically be unlocked at 12:00 midnight Pacific 

Standard Time of the same day of the fourth unsuccessful attempt. 


Returned Electronic Benefit Transfer (EBT) Cards 

Introduction This section contains information regarding returned Electronic Benefit 

Transfer (EBT) cards from the EBT Vendor. 

Cards returned 

report from the 

EBT Vendor 

EBT cards mailed to an undeliverable address will be returned to the EBT 

Vendor and will be destroyed. A report will be available on demand through 

the EBT Vendor. The table below lists the steps to follow when reconciling a 

Cards Returned Report. 


1 Supervising Office Assistant (SOA): 

• Retrieves the report from the EBT Vendor website daily. 

• Sorts the report by the EW number, and forwards the 

information to the appropriate EWS I. 

2 EWS I: 

• Distributes the report to the appropriate EW. 

• Instructs the EW to follow-up and return the report within a 

week with a brief explanation of actions taken. 

• Files the report in the unit and maintains the report for six 

months. 

3 EW: 

• Receives the report from the EWS I. 

• Accesses the Cardholder Information Management screen 

within the EBT Vendor website to review the address. 

• Does the EBT address match what is in C-IV? (Also Review 

the address reported on the most current application and 

QR7.) 

• Contact customer via phone or mail. 

− If contact is successful, verify address is correct and order 

a new Golden State Advantage (EBT) card for the 

customer. 

− If contact is successful, but is discovered that the address 

has changed, go to Step 5. 

• If returned mail is received, and attempts to contact the 

customer have failed, discontinue the case for loss of contact. 

• If the contact is successful but the customer’s address has 

changed, update the address on the Cardholder Information 

Management screen within the EBT Vendor website. Follow 

any additional steps taken when address changes occur. 



Returned Electronic Benefit Transfer (EBT) Cards, Continued 

Cards returned report from the EBT Vendor (continued) 


4 The EW inputs the current address within the EBT system if the 

address is correct in C-IV, but not on EBT and reorders a Golden 

State Advantage (EBT) card by: 

• Accessing the Cardholder Case Management screen. 

• Clicking CARD 

• On the Account Management – Card Issuance screen, 

selecting the: 

− Card issuance type: 

OTC (over the counter) 

Mail 

− PIN issuance type: 

Not to Mail 

Mail 

All cards should be mailed. However, if the customer has an 

emergency, an over-the-counter (OTC) card can be issued. 

5 OA documents action taken in C-IV. 


Cross-County Printing of EBT Cards 

Introduction Counties have the ability to print an EBT card in a county other than the 

county of issuance. This is called cross-county printing. 

When to use 

cross-county 

printing 

Process for 

former San 

Bernardino 

County 

customers 

New county 

resident, other 

County EBT 

account 

This section contains information when to use cross-county printing, and 

cross-county process. 

Cross-county printing will occur when: 

• A customer moves to another county, 

• Has benefits in his/her EBT account or benefits are owed to the 

customer, and 

• The EBT card is lost or stolen. 

When contacted by a former customer who reports his/her EBT card has 

been lost or stolen, and needs an EBT card, complete the following steps: 

Step Action 

1 Ask the customer in which city and county he/she is now living. 

2 Ask for a current telephone number where he/she can be 

contacted. 

3 Inform customer he/she will be contacted and told where to pick 

up his/her EBT card. 

4 Complete EBT 6 - Sections 1 and 4, “Issue HH/AU EBT card from 

___________County.” 

5 Send EBT 6 to the Authorized Issuance Office Assistant (AIOA). 


Note: Once the AIOA has completed the steps to print the card in the new 

county, they will contact the customer to let them know where and when to 

pick up his/her EBT card. 

When a customer has moved to San Bernardino County and requests an 

EBT card to access benefits from the former county, explain to the customer 

he/she should call his/her worker in the previous county and request a new 

card be printed through cross-county printing. 

The previous county of residence will issue a new EBT card through crosscounty 

printing, which will be printed in San Bernardino County. 


Electronic Benefit Transfer (EBT) Cardholders 

Introduction This section contains information regarding Electronic Benefit Transfer (EBT) 

Cardholders. 

Overview Each head of household or primary payee who receives CalFresh and/or 

cash aid benefits will receive an EBT card. Customers who receive cash aid 

benefits have an opportunity to apply for an exemption from EBT and 

continue to receive a warrant. There are no exemptions for CalFresh 

customers. 

Cardholder 

criteria 

The head of household/payee has the option of designating other people to 

have access to the household/assistance unit’s (HH/AU’s) benefits. Each 

cardholder will have his/her own EBT card and may select his/her own 

personal identification number (PIN). The cardholder uses the same EBT 

card and PIN to access CalFresh benefits and cash benefits. 

The head of household/caretaker relative (primary payee) will be the primary 

cardholder. In addition, the following persons may be issued an EBT card at 

the option of the payee: 

Each adult household/caretaker relative member (all, some or none) may be 

an Alternate Cardholder (ACH) with access to cash and/or CalFresh 

including: 

• One additional responsible adult outside of the HH/AU, 

• An EBT Authorized Representative (EBT AR) with access to CalFresh 

benefits, and/or 

• A Designated Alternate CardHolder (DACH) with access to cash benefits. 

If TAD determines no responsible adult is available to act as EBT AR or 

DACH, the head of household/caretaker relative may designate a minor to 

act in that capacity. A minor in the HH/AU may not be an ACH. 

EBT AR/DACH/ACH cards must be issued over the counter. 


Payee Changes 

Introduction Decisions about to whom aid is paid (primary payee) are made on a case-bycase 

basis. Each family presents a unique set of circumstances that must be 

evaluated to determine the correct actions to be taken when changing the 

payee on a case. 

Who gets the 

benefit 

Who is the 

primary payee 

Primary payee 

remains in the 

home 

The benefit is delivered (Accessed) only to the primary payee or otherwise 

according to the primary payee’s instructions [Designated Alternate 

CardHolder (DACH) for CalWORKs or an Alternate CardHolder (ACH) for 

CalFresh]. 

The primary payee on a CalWORKs case is the caretaker relative of the 

aided child(ren). The primary payee on a CalFresh case is the person 

designated as the Head of Household. 

When the primary payee remains in the home but requests another person 

becomes a payee, no change to the case number is necessary. 

The primary payee may provide access or not to their benefits by designating 

a DACH for CalWORKs or an ACH for CalFresh. 

Example: 

The primary payee (Grandma) is the head of household/caretaker relative 

and has care, custody, and control of the child(ren). Mom returns home. 

Mom must be aided under mandatory inclusion for both CalWORKs and 

CalFresh. Grandma continues to be the head of household/caretaker 

relative and continues to have care, custody, and control of the child(ren). 

Grandma can choose whether she wants Mom to have access to the benefits 

or not as Grandma is the primary payee. 



Payee Changes, Continued 

Continuation of 

benefits 

When the Eligibility Worker (EW) learns of the death of a caretaker relative of 

a child receiving CalWORKs benefits, the EW will determine whether the 

child remains eligible for CalWORKs benefits. 

If the child is… Then the EW will… 

Still eligible to receive CalWORKs 

benefits, 

No longer eligible for CalWORKs 

because the child is now living with a 

non-relative caretaker, 

Assist the child and the new 

caretaker relative with the process 

needed to ensure that benefits 

continue for the child (See change of 

Payee section in Chapter 1 of this 

handbook). 

Inform the non-relative caretaker 

that: 

• Foster Care (FC) benefits may be 

available for the child and refer 

them to the Foster Care Unit to 

apply 

• The local legal aid office or 

county bar association may be 

able to provide additional 

information and assistance in 

pursuing FC benefits. 


Designating an Electronic Benefit Transfer (EBT) Authorized 

Representative (AR) 

Introduction This section contains information regarding designating an Authorized 

Representative (AR), Designated Alternate Cardholder (DACH), or Alternate 

Cardholder (ACH). 

EBT 6 The customer completes an EBT 6 (EBT Card Issuance form) to request 

another individual receive an EBT card on their EBT account. This form is to 

be filled out by the customer when requesting a DACH/ACH or EBT AR. 

Both the customer and the requested DACH/ACH or EBT AR must sign the 

form. The Eligibility Worker (EW) must: 

Information 

required from 

the DACH/ACH 

or EBT AR 

Review of 

cardholders 

• Witness customer’s signature whenever feasible. 

• Check for valid signature on all mail-in forms. 

The signatures of customers using group home representatives as EBT ARs 

do not need a witness. 

A DACH/ACH or EBT AR is not required to divulge his or her Social Security 

Number or date of birth. If this information is not provided, the customer 

must be informed if the cardholder contacts the Automated Response Unit 

(ARU), the other cardholder will need to answer 000-00-0000 when prompted 

for the Social Security Number or 00-00-0000 for date of birth. 

During the yearly Re-Evaluation (RE), the EW must determine if the 

customer wishes to retain any other cardholders listed on the account. If the 

customer has no changes, no action is required. If the customer wants a 

change, the EW will take the appropriate action to make the change. 

Informing The EBT 6 is to be filled out by the customer when requesting a DACH/ACH 

or EBT AR. Upon receipt of a completed EBT 6 from a customer, the EW will 

review the form with the customer, verbally or face-to-face, the rights and 

responsibilities of a designated (DACH/ACH or EBT AR) cardholder. 

Changing or 

terminating an 

AR/DACH/ACH 

Only the primary payee has the option to change/discontinue the access of 

any EBT AR/DACH or ACH. If the payee calls to request discontinuance of 

an EBT AR, ACH or DACH, validate the person is the primary payee on the 

case and immediately have the appropriate clerical staff status the EBT AR, 

ACH or DACH card on the Administrative Terminal (immediate processing). 



Designating an Electronic Benefit Transfer (EBT) Authorized 

Representative (AR), Continued 

EBT Screen The customer may name one individual as an EBT AR and a different 

individual as a DACH or the same individual to act in both capacities. 

Notice of action Use the following Notices of Action to advise customers of action taken on a 

request for a DACH: 

• M16-505A – Approval of Request 

• M16-505B – Additional Information Needed 

• M16-505D – Denial of Request 


Unlinked Benefits 

Unlinked 

benefits/ 

demographic 

pending holds 

Unlinked 

benefit report 

When a benefit file is sent to the EBT Vendor through nightly batch, a 

demographic file must also be sent. The demographic file must reach the 

EBT Vendor first. If the benefit file arrives at the EBT Vendor before the 

demographic file, the benefits go into a pending benefits database because 

the benefits have no case (demographics) to link up to. When there are no 

demographics at the EBT Vendor, the benefits have no card to link to. This 

could happen if an action is taken on a case and something is rejected 

resulting in no demographic information being sent for the case. 

Auditing will send the Unlinked Benefits Report to each District Manual 

Issuance Coordinator (DMIC). The report is broken down by worker number. 

The DMIC will: 

• Pull the case record from C-IV for each case with unlinked benefits on 

the report. 

• Research why the demographics did not link up with the pending benefits 

at the EBT Vendor. 

− If the problem appears to be a system problem, call ITSD. 

− If the problem is incorrect information entered, make the appropriate 

corrections. 

• Check the next business day to ensure demographics were sent to the 

EBT Vendor and were linked to the benefits. 

• Access the EBT Vendor website and check Pending Benefits on the 

Benefit Management Screen to ensure there are no pending benefits for 

the customer and inform the EW of the outcome. 

• Document actions taken in C-IV. 

Note: Potential areas an error could occur are date of birth or Social 

Security Number (SSN) discrepancies when an account already exists in the 

EBT system. 


Electronic Benefit Transfer (EBT) Program Exemption 

Introduction This section contains information regarding EBT Program exemption. 

Exemption 

from EBT 

Exemption 

reasons/criteria 

How is an EBT 

exemption 

requested? 

State law provides CalWORKs cash assistance customers with an 

opportunity to request an exemption from the EBT system. If the exemption 

is granted, the customer will continue to receive a paper warrant. If 

circumstances change so the customer no longer needs the exemption, the 

exemption will be removed and the customer will receive CalWORKs benefits 

through EBT. 

Direct Deposit is an alternate method of issuance, and those customers 

who use Direct Deposit are exempt from CalWORKs EBT. 

Note: Per federal law, there are no exemptions from CalFresh EBT. 

The determination for exemption is made on a case-by-case basis on 

hardship to the customer. 

To continue to receive a warrant, an individual must demonstrate the inability 

to successfully use the EBT system. Use the following criteria to determine if 

a valid basis for exemption exists: 

• Permanent or temporary physical disability preventing successful use of 

the POS or ATM device required to access benefits via EBT. 

• Permanent or temporary mental disability preventing successful use of 

the POS or ATM device required to access benefits via EBT. 

• Primary language not English or Spanish and no Designated Alternate 

Card Holder (DACH) is available. 

• No DACH is available and customer is unable to access EBT. 

Note: All other options, including the use of another household member, a 

DACH, additional training, and Direct Deposit, must be explored with the 

customer before authorizing a warrant instead of EBT. In addition, if the 

customer receives CalFresh benefits, there is no exemption to EBT for 

CalFresh. 

The customer must complete the TEMP 2203 – EBT Exemption Request and 

submit it to the assigned Eligibility Worker (EW). 

The TEMP 2203 is forwarded to the District Manager (DM) or the designee 

who will make a determination of exemption from the EBT requirement within 

two business days. The form will then be returned to the EWS I. 

The exemption from the EBT requirements may be requested at any time. 



Electronic Benefit Transfer (EBT) Program Exemption, 

Continued 

Verification 

requirements 

Documenting 

the 

determination 

How is EBT 

reactivated? 

Why cash 

stagger? 

To allow an exemption from EBT, and allow issuance of a warrant based 

upon disability, the condition must be: 

• Readily apparent to the EW, or 

• Verified using the CW 61 signed by a medical doctor or licensed medical 

practitioner. 

If the condition is readily apparent to the EW or a current CW 61 is on file, no 

further verification is required. The EW must document the condition in the 

case journal. 

If new verification is required, the customer will have 60 days from the date of 

exemption request to provide a CW 61. During the 60-day period, the 

customer may receive cash benefits via a warrant pending the verification. 

Note: When the customer has made the effort to obtain the CW 61 and 

cannot provide the verification within the first 60 days, an additional 60-day 

extension may be granted. 

The DM or designee will document the determination on the bottom of the 

TEMP 2203. The TEMP 2203 is retained in the customer’s case file in the 

C-IV system. If the exemption is approved, Notice of Action (NOA) 16-325A 

will be mailed to the customer notifying them of the determination. 

When an EBT exemption ends, the customer has the option to choose either 

Direct Deposit or EBT. If the customer chooses Direct Deposit, the entries for 

Direct Deposit delivery override the EBT system. Notify the customer of the 

change using Notice of Action (NOA) M16-325D. 

State law requires CalWORKs benefits delivered via EBT be staggered over 

the first three days of each month to assure adequate cash availability for 

customers and to reduce the transaction traffic for the EBT system and cash 

access points such as Automated Teller Machines (ATMs) and store Pointof-Sale 

(POS) devices on the first day of the month. 



Electronic Benefit Transfer (EBT) Program Exemption, 

Continued 

What is an 

exemption from 

cash stagger? 

How does the 

customer 

request the 

exemption? 

How is the 

stagger 

exemption 

determination 

made? 

Criteria for 

exemption 

Documentation 

of the 

determination 

Based on the last digit of the case number, the EBT cash benefits will be 

available to the customer on either the 1 st , 2 nd , or 3 rd calendar day of the 

month. State law allows an exemption for individual customers from the 

three-day stagger requirement. 

If the customer is scheduled to receive cash benefits on the 2 nd or 3 rd 

calendar day of the month the customer has the opportunity to request an 

exemption from the stagger issuance. Customers exempt from the stagger 

issuance will receive CalWORKs benefits on the first calendar day of the 

month. 

The customer must complete the DPSS 3301-EBT Stagger Exemption 

Request to request an exemption to the stagger. The EW will make the 

determination of exemption from the stagger requirement. The EWS I must 

approve the exemption. 

The determination for exemption is made on a case-by-case basis on 

hardship to the customer as indicated on the DPSS 3301-EBT Stagger 

Exemption Request. 

Use the following criteria to assist in determining if a valid basis for 

exemption exists. If the benefit were received after the 1 st day of the month, 

the customer would: 

• Incur and be required to pay a “late” fee or penalty, 

• Suffer the termination of a service, 

• Have a significant health risk, or 

• Incur a negative impact on employment. 

All individual case factors are considered when the determination is made 

such as: 

• Unearned income available, 

• Earnings available, and 

• Length of exemption. 

The determination decision must be documented on the DPSS 3301-EBT 

Stagger Exemption Request and signed by both the EW and the EWS I. A 

journal entry will be made. 


Request for State Hearing/Appeal 

Introduction This section contains information regarding the request for a State 

hearing/Appeal for Electronic Benefit Transfer (EBT) for denial of exemption 

to: 

• EBT cash, or 

• The three-day stagger. 

Request for 

hearing/Appeal 

CalWORKs and General Relief customers can apply for either an exemption 

from: 

• EBT for cash altogether, or 

• The stagger if the three-day stagger will affect them and create a 

financial hardship. 

If the Eligibility Worker (EW) denies the customer the requested exemption, 

the customer can request a State hearing/appeal using regular 

hearing/appeal request processes. 


Electronic Benefit Transfer (EBT) Inactive, Dormant, and 

Expunged Accounts: General Information 

Introduction This section contains information regarding general information on Electronic 

Benefit Transfer (EBT) inactive, dormant, and expunged accounts. 

General 

information 

Customer 

notification 

EBT accounts are based on the type of benefit. For example, a person with 

both CalWORKs and CalFresh benefits would have two accounts – one for 

CalFresh and one for CalWORKs. 

One account becoming inactive or dormant or having benefits expunged 

does not affect the other account. For example, a customer’s CalFresh 

account may remain active even when the same customer’s CalWORKs 

account becomes dormant. As long as a customer performs an EBT 

transaction within each program at least once every 134 days, the EBT 

account will remain active. 

The EBT Vendor electronically notifies TAD when an account is inactive, 

dormant, or expunged. A Notice of Action (NOA) is generated to inform the 

customer the account has had no activity within a specified amount of time. 

Reports A report is available each month on the EBT Vendor website showing 

inactive and dormant EBT accounts. Office Assistant staff in each district 

office must print this report each month for distribution to appropriate staff. 

Definitions Inactive Account: An account that has not been accessed by the customer 

within 135 -179 days. 

How can I find 

an account 

status? 

Dormant Account: An account that has not been accessed by the customer 

within 180 - 364 days. 

Expungeable Account: An account that has not been accessed by the 

customer within 365 days or more. 

Eligibility Workers will be able to find account status via the EBT Account 

Detail page in manual create mode. The EW will be able to: 

• Search for an EBT account in the EBT Vendor system by the account 

number. The account and card information for that account number will 

be displayed. 

• Add the account and card information retrieved from the EBT Vendor 

system into C-IV. 

• Choose if the account will be an ongoing account or to add begin and 

end dates if the account is not an ongoing account. 


Inactive Accounts 

Introduction This section contains information regarding inactive accounts. 

When an 

account 

becomes 

inactive 

Action taken to 

reactivate an 

inactive 

account 

An account becomes inactive when there is no account activity by the 

customer within 135 – 179 days. The County can continue to deposit 

benefits into an inactive account. 

The customer retains access to benefits while the account is inactive. The 

sole action required to reactivate the account is to have the customer access 

benefits. 

Example: Mary has not used her cash aid account in 150 days. She makes 

a purchase at her local store using her CalFresh EBT account. This 

transaction will reset the account to an active status effective the date of the 

transaction. 


Dormant Accounts 

Introduction This section contains information regarding dormant accounts. 

When an 

account 

becomes 

dormant 

Who. 

Reactivates the 

dormant 

account? 

Overissuance 

collection 

Action required 

to reactive a 

dormant 

account 

An account becomes dormant when not accessed within the last 180 - 364 

days. Benefits in a dormant account are inaccessible. Reapplication cases 

with a previous EBT account may also be dormant. The EBT card itself may 

still be valid while the account is dormant. TAD may continue to deposit 

benefits into a dormant account. 

Eligibility Workers (EW) can reactivate a dormant account on reapplications 

and Immediate need situations via the Account Detail page. The Account 

Detail page has been modified to have a View, Create and Manual Create 

mode. The Reactivate button only displays if the account is in Dormant or 

Expunged status, and selecting the Reactivate button sends a request to the 

EBT Vendor to reactivate the account type. 

CalFresh over-issuances may be collected from dormant EBT accounts by 

providing the household written notification it intends to apply the stale 

benefits to any outstanding claim. 

A dormant account will not be reactivated until a customer contacts the 

County to request reactivation. Reapplication for CalWORKs and/or CalFresh 

is a request to reactivate the account. When the customer calls to say they 

do not have access to their account take the following actions: 

Step Action 

1 The EW accesses the EBT Account Detail page in view mode. It 

will show the current and historical information related to the EBT 

Account. If the account is in dormant status the Reactivate button 

will be displayed. The EW will select this button to send a request 

to the EBT Vendor to reactive the account. 

2 If the account is dormant, discuss with the customer the reasons 

the account is inaccessible, asking: 

• Why the account was not accessed within the last 180 days 

• How the customer met their expenses during that period 

• The accuracy of information such as primary and alternate 

names and card number 

3 Journal the questions to and answers from the customer in the 

journal. 

4 Remind customers when a customer has both a CalWORKs and 

CalFresh account; both accounts must be accessed at least once 

every 180 days. 



Dormant Accounts, Continued 

Follow-up 

actions 

Supervising Office Assistants (SOAs) in the district offices will receive a 

weekly report (Dormant Account Report) with all programs in which an 

account was reactivated. The SOA will: 

• Compare the log against the weekly detail report of all activated dormant 

accounts. 

• Provide documentation that each reactivation was reviewed. 

All dormant cases with $2000 or more in benefits will be referred to the 

District Manager (DM) for review immediately after the release is affected. 


Expunged Accounts 

Introduction This section contains information regarding expunged accounts. 

What are 

expunged 

benefits? 

When do 

benefits 

become 

expunged? 

Can expunged 

benefits be 

returned to the 

customer? 

Returning 

expunged 

benefits 

Expunged 

benefits and 

overpayments/ 

overissuances 

Expunged benefits are benefits removed from an EBT account and 

returned to the County, after 365 days of nonuse. 

Benefits are expunged from accounts after 365 days of nonuse. Benefits 

expunge on a daily basis. For example, if CalWORKs benefits were 

available on March 1 st and April 1st and never used, the March 1 st benefits 

would expunge 365 days after March 1 st while the April 1st benefits would 

expunge 365 days after April 1 st . 

Upon request by the customer, benefits may be returned to the customer. 

There is no time limit on when a customer can request the return of 

expunged cash benefits. 

When a customer contacts the department to request the replacement 

(reactivation) of an expunged cash benefit, the EW researches and 

reactivates the account to reissue those benefits. The expunged benefits 

can be accessed via the EBT Account Detail page, which displays only if the 

account is in dormant or expunged status. 

Expunged cash benefits may not be used to offset cash aid overpayments, 

and/or CalFresh overissuances. 


Resource and Residence Determinations 

Introduction This section contains information regarding resource and residence 

determinations. 

Resource 

determination 


when a 

customer’s 

name appears 

on the inactive, 

dormant report 

Residence 

determination 

Eligibility and Assistance Standards (EAS) 42-302.2 defines liquid resources. 

Included in this definition is the balance left over in a cash Electronic Benefit 

Transfer (EBT) account after the month for which the benefit was intended 

and should be treated in the same way as cash on hand. This cash balance 

applies to both CalWORKs and CalFresh resource determinations. 

When a case name appears on the Inactive/Dormant EBT Account Report, 

the Eligibility Worker (EW) will review the case for resource eligibility adding 

any EBT balance, less any benefit for the current month for the QR Data 

Month following Quarterly Reporting regulations. 

Example: Fred’s case appears on the Dormant EBT Account Report for 

September for CalWORKs. Fred has $895 in the cash aid account. $325 of 

the balance is the benefit issued for September. The EW subtracts $325 

from $895 to determine $670 balance of benefits in the account issued July 

and August. The $670 balance is added to other resources to determine if 

Fred remains under the resource limits. 

Because CalWORKs benefits are rarely mailed, returned warrants no longer 

provide a viable method to track residence. The following information may 

be used to track the residence of a customer: 

• Nonuse of EBT benefits, as in a dormant account. 

• EBT transaction reports revealing out-of-county or out-of-state purchases 

made by the customer. 

When the EW suspects the customer is no longer a resident of this county, 

the EW should attempt to contact the customer to clarify his/her residence 

prior to completing a referral for fraud investigation. 


Overview 


Introduction Legislation requires counties who offer Direct Deposit services to employees 

to offer the service to CalWORKs recipients. Included in this section is 

information about Direct Deposit processes. 

The Direct Deposit system is a voluntary program, available to all CalWORKs 

customers with open checking or savings accounts, allowing customers to 

have their cash benefits deposited directly into their personal bank accounts. 


• EAS 44-302 



Direct Deposit: General Information 13.41 

Direct Deposit: Definitions 13-42 

Direct Deposit: What to tell the Customer 13-43 

Direct Deposit: Process 13-46 

Rejected Deposits 13-48 

Verifying Direct Deposit 13-50 

Direct Deposit: System Errors 13-51 

Direct Deposit: Miscellaneous 13-52 


Direct Deposit: General Information 

Introduction Legislation requires counties who offer Direct Deposit services to employees 

to offer the service to CalWORKs recipients. 

Advantages of 


The Direct Deposit system is a voluntary program, available to all CalWORKs 

customers with open checking or savings accounts, allowing customers to 

have their cash benefits deposited directly into their personal bank accounts. 

Direct Deposit has advantages for both the County and the customer. 

For the County, Direct Deposit eliminates the costs of: 

• Printing and mailing warrants, and 

• Lost, stolen, or damaged warrants that need to be investigated and 

resolved. 

For the customer, Direct Deposit: 

• Is reliable - the money will be in the account. 

• Is convenient - no waiting for the check to be delivered and then finding a 

place to cash it. 

• Is safe because: 

– There are no lost or stolen warrants (and no waiting for replacement), 

and 

– Cash withdrawals can be for amounts needed, thus need to carry less 

cash. 

• Is cost saving - no check cashing fees. 

• Encourages a conventional link to the community, which promotes 

self-reliance. 

• Ensures the customer’s benefits are available on the first of each month. 

With Electronic Benefit Transfer (EBT), the customer’s benefits might be 

delayed until the second or third of the month due to the staggering of 

EBT issuance. 

Process Cash benefits are sent as an Electronic Fund Transfer (EFT) from HSS 

Auditing to Wells Fargo Bank’s Automated Clearing House (ACH). The ACH 

then transfers the money to the customer’s bank. 


Direct Deposit: Definitions 

Definitions ACH (Automated Clearing House): A fund transfer system that provides 

for the inter-bank clearing of electronic entries. For San Bernardino County, 

Wells Fargo bank provides the service. 

Addenda Record: A deposit description sent with the EFT to the bank. It 

includes information that identifies the deposit. This information may be 

printed on the customer’s bank statement, by the bank, to help identify the 

deposit. 

Bank Account: Any checking or savings account owned by a customer and 

maintained by a financial institution such as a bank, credit union, or savings 

and loan. 

Direct Deposit: Issuance of a customer’s CalWORKs benefits to his or her 

personal bank account. 

EFT (Electronic Fund Transfer): The electronic process of sending case 

benefit monies through the ACH to the customer’s bank account. 

Participant: Any payee who requests Direct Deposit. 

Prenote: The process of setting up new Direct Deposit service by sending 

the customer’s information through the ACH to the participant’s bank. 

Reversal: The action taken by the County to obtain funds that were 

transferred and deposited in error back from the participant’s bank account. 

Settlement Date: The date cash funds are available to the customer in his 

or her bank account. 


Direct Deposit: What to tell the Customer 

General 

information 

In order to participate in Direct Deposit, the customer/payee must: 

• Have a bank account. The name on the bank account must match the 

payee. Joint accounts are acceptable as long as the payee’s name 

matches one listed on the account. If the payee’s name is not listed on 

the check or bank statement provided as verification, a note of 

explanation must be provided from the bank. 

• Complete the HSS 27 - Direct Deposit Request Form, attaching a voided 

check or including the savings account number and other required bank 

information. 

It is important customers are made aware of the following: 

• Participation in Direct Deposit is voluntary. 

• No fee is charged by the County or the ACH to transfer funds directly to a 

personal bank account. 

• The HSS 27 is the only form that will be accepted for Direct Deposit 

requests. 

• Separate deposits will be made for each CalWORKs supplement issued. 

• Direct Deposit can be stopped at anytime upon the customer’s request. 

Note: All correspondence will continue to be sent to the customer’s home 

address. If the customer is homeless, all correspondence will continue to be 

sent to the appropriate district office. 



Direct Deposit: What to tell the Customer, Continued 

Hints for 

finding the 

right bank 

account 

Opening a bank 

account 

Many customers do not own a bank account. Others may wish to “shop” for 

a bank account that is the most economical. 

It is TAD’s intention customers incur as little expense as possible to access 

their benefits. Eligibility Workers (EWs) should offer pointers to customers 

on how to find the right account for their needs and avoid unnecessary 

expenses. 

Here are some questions for customers to ask banks that may help in finding 

the best deal: 

Are fees charged, and how much is charged, for: 

• Monthly service, or it is waived because of direct deposit 

• A balance less than a required minimum balance 

Example - Savings account X is charged $1.00 a month when the 

balance drops below $100.00. 

• ATM withdrawals 

• Check printing 

• Bounced checks 

• Cashier or bank checks 

• Money orders 

• Stop payments 

Other questions: 

• What is the minimum deposit needed to open an account? 

• How often are savings account statements sent? 

• How do I qualify for an interest bearing account, and what is the interest 

rate on accounts? 

• Is there unlimited check writing? 

• Is ATM service available? 

• Are ATM machines conveniently located? 

• How much money can be withdrawn through the ATM per day? 

Normally the banking institution will require: 

• Photo identification - Driver’s license, California ID or passport is best, 

• A minimum deposit, and 

• A background check on the individual’s banking history. 

Note: If a customer does not qualify for a checking account due to prior 

banking problems, he or she may be able to open a savings account instead. 



Direct Deposit: What to tell the Customer, Continued 

Participating in 


When will the 

first benefits be 

deposited? 

Notification of 


Participating in Direct Deposit is easy. The customer must complete the 

HSS 27 - Direct Deposit Request Form and attach a voided check from the 

checking account, a copy of the savings account statement, or letter from the 

bank with the bank name, bank account number, and names listed on the 

account. 

If the customer has a newly opened checking account with temporary checks 

only (no personal account information printed on checks) a letter from the 

bank with information listed above must be provided. 

The following items are not acceptable verification of the account: 

• ATM slips 

• Deposit slips 

• Temporary checks 

Note: A check is voided by having the customer write “VOID” in capital letters 

across the front of the check. 

The initial process takes a maximum of 11 calendar days from the time HSS 

Auditing receives the HSS 27 and inputs the prenote. The first deposit will 

occur at the next benefit issuance (regular or supplemental payment) 

following the set-up of the prenote. 

Example: HSS 27 received by HSS Auditing on 7/9, Direct Deposit effective 

7/20 for any benefit issuance. 

The customer will receive a letter confirming or rejecting the Direct Deposit 

request with a copy sent to the EW, approximately 10 to 15 calendar days 

after the HSS 27 is submitted. 

Deposit days When the first of the month aid payment is due on a Saturday, Sunday, or a 

Monday banking holiday, the funds will be deposited the prior Friday (or the 

prior Thursday if Friday is also a banking holiday). 


Direct Deposit: Process 

Signing up for 


To begin the Direct Deposit process, the customer must complete the 

HSS 27 - Direct Deposit Request Form. 

It is critical all information on the HSS 27 be accurate. Any errors may 

cause the request to be rejected from the ACH or, in the worst case, allow 

money to be deposited in the wrong account. 

The table below explains the process for setting up Direct Deposit: 


1 Customer: 

• Completes the HSS 27 - Direct Deposit Request Form 

sections I and II. 

• Attaches voided check, copy of savings account statement, or 

statement from the bank including the bank’s name, account 

number, and customer’s name. The following items are not 

acceptable verification of the account: 

− ATM slips 

− Deposit slips 

− Temporary checks 


• Reviews HSS 27 for completeness and accuracy. 

• Gives goldenrod copy to customer. 

• Retains pink copy in case record. 

• Continuing: Forwards original and canary copy to HSS 

Auditing, with account verification attached. 

• Intake: Retains original and canary copy with account 

verification attached in case record until CalWORKs is Active 

in C-IV, then forwards to HSS Auditing. 

• Narrates the action taken in the case journal. 

3 HSS Auditing Reviews HSS 27 for completeness. 

• If not complete, rejects and returns the canary copy of the 

HSS 27 and account verification to the EW. 

• If complete, processes the HSS 27 request and sets up a 

prenote to confirm account information with the bank. 

• If prenote rejects, sends the DD 4500D (FIN 201 CIV) reject 

letter to the customer with a copy to the EW, advising Direct 

Deposit has been rejected. 

• If no response is received within 10 calendar days or the 

prenote is accepted, sets up Direct Deposit for transmittal of 

cash benefits into the customer’s bank account effective with 

the next payment issuance and sends DD 4500A (FIN 200 

CIV) letter to the customer with a copy to the EW advising that 

Direct Deposit has been set up. 



Direct Deposit: Process, Continued 

Prenote 

process 

Prenote 

rejects 

The prenote is the process of setting up Direct Deposit service so the 

benefits go directly through the ACH to the customer's bank account. The 

customer's account information is sent to the bank for confirmation, and HSS 

Auditing waits 10 calendar days for a response: 

If … Then … 

A response is not received 

from the customer’s bank 

after 10 calendar days, 

The prenote rejects for any 

reason, 

The prenote rejects 

because the customer’s 

bank is not capable of 

receiving the EFT 

transaction, 

Direct Deposit goes into effect with the next 

benefit issuance. 

A DD 4500D (FIN 201 CIV) – Direct Deposit – 

Rejected letter will be sent to the customer 

with a copy to the EW. The customer’s 

benefits will continue to be mailed until the 

problem has been corrected. 

Direct Deposit will not be possible. 

When a prenote process problem occurs, the ACH informs HSS Auditing. 

HSS Auditing will review the HSS 27 and look for data entry errors. If an 

error is found, it is corrected and the prenote request is resubmitted to the 

ACH. When HSS Auditing cannot identify any problem, the table below 

explains the process: 


1 HSS Auditing: 

• Sends the DD 4500D (FIN 201 CIV) reject letter to the 

customer with a copy to the EW. 

• Returns the canary copy of the HSS 27 with account 

verification to the EW, with reason for rejection noted. 

2 Customer: 

• Corrects the problem. 

• Completes a new HSS 27 with correct information and 

attaches voided check, or copy of savings account statement 

or statement from the bank that includes the bank’s name, 

account number, and customer’s name. 

3 EW: 

• Submits new HSS 27 to HSS Auditing, with previously 

rejected canary copy attached. 

• Narrates action taken in the case journal. 

4 HSS Auditing inputs the new HSS 27. See Signing Up for Direct 

Deposit section in this Chapter. 


Rejected Deposits 

Rejected 

EFT deposits 

The customer’s bank may occasionally reject Direct Deposit funds. This may 

occur during the first transaction because of a problem not identified when the 

Direct Deposit was set up, or after the process has been working for a time for 

reasons such as a closed bank account or a change in account number. 

When an EFT deposit is rejected, the bank will return the funds through the 

ACH to HSS Auditing. HSS Auditing will review the HSS 27 and look for data 

entry errors. If an error is found, it is corrected and the deposit is resubmitted 

to the ACH. 

If the problem cannot be identified, the table below explains the process: 



• Returns the canary copy of the HSS 27 with account 

verification attached to the Eligibility Worker (EW), if the action 

is a first-time Direct Deposit. If the action is not a first-time 

deposit, the HSS 27 is not returned, and 

• Cancels Direct Deposit benefits and reissues benefits via 

Electronic Benefit Transfer (EBT), and 

• Sends the DD 4500D (FIN 201 CIV) reject letter to the 


2 

If customer … Then customer … 

Doesn’t know why the 

deposit rejected, 

Knows why the 

deposit rejected, 

• Contacts the bank to verify 

account information, and 

• Submits a new HSS 27 with the 

correct information to the EW. 

• Corrects the problem, and 

• Submits a new HSS 27 with 

correct information to the EW. 

3 EW: 

• Submits the new HSS 27 to HSS Auditing, with the previously 

rejected canary copy attached. 

• Narrates action taken in the case journal. 

4 HSS Auditing inputs the new HSS 27. See Signing Up for Direct 

Deposit section in this Chapter. 



Rejected Deposits, Continued 

EBT issuance Benefits will be issued via EBT when the EFT rejects. 

In case of EFT reject, the DD 4500D (FIN 201 CIV) – Reject letter will be sent 

to the customer with a copy to the EW. 

When the EFT rejects, the HSS Auditing Clerk will call the EW. The EW is to 

contact the customer, if a telephone number is available, and inform him or her 

benefits are being issued via EBT. The customer may receive the EBT 

benefits prior to receiving the DD 4500D (FIN 201 CIV). 


Verifying Direct Deposit 

Identifying 


participants 

Verifying EFT 

deposit via 

bank contact 

Verify benefits issued through Direct Deposit by referring to the Issuance 

Search page for the customer’s name (payee) or Case Number. For Direct 

Deposit payments, the Issuance Method will be listed as “Direct Deposit”. 

The customer can verify Direct Deposit by calling their bank or by checking 

their monthly statement. 

Some banks routinely identify the origin of each deposit, called an addenda 

record, on the monthly statement. If the bank does not do this, the 

participant can request their bank give itemized deposit information on the 

bank statement. Not all banks will accommodate this request. 


Direct Deposit: System Errors 

Systems errors 

in benefit 

amounts 

Very rarely, a systems error can occur that causes the payment amount to be 

more or less than the amount budgeted. 

If the error in payment is less than budgeted, the Eligibility Worker (EW) will 

issue a supplemental payment when the underpayment is identified. 

If the error in payment is more than budgeted, HSS Auditing will determine 

whether a reversal action should be initiated. Reversal action will be initiated 

on overpayments $500.00 or more (based on cost effectiveness). If reversal 

action is initiated, HSS Auditing will: 

• Initiate reversal action, 

• Send DD 4500F (FIN 205 CIV) – Direct Deposit – Reversal letter to the 

customer with a copy to the EW, and 

• Notify the EW of the reversal action. 

When HSS Auditing determines reversal action is not to be taken (the 

overpayment amount is less than $500.00) or the reversal process fails 

because the benefits are withdrawn by the participant before they can be 

reversed out of the account, the following action is taken: 


1 HSS Auditing emails the EW and provides: 

• Payee name, 

• Case number, 

• Amount of cash aid the customer was eligible to receive, 

• Amount of cash aid actually received by the customer, and 

• The month/year of the excess payment. 

2 EW: 

• Follows procedures listed in the Overpayment section of the 

Budgeting Chapter, and 

• Ensures that the following items are filed in the customer’s 

case record: 

− HSS e-mail, and 

− A narrative entry in the case journal regarding the 

overpayment. 


Direct Deposit: Miscellaneous 

Funds not 

deposited 

When funds are not received into the customer’s account, the table below 

explains the process: 


1 Customer: 

• Contacts the bank to verify: 

− The account is open, and 

− The deposit has not been received. 

• Contacts the Eligibility Worker (EW) to report the funds were 

not deposited into the account. 

2 EW: 

• Confirms the bank account information is correct. 

• Checks the C-IV system to ensure: 

– Benefits are due, and 

– Issuance was sent Direct Deposit and not issued as a 

warrant. 

• If no reason is found for deposit failure, contacts HSS Auditing 

Management Reporting Unit at (909) 383-9734 and advises of 

need to have deposit traced. The following information must 

be provided: 

– Case name and number, 

– Payee name, 

– Direct Deposit control number, 

– Direct Deposit issue date, 

– Bank account number, and 

– Date the customer contacted the bank regarding the nonreceipt. 


• Contacts ACH to have the deposit traced. 

• Reissues the benefit to the customer, as needed. 

Banks take one (1) to five (5) days to respond to the County regarding a 

traced deposit. HSS Auditing will treat traces as a priority and will reissue 

benefits, if necessary, as soon as a response is received. 



Direct Deposit: Miscellaneous, Continued 

Stopping 


When a customer decides to stop the Direct Deposit service or closes the 

bank account the EFT is being deposited into, the table below explains the 

process: 


1 Customer: 

• In office: Completes form HSS 27 sections I and III, and 

checks "cancellation" box, or 

• By telephone: Requests EW stop Direct Deposit. 

2 EW: 

• Advises the customer next payment may be late. 

• In office request: Completes HSS 27 section I. 

• Telephone request: 

– Reads the statement in Section III to customer and asks if 

he or she understands, 

– Completes HSS 27 sections I and III, checking 

"Cancellation" box and signing and dating the affirming 

statement and payee acknowledgement. 

• Mails the goldenrod copy to customer. 

• Files the pink copy in the case record. 

• Forwards the original and canary copy to HSS Auditing. 

• Narrates the request and action taken in the case journal. 


• Stops Direct Deposit. 

• Send DD 4500C – Direct Deposit – Stopped letter to the 





Changing 

banks 

Banking 

problems 

Vendor 

payment cases 

A new HSS 27 Direct Deposit Request Form must be completed when a 

customer changes accounts or banks. The table below explains the process: 


1 Customer: 

• Completes HSS 27 sections I and II, and checks “change” 

box. 

• Attaches voided check, copy of savings account statement, or 

statement from the bank that includes the bank’s name, 

account number, and customer’s name. 

2 EW: 

• Reviews HSS 27 for completion. 

• Gives goldenrod copy to customer. 

• Retains pink copy in case record. 

• Sends original and canary copy to HSS Auditing, with new 

account verification attached. 


• Stops Direct Deposit on old account. 

• Starts Direct Deposit on new account. 

• Sends DD 4500B (FIN 202 CIV) – Direct Deposit – Change 

letter to customer with a copy to the EW. 

EWs are responsible for ensuring benefits are correct and issued timely. 

Once the EFT has been sent and received by the bank, problems or 

concerns the customers may have about their bank accounts must be 

discussed by the customers with their bank. 

Direct Deposit service is available to vendor payment CalWORKs customers 

if there are remaining benefits to be issued to the customer after the vendor 

payment is made. 




Contingency 

plan 

In the unlikely event the County is unable to transmit a Direct Deposit file to 

initiate EFT within a reasonable amount of time, a contingency plan has been 

developed. This plan provides for issuing EBT benefits to Direct Deposit 

customers on a one-time only basis, so payments are not unnecessarily 

delayed. 

The chart below outlines the contingency plan process. 


1 HSS Auditing/ITSD: 

• Determines that a Direct Deposit file needs to be cancelled 

and reissued. 

• Takes action to cancel Direct Deposit. 

• Reinstates Direct Deposit for all cancelled customers for next 

benefit issuance. 

• Sends DD 4500E – Direct Deposit – Contingency letter to 


2 C-IV system: 

• Issues EBT benefits to all customers for whom Direct Deposit 

was cancelled. 


RESERVED 

FOR 

FUTURE USE 


RESERVED 

FOR 

FUTURE USE 


RESERVED 

FOR 

FUTURE USE 


Overview 

Warrants 

Introduction State law provides each CalWORKs cash assistance customer with an 

opportunity to request an exemption from Electronic Benefit Transfer (EBT). 

If the exemption is granted, the customer will continue to receive a paper 

warrant. Once the exemption is granted, this section includes information 

regarding: 

• Stop Payments 

• Semimonthly warrants 

• Counter warrants and warrant pick-up 

• Priority mail outs 

Exemption 

from EBT 

See Electronic Benefit Transfer (EBT) Program Exemption in this Chapter for 

more information on making the determination whether or not a customer is 

eligible to receive a paper warrant. 


• ACL # 86-07 and 00-24 



Stop Payments 13-60 

Counter Warrants and Priority Mail-out Warrants 13-63 

Returned Warrants 13-66 

Warrant Pick-up 13-67 


Stop Payments 

Overview There are times when a customer states his/her warrant has been lost, 

stolen, or destroyed. Use the procedures on the following pages when this 

happens. Stop payments can be done on a customer’s CalWORKs 

payments/warrants. 

Note: The Department of Child Support Services (DCSS) completes stop 

payments on Child Spousal Support Disregard (CSSD) payments/warrants. 

Policy A warrant is considered lost if the customer has not received it within two 

mail days. The customer may sign the HSS 50A on the second mail date, 

providing it is after the time the customer’s mail has been delivered. 

Non-receipt of 

warrant issued 

by San 

Bernardino 

County 

If the warrant was stolen, destroyed, or lost other than in the mail, the 

customer may sign the stop payment affidavit immediately. 

A replacement warrant is to be issued within five working days after the stop 

payment declaration is signed, even if it has been determined that the 

warrant was not lost, stolen, or destroyed. However, in most cases Auditing 

will process the stop payment and issue a replacement warrant within two 

days. 

When the customer lives in San Bernardino County and reports non-receipt 

of a warrant issued by San Bernardino County, the process in the table 

below is followed: 



• Verifies the customer’s current address 

• Determines whether the warrant was issued. If not issued, the 

EW will complete actions to issue warrant. 

2 Customer comes into the office to complete an HSS 50A 

Stop/Release Payment Declaration. 

3 EW: 

• Informs the customer to contact his/her worker immediately if 

the original warrant is received. 

• Authorizes the replacement warrant and forwards the 

HSS 50A to Auditing. 

4 Auditing issues the replacement warrant within five working days 

after the HSS 50A is signed. However, in most cases Auditing will 

process the stop payment and issue a replacement warrant within 

two days. 

When an EW receives a DFA 874 (Statewide Intercounty Lost Warrant 

Replacement Affidavit) from another county, follow Steps 2 through 4 of the 

chart above replacing references to the HSS 50A with the DFS 874. 



Stop Payments, Continued 

Non-receipt of 

warrant issued 

by another 

county 

Original 

warrant is 

received after 

stop payment 

forms are 

completed 

Original 

warrant and 

replacement 

warrant both 

cashed 

When the customer lives in San Bernardino County and reports non-receipt 

of a warrant issued by another county, the process in the table below is 

followed: 


1 Customer comes into the office to complete a DFA 874 Statewide 

Intercounty Lost Warrant Replacement Affidavit. 

2 EW immediately mails, within one working day, the original copy 

of the DFA 874 to the county that issued the warrant. 

Once the customer has completed the stop payment forms, he/she is not to 

cash the original warrant until the EW has been contacted. If the customer 

receives the warrant, the EW will contact Auditing to determine if the stop 

payment can be halted. 

• If the stop payment can be halted, the customer can cash the warrant 

and Auditing will return the HSS 50A/DFA 874 to the EW to be voided. 

• If the stop payment cannot be halted, the EW will advise the customer to 

return that warrant and wait for the replacement warrant. 

The EW will narrate the action taken in the case journal. 

If both the original and replacement warrants are cashed, the process in the 

table below is followed: 


1 Auditing forwards photocopies of both warrants and the 

HSS 50 A to the Quality Review Unit (QRU). 

2 Quality Review Specialist (QRS) contacts the customer and 

schedules an appointment for review of the documentation. 

• If the customer cashed both warrants, the QRS will compute 

an overpayment and an IPV may be pursued. 

• If the customer did not cash both warrants, a Declaration of 

Forgery is completed and forwarded to Auditing; Auditing then 

forwards one copy of the Declaration of Forgery to the vendor 

that redeemed the forged warrant. 



Stop Payments, Continued 

Exception to 

the two mailing 

days 

If the customer has an emergency, such as a pending eviction, utilities will be 

turned off, etc., he/she can complete the stop payment affidavit on the first 

mailing day, and pick-up the warrant at Auditing the next day. In extreme 

situations, the customer may pick-up the warrant the same day with the 

Deputy Director or in-charge’s approval, written on the HSS 50A. If the 

Deputy Director/in-charge’s approval is not written on the HSS 50A, the 

customer will not be allowed to pick-up the warrant. 


Counter Warrants and Priority Mail-out Warrants 

Introduction In the situation where a customer meets the EBT exemption, a counter 

warrant or priority mail-out warrant can be issued at Intake when an applicant 

has an emergency situation. In the situation where a customer meets the 

EBT exemption a Continuing CalWORKs program counter warrant can also 

be issued to meet State imposed deadlines. 

For specific eligibility requirements refer to the Immediate Need section in the 

Application Chapter of this Handbook. 

Definitions A counter warrant is a process that allows the applicant or recipient customer 

to go to Auditing to pick up the warrant. 

A priority mail-out is a process that allows a warrant to be issued within three 

days. 

C-IV “coding” When running EDBC (Eligibility Determination and Benefit Calculation) in 

C-IV, the Eligibility Worker (EW) has two options for Delivery Method and two 

options for Immediacy Indicator. 

Use the Delivery Method of: 

• “Pickup” for Counter Warrants, and 

• “Mailout” for Priority Mail-outs. 

• 

Use the Immediacy Indicator of “Rush” for both Counter Warrants and 

Priority Mail-outs. 

Note: Running EDBC with an Immediacy Indicator of: 

• Rush means the warrant will print that day, and 

• Routine means the warrant will print the next day. 



Counter Warrants and Priority Mail-out Warrants, Continued 

Intake In the situation where a customer meets the EBT exemption, the Intake 

Eligibility Worker (EW) will follow these procedures to determine whether to 

take a priority mail-out or counter warrant action: 

If the situation is … Then the action is … And the level of 

approval is … 

Intercounty Transfer • Priority mail-out. 

(ICT) 

• Counter warrant can only be 

issued if payment cannot be 

received by the 1 st EWS I 

by doing a 

priority mail-out. 

Immediate Need (IN) Issue counter warrant by the next EWS I 

for: 

working day following the date of 

• Rent/mortgage the IN request. Refer to the 

• Utility bills Immediate Need section of the 

• 

• 

Clothing 

Medical bills 

Applications Chapter for complete 

instructions. 

• Food 

• Transportation 

• Other Nondeferrable 

needs 

No address Counter warrant or priority mail-out. EWS I 

To meet 45-day • Priority mail-out only. 

EWS I 

processing time • There will be no counter 

warrants approved based on 

the lack of timely processing, 

unless the applicant meets the 

Immediate Need criteria. 



Counter Warrants and Priority Mail-out Warrants, Continued 

Continuing In the situation where a customer meets the EBT exemption, the Continuing 

EW will follow these procedures to determine the level of approval required 

for the following situations. 

If the situation 

is … 

Homeless 

Assistance 

Then the action is … And the level of 

approval is … 

• Voucher 

− TEMP - Issuance beyond 10 days 

− PERM - All issuance 

EWS I 

• Warrant DM 

Aid Paid • Counter warrant or priority mail-out, 

EWS I 

Pending (APP) • Warrant must be in the U.S. mail or customer’s 

hand within five working days of the date the 

hearing request, or 

• Customer must receive the warrant on the 

regular issuance date, whichever is later. 

Rescind • Priority mail out requires that the rescind be 

discontinuance done prior to the last day of the report month, or 

• Counter warrants require that the rescind must 

be done the 1 st EWS I 

of the payment month or later. 

Supplements Assess customer’s needs to determine if the • Priority mail out: 

amount of the warrant will meet a critical need. EWS I 

Add persons • If not, issue priority mail-out. 

• If the need will be met, evaluate for counter • Counter Warrant: 

warrant. 

DD 

• Example: Amount of supplement is $25 and 

the customer’s need is a $100 electric bill. The 

$25 supplement will not meet the need. Issue 

priority mail-out. 

Pick-up Process a pick-up only if a critical need such as lack DM 

release of of housing, utility shut off notice, or insufficient food 

scheduled exists and CalFresh haven’t been received. EWS I must review the 

warrant 

cased for critical need 

Refer to the Warrant Pick-up section of this Chapter and reason warrant 

for complete instructions. 

not released prior to 

taking case to DM for 

review and approval. 

Advance the 

15 th warrant 

• 

• 

Counter warrant or priority mail-out 

Used ONLY when the 1 st warrant is stolen or 

destroyed and customer is on semi-monthly 

payment system. 

EWS I 


Returned Warrants 

Returned 

warrants 

Returned warrants will be remailed unless a critical need exists. If need 

exists, a returned warrant may be picked up at Auditing. Refer to the 

Warrant Pick-up section in this Chapter for the criteria and instructions. 

When a warrant is returned, Auditing checks for any address changes. If 

there is a change of address on file, the warrant is remailed the same day. 

If a warrant has been returned to Auditing more than one time, the EWS I 

must approve the release. 


Warrant Pick-up 

Introduction A customer may pick up a returned warrant from Auditing only when a critical 

need exists. 


critical need 

Verifying 

housing and 

utility needs 

Critical food 

need 


approval 

Note: An Assistance Unit (AU) without a critical need may be authorized to 

pick up a returned warrant only when: 

• The agency failed to release benefits timely, and 

• The DM or DD approves the pick up request. 

A critical need exists when the AU: 

• Lacks housing, 

• Lacks or is about to lose utility service, 

• Lacks food, and 

• Has insufficient resources to meet the need. 

The verification required depends on the critical need as described in the 

table below: 

If the critical need is … Then verify with … 

Lack of housing, A Marshal’s eviction notice. 

Completed or pending utility shut • Final call notice with shutoff date, or 

off, 

• Proof the utility has already been 

turned off. 

Verification the AU lacks food is not required. However, take the following 

steps to meet a critical food need before authorizing a warrant pick-up to 

meet the food need: 

Step Action 

1 Explore the customer’s personal resources. 

2 Refer the AU to a source of help from the emergency resource list. 

The EWS I will give preliminary approval of the warrant pick-up. The EWS I 

must then get approval from the DM or DD. 



Warrant Pick-up, Continued 

Procedures for 

authorizing 

warrant pick-up 

Only the payee for the cash assistance program may pick up the warrant 

from Auditing. Take the following steps when authorizing the payee to pick 

up the warrant. 

Step Action 

1 Complete the TAD 14 H to release benefits as appropriate 

considering information from the QR 7 and Notice of Action (NOA) 

requirements. 

2 Attach the following to the outside of the case file with a paper clip: 

• An empty envelope addressed to Auditing with the case name 

and number and the following notation in red ink: “For pick-up 

only.” 

• The HSS 1000 form giving directions to Auditing, business hours, 

and customer identification requirements. 

• The required verification of the critical need. 

• The completed TAD 14 H. 

3 Take the case to your supervisor (or supervisor’s designee) for 

preliminary warrant pick-up approval. 

4 Contact the customer with the decision regarding the warrant pick-up. 

• Stop here if the pick up request was denied. 

• Continue to step 5 if the request was approved. 

5 If the customer is not waiting in the lobby, make arrangements for the 

customer to come to the district office to get the necessary items for 

the warrant pick-up. 

6 Give the following items to the customer to take to Auditing to pick up 

the warrant: 

• The TAD 14 H, sealed in the envelope prepared in step 3. Stress 

to the customer that only Auditing may open the envelope. 

• The HSS 1000. Make sure the customer is aware of Auditing’s 

public contact hours and the need for positive identification for the 

payee. 

7 File the copies of the critical need verification and the TAD 14 H in the 

case record according to filing instructions on the Forms and 

Procedures guides. 

8 Narrate the reason for the warrant pick-up request and final 

determination in the case journal. 


Overview 

Emergency Grocery Assistance 

Introduction Emergency Grocery Assistance is intended to supplement existing staples to 

meet the emergency needs of a recipient customer only. Applicant 

customers are not eligible. This section contains a brief overview of the 

program. 


• General Relief Policy Handbook (GRPHB) 

In this section This section contains the following topic: 




Emergency Grocery Assistance 

Introduction Emergency Grocery Assistance is intended to supplement existing staples to 

meet the emergency needs of a recipient customer only. Applicant 

customers are not eligible. 

Eligibility 

requirements 

Amount of 

issuance 

Emergency Grocery Assistance is issued in the form of a vendor payment to 

a specific grocery store on behalf of the individual/family. 

The emergency Grocery Assistance, also called a grocery order, cannot be 

utilized for non-food products, and cash is not received as change. 

This assistance is always a General Relief loan and, as such, must be 

repaid. 

Eligibility for this assistance is limited to persons meeting ALL of the following 

criteria: 

• Receiving SSI/SSP, CalWORKs only, CalWORKs and CalFresh, 

CalFresh only, General Relief and CalFresh, or General Relief assistance 

program benefits only, 

• Assistance payments for the current month have not arrived from all 

assistance programs, 

• Have no liquid assets, 

• Have no income other than the assistance program benefits listed above, 

and 

• Needs cannot be met by other personal or community resources or 

programs. 

This assistance will be issued only for the number of persons and the 

number of days it is expected to take for the receipt of the missing program 

benefits. The payment should rarely exceed five days for any program 

except SSI/SSP. 

Reference Eligibility Workers (EWs) should refer to the General Relief Policy Handbook 

for further information and instructions. 




CHAPTER 14 


Overview .........................................................................................................14-1 

General Discontinuance Procedure.................................................................14-2 

Notice of Action (NOA) ....................................................................................14-3 

Notice of Action (NOA): Situations...................................................................14-4 

Waiver of 10-day Notice Requirement.............................................................14-5 

Customer Requests Discontinuance ...............................................................14-6 

Partial Discontinuance.....................................................................................14-8 

Change of Payee.............................................................................................14-9 

Full Discontinuance .......................................................................................14-10 

Foster Care Placement.................................................................................. 14-11 

Sanctions.......................................................................................................14-12 

Inter-County Transfers (ICTs)-Out................................................................. 14-14 

Overpayments (OPs)..................................................................................... 14-16 

Post-benefits and Referrals...........................................................................14-17 


Overview 


Introduction One of the primary functions of casework is the establishment of ongoing 

CalWORKs eligibility. It is important to take timely action to discontinue cash 

aid benefits for individuals or entire programs when ineligibility is discovered 

or discontinuance is requested. 

Discontinuance actions are always effective on the last day of the month and 

show as the first of the following month is the C-IV system. Whether the 

action is effective at the end of the month of discovery or at the end of the 

last month of the QR Payment Quarter depends on the reason for the action, 

the type of report, and when the information is received. See the Reporting 

and Budgeting Chapters for specific information. 

Timely discontinuance action helps to: 

• Avoid overpayment of benefits that will have to be repaid 

• Ensure time-limited eligibility months are applied accurately 

• Ensure child support payments are forwarded in a timely manner 

It is important to use the correct discontinuance reason when taking a 

discontinuance action. This information is used to determine appropriate 

post-Medi-Cal benefit information, and for data gathering and statistical 

purposes. 

Contents This Chapter contains the following topics: 


General Discontinuance Procedure 14-2 

Notice of Action (NOA) 14-3 

Notice of Action (NOA): Situations 14-4 

Waiver of 10-day Notice Requirement 14-5 

Customer Requests Discontinuance 14-6 

Partial Discontinuance 14-8 


Full Discontinuance 14-10 

Foster Care Placement 14-11 

Sanctions 14-12 

Inter-County Transfers (ICTs)-Out 14-14 

Overpayments (OPs) 14-16 

Post-benefits and Referrals 14-17 

CWPHB #4605 (04/11) DISCONTINUANCE 14-1

General Discontinuance Procedure 

Introduction When ineligibility is determined or discontinuance is requested, a general 

discontinuance procedure is followed. This procedure ensures all necessary 

actions are taken. 


procedure 

When discontinuance action is necessary, take the following steps: 

Step Action 

1 Determine when the discontinuance action is effective. See the 

Reporting and Budgeting Chapters of this Handbook. 

2 Take appropriate discontinuance action in the C-IV system. 

3 Determine eligibility for post-benefits, as appropriate. See the 

Post-benefit section of this Chapter. 

4 Send appropriate NOAs, advising the customer of: 

A discontinuance effective the end of the month/first of the 

following month, or 

A change in cash aid amount due to partial discontinuance, 

effective the first of the month, and 

Changes to any other benefits (Medi-Cal, CalFresh, etc.). 

5 Identify any overpayments and take appropriate action. See the 

Overpayment section of this Chapter. 

6 Notify other departments/workers of discontinuance action 

[Welfare-to-Work (WTW) program, Department of Child Support 

Services (DCSS), Child Care Eligibility Worker (EW), etc.]. 

7 Narrate the action(s) taken with a Journal entry in the case record. 

8 Prepare the case file for post-benefits, if appropriate. 

9 Follow existing District policy for sending the physical case file to 

Closed Files. 


Notice of Action (NOA) 

Introduction Customers must be notified of proposed actions to discontinue aid or to 

reduce the amount of benefits received. This notification is done with letters 

referred to as Notices of Action (NOAs). 

All NOAs must be adequate and timely in order for discontinuance action or 

reduced benefit action to be taken. 


• ACL 03-18 

• EAS 22-001a.(1) 

• EAS 22-001t.(1) 

• EAS 22-071 

• EAS 22-072 

Adequate 

notice 

An adequate notice must be dated and sent no later than the effective date of 

the proposed action, and must contain the following information: 

• Effective date of the proposed action 

• The specific action to be taken 

− Complete discontinuance 

− Change in benefit amount due to partial discontinuance 

• Reason for the action 

• Pertinent State manual sections 

Timely notice Timely notice is a notice that meets the requirements of an adequate notice 

and is mailed to the customer at least 10 days prior to the effective date of 

the proposed action. 

NOAs that do 

not require 

timely notice 

Discontinuance or reduced benefit actions that require an adequate but not 

necessarily timely notice are: 

• Written request for discontinuance from the customer is received 

• Confirmed death of an AU member 

• The whereabouts of the customer are unknown and the County has 

returned mail and no forwarding address is indicated 

• The person affected has been admitted or committed to an institution and 

the temporary absence criteria or exceptions are not met 

• A child is removed from the home as a result of a judicial determination 

or voluntarily placed in foster care by his or her parent or legal guardian 

• A TAD 239 W (E/S) waiver to 10-day notice has been signed by the 

customer 

• The person affected has been accepted for aid in a new jurisdiction 


Notice of Action (NOA): Situations 

Warrant sent 

out after 

effective date 

of NOA 

NOAs sent with 

different 


dates 

Take the following actions when timely discontinuance notice is sent and the 

following month’s aid payment is sent in error: 

Step Action 

1 Compute an overpayment for the month the check went out in 

error. See Overpayment section of the Budgeting Chapter. 

2 Enter correct discontinuance action information into the C-IV 

system. 


If the customer reapplies for aid in the month in which the payment went out 

in error, the case is restored and the correct aid payment is determined as 

follows: 

Step Action 

1 Determine the amount of the prorated aid payment due for the 

reapplication/restored month. 

2 Subtract the correct aid payment from the amount of aid that went 

out in error. 

3 The difference is the amount of the supplement due or the revised 

overpayment. 

4 Send the appropriate Notice of Action. 


Sometimes more than one NOA is sent to a customer informing him or her of 

discontinuance actions for different reasons, and with different effective 

dates. When this happens, both notices are valid and discontinuance action 

will be taken unless both discontinuance reasons are cured. 

Example: 

A notice is sent on 5/13 to discontinue a case effective 5/31 for non-receipt of 

a QR 7. Then on 5/25 a notice is sent to discontinue the case effective 6/30 

due to only eligible child 18 years old and graduating from high school. The 

following action is taken: 

• The first NOA remains valid and the case can be discontinued effective 

5/31 for no QR 7. 

• If the QR 7 is provided, the second notice is valid and the case can be 

discontinued effective 6/30 for no eligible child in the home. 


Waiver of 10-day Notice Requirement 

Introduction Occasionally, information is received too late in the month or action is taken 

too late in the month for the Eligibility Worker (EW) to give timely notice. 

When this happens, the EW may suggest to the customer that he or she sign 

the TAD 239 W (E/S) Waiver of Timely Notice to waive his or her right to the 

10-day notice requirement in order to avoid an overpayment. 

Procedure When the customer agrees to waive the right to timely notice, the EW will do 


Step Action 

1 Conduct a face-to-face interview with the customer. Do not mail 

the TAD 239 W (E/S) to the customer. 

2 Explain the reason for the action and the benefit of completing the 

waiver. 

3 Give the NOA to the customer, if it has not already been mailed. 


Customer Requests Discontinuance 

Introduction CalWORKs customers may request discontinuance of the entire Assistance 

Unit (AU)/household or any individual member of the AU/household who is 

no longer in the home or is an optional member. 

Method of 

request 

Process to 

follow when 

request is 

received 

These voluntary discontinuance requests can result in mid-quarter benefit 

adjustments, depending on the timing of the request. 

Customer requests for discontinuance can be made in the following ways: 

• Verbally – via telephone call or office visit 

• In writing – on the Quarterly Report (QR 7) or in a letter or note to the EW 

Verbal requests for discontinuance should be put in writing by the customer, 

whenever possible. Information regarding the receipt of CalFresh and/or 

Medi-Cal benefits should also be included. 

When discontinuance is requested, make sure the customer is aware of the 

consequences and he or she knows what benefits they may still be eligible to 

receive. 

Questions to ask the customer include: 

• Why does he or she want to be discontinued? 

• Does he or she want to continue to receive CalFresh, Medi-Cal, and/or 

Child Care benefits? 

If the customer still wants to be discontinued, then follow the process outlined 

in the General Discontinuance Procedure section of this Chapter. 

Example: 

Customer wrote on QR 7, “Stop my aid at the end of the month.” The EW 

called to ask why the customer wanted to be discontinued and was told, “I 

am moving to Fresno.” The EW then explained continuing eligibility and 

transferring the case to Fresno County. The customer agreed to this, and 

the EW initiated the ICT. If the EW had not clarified the customer’s request, 

the case would have been discontinued. The EW would likely have received 

a telephone call from Fresno later requesting an ICT. The EW would have 

had to rescind the discontinuance and then send the ICT. 



Customer Requests Discontinuance, Continued 

Notice 

requirement 

Verbal request 

received late in 

month 

The notice requirement for discontinuance requests depends on the method 

of request. 

If the request is made… Then the requirement is a(n)… 

Verbally 10-day notice. 

In writing Adequate notice. 

Do the following when the customer verbally requests case discontinuance 

after the deadline for issuing a timely notice of discontinuance: 

Step Action 

1 Offer the customer the opportunity to sign a TAD 239 W (E/S) 

Waiver. 

2 Advise the customer to return the following month’s payment 

when it is received. 

3 Give, or send, an NOA to the customer with the effective date 

determined as: 

The date on the TAD 239 W (E/S), if one was signed, or 

The last day of the month for which timely notice can be given, 

if a TAD 239 W (E/S) was not signed. 

4 Complete the discontinuance action in the C-IV system. Be sure 

to use the correct discontinuance date for accurate time limit 

tracking. 






closed files. 


Partial Discontinuance 

Introduction A partial discontinuance action is required when an individual(s) becomes 

ineligible to receive aid, but other Assistance Unit (AU) members remain 

eligible. 



NOA effective 

date 


procedure 

Some reasons for partial discontinuance are: 

Individual(s) leaves the home 

Eligible child reaches age limit 

Adult reaches the CalWORKs 48-month time limit 

Individual is sanctioned (Refer to the Sanction section of this Chapter) 

A partial discontinuance action is effective the last day of the last month or 

quarter an individual(s) was eligible to receive benefits (See Reporting and 

Budgeting Chapters). In the C-IV system, the discontinuance date shows as 

the first of the following month. 

If the discontinuance action is taken after the date it should have been 

effective, an overpayment is computed for all months aid was paid after the 

correct discontinuance effective date. Refer to the Budgeting Chapter. 

Since a partial discontinuance action results in a change in benefit amount, 

the effective date on the Notice of Action (NOA) is the first day of the month 

the changed benefit amount will actually be received. 

Take the following action to complete a partial discontinuance: 

Step Action 




3 Send appropriate NOAs, advising the customer of 

A change in cash aid amount due to partial discontinuance, 

effective the first of the month, and 



Overpayment section of this chapter. 





7 Transfer case to post-benefits, if appropriate. 



Introduction A change of payee is required when the payee leaves the home and the 

aided child(ren) continues to be eligible to receive cash aid. 

References The following references are applicable to a change of payee: 

• EAS 44-203 

• EAS 44-317 

Procedures Refer to the Application Chapter and the C-IV User Guide for specific 

instructions. 


Full Discontinuance 

Introduction The entire Assistance Unit (AU) is discontinued when all AU members 

become ineligible to receive cash aid benefits or request discontinuance. 

Some reasons for full discontinuance are: 

The AU moves out of the county or state 

The only eligible child reaches the age limit or leaves the home 

Income exceeds the financial eligibility limit 

Property resources exceed the allowable limit 

Property conversion with a Period of Ineligibility (POI) 

Lack of residency or whereabouts unknown 

Customer requests full discontinuance 

Customer fails to provide complete QR 7 

Effective date A full discontinuance action is effective the last day of the last month in which 

a payment is issued. In the C-IV system, the discontinuance date shows as 

the first of the following month. 


procedure 

If the discontinuance action is taken in a month after eligibility has ended, an 

overpayment is computed for all months aid was paid when the customer 

was ineligible. Refer to the Reporting and Budgeting Chapters. 

Take the following actions to discontinue an entire AU: 

Step Action 




3 Send appropriates NOAs, advising the customer of 

A discontinuance effective the end of the month/first of the 

following month, and 




5 Notify other departments/workers of discontinuance action (WTW, 

LFSA, Child Care Eligibility Worker (EW), etc.). 


7 Prepare the case file for post-benefits, if appropriate. 


Closed Files. 


Foster Care Placement 

Introduction Sometimes a child is removed from a customer’s home and is placed into 

Foster Care. When this happens, the Eligibility Worker (EW) must take 

action to discontinue aid for the child and to forward necessary items to the 

Foster Care EW. 

How the EW is 

notified of 

placement 

Information 

requested by 

the Foster Care 

CW 

When a child is removed from a customer’s home and placed in Foster Care, 

the EW should be notified by: 

• Verbal or written contact from the customer 

• Telephone call and Task from a Foster Care EW 

A copy of the Task is also sent to the EWS I, for control purposes. 

The Foster Care EW will request certain information and verification from the 

cash aid case. Information requested by the Foster Care EW may include: 

• Birth verification 

• Social Security number 

• Income and resource information 

Procedure The EW will take the following action when notified that a customer’s child 

has been placed in Foster Care: 

Step Action 

1 Narrate with a Journal entry in the case record how the 

information regarding Foster Care placement was received. 

2 Fax verification to the Foster Care EW, if requested. 

3 Determine whether a partial or full discontinuance action is 

appropriate. 

4 Complete discontinuance action. Refer to the Partial 

Discontinuance or Full Discontinuance sections of this Chapter 

and the C-IV User Guide for specific instructions. 



Note: Use appropriate discontinuance information for the affected child to 

avoid auto-transfer to post-Medi-Cal aid code 38 and prevent MEDS alerts. 


Sanctions 

Introduction A sanction is a punitive action. It affects the amount of cash aid received and 

the amount of cash aid used in the CalFresh budget. A sanction occurs 

when an individual is discontinued from the Assistance Unit (AU), and the 

cash aid payment amount is reduced. 

Reasons for 

sanctions 

Sanction 

procedure 

Sanction is 

cured or 

expires 

A sanctioned individual may or may not remain eligible for CalFresh, 

depending on specific program requirements. Refer to the CalFresh Policy 

Handbook for specific instructions. Sanctioned individuals remain eligible to 

Medi-Cal, except for certain child support noncooperation sanctions (See 

Deprivation Chapter). Refer to the Post-benefits and Referrals section of this 

Chapter. 

Sanctions may occur for the following reasons: 

Non-participation or failure to cooperate in Welfare-to-Work (WTW) 

activities 

Failure to provide a Social Security number 

Failure to verify citizenship or noncitizen status 

Refusal to assign child support rights 

Fleeing felon 

Felony drug conviction 

Probation or parole violation 

Intentional Program Violations (IPV) prior to 12/31/97 

Participating in a strike 

When it is determined a sanction should be applied to a member of the AU, 

follow the steps outlined in the Partial Discontinuance section of this Chapter. 

Refer to the CalFresh Policy Handbook for instructions on how to use the 

income of a sanctioned person and the CalWORKs grant in the CalFresh 

budget. 

When a sanction is cured or expires, the individual(s) is added back to the 

AU. Refer to the Application and Budgeting Chapters. 



Sanctions, Continued 

Sanction and 

penalty both 

apply 

Penalty 

information 

When a penalty and a sanction both apply to the same person/AU, the 

sanction should be applied first and the penalty is applied after the sanction 

is lifted or cured. 

When a penalty has already been applied and then a sanction needs to be 

imposed, the penalty is stopped and the sanction is applied. If the sanction 

is subsequently lifted or cured and the penalty is still applicable, the penalty 

is reapplied. 

Exception: Child support, Cal-Learn, and MFG penalties are to be applied at 

the same time as any appropriate sanction. 

A penalized individual remains a member of the AU, but his/her financial 

needs are not included in the CalWORKs cash aid grant. 

Do not complete a partial discontinuance for the penalized individual. 

Examples of penalty situations are: 

• Failure to cooperate in the child support process 

• Failure of the parent(s) to provide proof of age appropriate immunizations 

• Failure of the parent(s) to cooperate with the school attendance 

requirement for an aided child(ren) under age 16 

• Intentional Program Violation (IPV) after 1/1/98 

• Cal-Learn 

• Maximum Family Grant (MFG) 

Refer to the Deprivation Chapter and the Children and Eligibility Chapter for 

more information regarding the penalty situations listed above. 


Inter-County Transfers (ICTs)-Out 

Introduction Customers who move from one county to another within the state of 

California are entitled to continue receiving cash aid benefits without a break 

in aid. The Inter-County Transfer (ICT) process ensures benefits continue in 

one county while the customer reapplies in the new county of residence. 

The ICT process is completed manually and mailed to the new county, or 

electronically through the electronic ICT (eICT) interface (see the e-Tools 

Chapter in the Operations and Reference Handbook (ORHB) for information 

regarding eICTs). 

References The following references are applicable to information regarding ICTs: 

• ACIN 1-60-09 

• EAS 40-187 

• EAS 40-188 

• EAS 40-190 

Procedure When information is received that a customer has moved from San 

Bernardino County to another county within California, the Eligibility Worker 

(EW) will complete an eICT, if appropriate. If an eICT cannot be completed, 

the EW will take the following actions: 

Step Action 

1 Update address in the C-IV system to the new address. 

2 Advise the customer to reapply for assistance as soon as possible in 

the new county. 

Note: Under Quarterly Reporting/Prospective Budgeting (QR/PB), 

CalFresh benefits are discontinued at the end of the month in which 

the CalWORKs case is transferred to the new county. See the 

CalFresh Policy Handbook for specific instructions. 

3 Complete the CW 215 (from the C-IV system) and send the ICT 

packet to the new county (see ORHB Chapter H for required forms 

included in ICT packet). 

Note: If the customer is a non-needy caretaker relative receiving 

CalWORKs benefits on behalf of a child(ren) who is a dependent of 

the court and not eligible for federal Foster Care, this information must 

be documented on the CW 215 to notify the receiving county the 

customer is exempt from the face-to-face interview requirement. 

4 Send an ICT Reminder letter to the customer advising him or her of 

the transfer procedure within two (2) days of notification of the 

move. 

5 Set a Task for the ICT discontinuance action. 

6 Continue to make all eligibility and grant determinations during the ICT 

period. 

7 Discontinue when eligibility ceases, or by main payroll in which the 

ICT period ends, whichever comes first. 

8 Send the physical case file to closed files. 




Inter-County Transfers (ICTs)-Out, Continued 

Partial 

Inter-County 

Transfers 

(ICTs) 

Domestic 

violence and 

ICTs 

A partial ICT occurs when some members of an existing Assistance Unit 

(AU) move to another county and apply for assistance as a new case or on 

an existing case in that county before the members are discontinued from 

San Bernardino County. The members will continue to receive assistance 

without interruption. 

The Eligibility Worker (EW) will manually complete the partial ICT process 

following the steps below: 

Step Action 

1 Update the address in C-IV for the members being transferred. 

Note: An adult moving out of the home must have continuing 

CalWORKs eligibility in order to complete a partial ICT. 

2 Complete the CW 215 including the following: 

• Income, property and other information about the members being 

transferred, 

• Name of transferred member and “Partial ICT” listed in the Case 

Name block, and 

• “Partial ICT” listed in the Payee Name block. 

3 Send the ICT packet for the transferred members to the new county. 

4 Set a Task for the ICT discontinuance action. 

5 Discontinue the transferred members when eligibility ceases or prior 

to main payroll in which the ICT period ends, whichever comes first. 


Note: A partial ICT cannot be sent to the new county through the eICT 

process. 

When a customer who is a victim of domestic abuse moves out of San 

Bernardino County to another county within California, domestic 

abuse related confidential case information cannot be released to the 

receiving county unless the customer has completed and signed form 

WTW 37, Permission to Release Domestic Abuse Information When Moving 

to Another County. 

WTW 37 form The WTW 37 form will be given to the customer along with an explanation of 

what information the county can send to the receiving county. 

When the customer reports an address outside of San Bernardino County, 

the WTW 37 will be given to the customer moving to another county if he/she 

is a victim of domestic abuse. 

If the customer moves to a new county and has not signed a new WTW 37 

form, any information regarding his/her domestic abuse situation will not be 

sent to the receiving county. 


Overpayments (OPs) 

Introduction When an Assistance Unit (AU) is discontinued, the CalWORKs program must 

be reviewed for new or existing overpayments. Necessary action must be 

taken so repayment can be pursued. 

Procedure Refer to the Overpayment section of the Budgeting Chapter for procedures to 

follow when discontinuing an AU with a new or existing overpayment. 


Post-benefits and Referrals 

Introduction Ineligibility for cash aid does not always mean that a customer is ineligible to 

receive benefits under another program. 

Review for eligibility to other program benefits when discontinuing cash aid 

for an individual(s) or a family. 

CalFresh Depending on the reason for cash aid discontinuance, there may still be 

CalFresh eligibility including eligibility to Transitional CalFresh. Consult the 

CalFresh Policy Handbook for specific information. 

Eligible to 

continuing 

CalFresh 

Ineligible to 

continuing 

CalFresh 

CalFresh eligibility may continue for a person(s) or AU that: 

Is Welfare-to-Work (WTW) sanctioned and cares for a child under six (6) 

years of age 

Is financially ineligible for CalWORKs, but within the financial limits for 

CalFresh 

The youngest child no longer meets the age requirement for cash 

eligibility 

If the customer remains eligible to continue receiving CalFresh benefits, take 

the following action: 

Step Action 

1 Determine the continuing CalFresh benefit amount. 

2 Complete necessary action in the C-IV system. Refer to the C-IV 

User Guide. 

3 Send a notice advising the customer of the benefit amount. 

4 If cash aid action is a full discontinuance, transfer the CalFresh to 

the appropriate CalFresh aid code. Refer to the CalFresh Policy 

Handbook and the C-IV User Guide. 

If there is no continuing CalFresh eligibility and CalFresh benefits are being 

received: 

CalFresh are discontinued with the cash aid, and 

Notify the customer of the CalFresh discontinuance action. 

Medi-Cal People may continue to be eligible for Medi-Cal benefits after cash aid 

discontinuance. Refer to the Medi-Cal Chapter for specific information. 

NOTE: It is important customers are placed on the appropriate Medi-Cal aid 

code when discontinued from cash aid, if they remain Medi-Cal eligible. 



Post-benefits and Referrals, Continued 

Child Care Child Care benefits are available after discontinuance if certain criteria, as 

determined by the Child Care Eligibility Worker (EW), are met. 

Follow the chart below for Child Care determination: 


Receiving Child Care benefits at the 

time of discontinuance, 

Not receiving Child Care benefits at 

the time of discontinuance, 

Notify the Child Care EW of the 

discontinuance so appropriate 

action can be taken in the Child 

Care program. 

Customer must be advised to apply 

if there is any interest in pursuing 

Child Care benefits. 

Child support When the County has been collecting Child Support payments for an aided 

child and the child’s cash aid is discontinued, the parent or caretaker of that 

child is eligible to receive the Child Support benefits directly on the child’s 

behalf. This action is triggered by the discontinuance action on the C-IV 

system, which sends the information to the Department of Child Support 

Services (DCSS) via the interface. 

Cash aid 

payments after 


Child Support money collected by the DCSS cannot be sent to the parent or 

caretaker relative until the discontinuance action is completed on the C-IV 

system, so it is important to take timely action. Waiting to take 

discontinuance action causes delays in this process that keep the parent or 

caretaker relative from receiving direct support money in a timely manner. 

Sometimes, after a discontinuance action is taken, it is determined a former 

customer is entitled to additional benefits. If this happens, refer to the 

Underpayments section of the Budgeting Chapter. 




CHAPTER 15 

Medi-Cal 

Overview ......................................................................................................................15-1 

Continuing Medi-Cal.....................................................................................................15-2 

Continuing Medi-Cal Aid Codes ...................................................................................15-3 

Post Medi-Cal Aid Code 38..........................................................................................15-4 

1931(b) Medi-Cal Aid Code 3N ....................................................................................15-6 

Refugee Medical Assistance (RMA) ............................................................................15-7 

Postpartum Medi-Cal Aid Code 76...............................................................................15-8 

Transitional Medi-Cal (TMC) ........................................................................................15-9 

The Transitional Medi-Cal (TMC) Flyer......................................................................15-10 

Post Medi-Cal Aid Code 54 – Four Month Continuing ...............................................15-11 

Continuing Medi-Cal Aid Code 6J ..............................................................................15-12 

Companion Cases......................................................................................................15-13 

Qualified Medicare Beneficiaries (QMB) ....................................................................15-15 

Accelerated Enrollment (AE) for Children ..................................................................15-17 

Deemed Eligible (DE) Infants.....................................................................................15-19 

Exception Eligible Report – Deemed Eligible Infants .................................................15-23 

California Children Services.......................................................................................15-24 

Methods of Medi-Cal Card Issuance..........................................................................15-27 

Letters of Authorization (LOA)....................................................................................15-29 




Retroactive Medi-Cal..................................................................................................15-31 

Medi-Cal Hospice Care ..............................................................................................15-32 

Add Persons – Quarterly Reporting ...........................................................................15-33 


Overview 

Medi-Cal 

Introduction All states are required by law to provide a program of medical services for 

children and adults in low-income families. In California, the State Plan is 

called Medi-Cal. 

In this chapter This Chapter contains the following topics. 


Continuing Medi-Cal 15-2 

Continuing Medi-Cal Aid Codes 15-3 

Post Medi-Cal Aid Code 38 15-4 

1931(b) Medi-Cal Aid Code 3N 15-6 

Refugee Medical Assistance (RMA) 15-7 

Postpartum Medi-Cal Aid Code 76 15-8 

Transitional Medi-Cal (TMC) 15-9 

The Transitional Medi-Cal (TMC) Flyer 15-10 

Post Medi-Cal Aid Code 54 – Four Month Continuing 15-11 

Continuing Medi-Cal Aid Code 6J 15-12 

Companion Cases 15-13 

Qualified Medicare Beneficiaries (QMB) 15-15 

Accelerated Enrollment 15-17 

Deemed Eligible (DE) Infants 15-19 

Exception Eligible Report – Deemed Eligible Infants 15-23 

California Children Services 15-24 

Methods of Medi-Cal Card Issuance 15-27 

Letters of Authorization (LOA) 15-29 

Retroactive Medi-Cal 15-31 

Medi-Cal Hospice Care 15-32 

Add Persons – Quarterly Reporting 15-33 

CWPHB #4605 (04/11) MEDI-CAL 15-1

Continuing Medi-Cal 

Introduction When a CalWORKs individual or program is discontinued, the customer is 

usually eligible to some type of continuing Medi-Cal. Continuing Medi-Cal 

eligibility may continue for one month or more, depending on the reason for 

the discontinuance. There are very few instances when the customer will not 

receive continuing Medi-Cal. This section describes the continuing 

Medi-Cal process. 


continuing 

Medi-Cal 

The chart below lists the aid codes used when granting continuing Medi-Cal 

to customers who have been discontinued from the CalWORKs program. 

Eligibles Type Aid Code Eligibility Period 

Refugee Cash 

Assistance (RCA) 

cases discontinued 

due to increased 

earnings 

Individuals 

discontinued for 

specific reasons 

Individuals or 

cases discontinued 

for reasons which 

do not affect 

Medi-Cal eligibility 

Eligible pregnant 

woman 

CalWORKs cases 

or individuals 

discontinued for 

increased earnings 

Discontinuance for 

increase in 

child/spousal 

support 

Refugee Medical 

Assistance (RMA) 

Edwards v. Kizer 

(Myers) 

Zero SOC 

Medi-Cal under 

1931(b) program 

Postpartum 

Medi-Cal 

Transitional 

Medi-Cal 

Zero SOC 

Medi-Cal 

02 Zero Share of Cost 

(SOC) for up to four 

months, or until the 

end of the original 

eight month RMA 

period 

38 One or more months 

zero SOC after 


3N Review for eligibility 

for 1931(b) must be 

done by Medi-Cal 

Eligibility Worker 

76 Zero SOC through 


month in which the 

60 th day after 

termination of 

pregnancy falls 

39 Zero SOC for first 

six months 

Note: If certain 

criteria met, 

additional six 

months on aid code 

CWPHB #4605 (04/11) MEDI-CAL 15-2 

59 

54 Zero SOC up to four 

months

Continuing Medi-Cal Aid Codes 

Introduction This section contains information on Continuing Medi-Cal (MC) aid codes. 

Determining 

Post Medi-Cal 

type 

Use the chart below to determine what type Post Medi-Cal the case or 

individual is eligible to receive once CalWORKs has been discontinued. 

Discontinuance Reason 

02 

Post MEDI-CAL Aid Code 

38 3N 76 39 54 6J 34 

Increased earned income X 

Refugee Cash Assistance (RCA) cases discontinued 

due to increased earnings 

X 

Time expired – reached CalWORKs 48-month time limit X 

Welfare-to-Work sanctioned X 

Department of Child Support Services (DCSS) -failed to 

assign support rights 

X 

Failed to cooperate with Statewide Fingerprint Imaging 

System (SFIS) 

X 

Over property X 

Change in law or agency policy X 

Failure to provide QR 7 X 

Whereabouts unknown X 

All other CalWORKs reasons X 

Discontinued for any reason within 60 days of birth/end 

of pregnancy 

X 

Failure to complete Re-Evaluation (RE) X 

Increase in Child/Spousal Support 

Last child discontinued, customer claims to be disabled 

X 

and does not currently have verification of disability for 

Medi-Cal purposes 

X 

18- and 19-year olds discontinued for age and/or school 

requirements 

X 


reasons 

NOT eligible 

to continuing 

Medi-Cal 

Individuals or programs discontinued for the following reasons are not eligible 

to continuing Medi-Cal: 

• Death 

• Customer’s written request for discontinuance from both CalWORKs and 

Medi-Cal Programs 

• Child placed in Foster Care 

• In jail or other ineligible institution 

• Moved out of state 

• Approved for Supplemental Security Income (SSI) 

Note: It is important that customers are placed on the appropriate Medi-Cal 

aid code (if eligible) when discontinued from cash aid. C-IV will make a 

determination for continuing Medi-Cal eligibility effective the first of the month 

following CalWORKs discontinuance. The Medi-Cal case is transferred to 

the appropriate Medi-Cal Eligibility Worker per district policy. 

CWPHB #4608 (05/11) MEDI-CAL 15-3

Post Medi-Cal Aid Code 38 

Introduction This section explains who is eligible and not eligible to aid code 38 Post 

Medi-Cal, the effective dates, and inter-county transfers (ICTs). 

Who is and is 

not eligible 


of aid code 38 

Auto Transfer 

to aid code 38 

All individuals receiving CalWORKs are eligible for one or more months at 

zero Share of Cost (SOC) Medi-Cal following discontinuance of cash benefits 

except when discontinued for the following reasons: 

• Death 

• Customer’s written request for discontinuance from both the CalWORKs 

and Medi-Cal programs 

• Child placed in Foster Care 

• In jail or other ineligible institution 

• Moved out of state 

• Approved for SSI/SSP 

• Person/family is transferred to other Post or regular Medi-Cal aid code. 

Note: The child placed in Foster Care is not eligible for aid code 38 Medi-Cal 

because he/she will receive Medi-Cal benefits on the Foster Care program. 

The parent who loses CalWORKs eligibility because the only child(ren) in the 

home is placed in Foster Care is eligible for Post Medi-Cal benefits on aid 

code 38 until his/her on-going Medi-Cal eligibility is determined. 

Aid code 38 begins with the month following the CalWORKs discontinuance 

date regardless of when the CalWORKs eligibility ended. 

Example: CalWORKs case discontinued after cut-off in March 2009. Aid 

code 38 is effective April 2009. 

CalWORKs discontinuances automatically transfer to aid code 38 (unless 

case was discontinued for one of the reasons listed in the block “Who is and 

is not eligible”, or the case was transferred to another Medi-Cal aid code). 

C-IV will auto-test for ongoing Medi-Cal eligibility and approve Medi-Cal on 

the correct aid code. 


CWPHB #4605 (04/11) MEDI-CAL 15-4

Post Medi-Cal Aid Code 38, Continued 

Inter-County 

Transfer (ICT) 


If the ICT is 

picked up 

timely 

If the ICT is not 

picked up in 

the receiving 

county 

ICT-in 

discontinued 

for failure to 

provide 

Runaway aid 

code 38 MEDS 

alerts 

When a case is discontinued with reason of ICT, C-IV creates an aid code 38 

program. If the receiving county picks up the ICT, the new case/ aid code will 

overlay the aid code 38 on MEDS as long as the names, Social Security 

Numbers (SSNs), and Dates of Birth (DOBs) match, and the receiving county 

makes Medi-Cal effective future month. 

If the ICT is picked up timely in the receiving county, complete action to 

discontinue the Medi-Cal program in C-IV. 

When a CalWORKs ICT is not picked up in the new county, CalWORKs staff 

in both the sending and the receiving counties is responsible for ensuring 

that the family is evaluated for ongoing Medi-Cal benefits. 

In order to accomplish this, CalWORKs Eligibility Workers (EWs) must follow 

these guidelines: 

• When the receiving county denies the ICT for any reason, the 

CalWORKs EW in the receiving county must contact the CalWORKs EW 

in the sending county. 

• The CalWORKs EW in the sending county will photocopy and send all 

verifications required in a Medi-Cal packet to the CalWORKs EW in the 

receiving county within 10 days. 

• The receiving county will follow county/district procedures to determine 

ongoing Medi-Cal eligibility. 

In some circumstances, an incoming CalWORKs ICT will be discontinued for 

failure to provide. The CalWORKs ICT will be discontinued and reassigned 

to a Medi-Cal EW to determine Medi-Cal eligibility. 

When there is a discrepancy between information on C-IV and on MEDS, an 

aid code 38 program is created on MEDS even if the program is discontinued 

on C-IV. These cases are commonly referred to as “Runaway” 38s or 

“Edwards Alerts”. 

If the Eligibility Worker (EW) receives a MEDS alert showing an open aid 

code 38, refer to MEDS My Easy Desk Source for instructions. 

CWPHB #4605 (04/11) MEDI-CAL 15-5

1931(b) Medi-Cal Aid Code 3N 

Introduction State law requires that families who met, or would have met, the 

requirements of the old Aid to Families with Dependent Children (AFDC) 

program be given zero Share of Cost (SOC) Medi-Cal under the 1931 

program. This section contains information regarding this program. 

When is aid 

code 3N 

used? 


reasons 

The 1931 program aid code 3N is used when discontinuing CalWORKs 

cases for reasons that are not considered changes in circumstances that 

affect Medi-Cal eligibility (a separate application, budgets, or eligibility 

determination is not required). 

CalWORKs programs discontinued for the following reasons are eligible to 

aid code 3N Medi-Cal: 

• Failure to return the QR 7 

• Failure to comply with SFIS, 

• Individual discontinued due to time-limits, 

• Individual discontinued due to a Welfare to Work (WTW) sanction, 

• Individual discontinued due to drug felon/fleeing felon. 

CWPHB #4605 (04/11) MEDI-CAL 15-6

Refugee Medical Assistance (RMA) 

Introduction Customers discontinued from Refugee Cash Assistance (RCA) because of 

increased earnings from employment may be eligible to refugee Medical 

Assistance (RMA) zero share of cost (SOC) Medi-Cal. 

Eligibility 

period 

Eligibility 

Worker (EW) 

procedures 

when RCA case 

is discontinued 

Eligible refugees may receive RMA for four months, or until they reach the 

end of their original eight-month Refugee Cash Assistance (RCA) time 

eligibility period, whichever comes first (see the Refugee Cash Assistance 

section in this handbook). 

The RMA program requires a manual EDBC. EWs will refer to the C-IV User 

Guide for the procedures below when discontinuing a RCA case. 

Step Action 

1 Determine RMA period: 

• Start date is the first month or RMA eligibility. 

• MC discontinuance stop date is the last month of the four month 

period, or the end of the 8 th month as a refugee, whichever 

comes first. 

2 Approve Medi-Cal RMA benefits for the appropriate month(s). 

3 Reassign case to Medi-Cal EW or other assigned staff. 

Note: If there is an open Medi-Cal case for other family members, 

the RMA case should be assigned to the EW handling the family’s 

case. 

CWPHB #4605 (04/11) MEDI-CAL 15-7

Postpartum Medi-Cal Aid Code 76 

Introduction Postpartum aid code 76 is a limited-service Medi-Cal program covering 

eligible pregnant women following the birth of a child or termination of 

pregnancy. As aid code 76 only covers medical services related to the 

pregnancy, it is only used when the pregnant woman has no on-going 

eligibility to Medi-Cal under any other program, including aid code 38. 

When to grant 

aid code 76 

In a Pregnant Woman Only (PWO) case, the customer suffers a miscarriage 

in her last trimester. If the CalWORKs Eligibility Worker (EW) determines 

she has no on-going eligibility to CalWORKs or Medi-Cal, aid code 76 

Medi-Cal will be granted. 

Eligibility In order to be eligible for postpartum aid code 76, a woman must have 

received zero Share of Cost (SOC) Medi-Cal under any program in the 

month the pregnancy ended. 

Note: This does not include retroactive months. If the end of pregnancy 

occurred in one of the three months prior to the application date, and the 

woman is requesting retroactive Medi-Cal, she will not be eligible to aid code 

76. 

Eligibility 

period 


eligibility 

period 

Postpartum coverage begins the first of the month after delivery or the end of 

the pregnancy (assuming 10-day notice was given to discontinue the 

CalWORKs program) and continues to the end of the month in which the 60 th 

day after the end of the pregnancy falls. If no 10-day notice given, aid code 

76 begins the following month after 10-day notice was given. 

The following example illustrates the eligibility period of Aid Code 76 Medi- 

Cal. Woman suffers a miscarriage on September 12 th . CalWORKs is 

discontinued September 30 th . The 60 th day following the miscarriage is 

November 11 th . The aid code 76 program is processed for October and 

November, and terminated 12/1. 

CWPHB #4605 (04/11) MEDI-CAL 15-8

Transitional Medi-Cal (TMC) 

Introduction Transitional Medi-Cal (TMC) is a program that provides Medi-Cal benefits for 

a maximum of 12 months to persons discontinued from CalWORKs due to 

increase in earned income. 

Aid codes The following aid codes are used for TMC: 

Initial eligibility 

– Aid Code 39 

Aid Code Description 

39 First six months TMC – full scope benefits 

3T First six months TMC – restricted benefits 

59 Second six months TMC – full scope benefits 

5T Second six months TMC – restricted benefits 

CalWORKs cases discontinued for increased earnings are eligible for six 

months TMC if all of the following conditions are met: 

• Must have received, and been eligible for, CalWORKs or 1931(b) Medi- 

Cal in at lease three of the six months immediately before 

discontinuance, 

• Must have at least one eligible child in the MFBU (this includes SSI or 

Foster Care children), 

Note: Children ages 18 and older are not eligible to aid code 39 unless 

they meet the definition of child (enrolled in school, expected to graduate 

prior to 19 th birthday) or they were a child prior to entering TMC. 

• Must continue to live in California. 

Note: State Disability Insurance (SDI) and Temporary Worker’s 

Compensation (TWC) are not considered earnings for TMC purposes. If the 

CalWORKs case became ineligible due to receipt of SDI or TWC, C-IV will 

transfer to Post Medi-Cal aid code 38 or other appropriate Medi-Cal aid code. 

CWPHB #4605 (04/11) MEDI-CAL 15-9

The Transitional Medi-Cal (TMC) Flyer 

Introduction This section explains the Transitional Medi-Cal (TMC) flyer, when the flyer is 

sent and Eligibility Worker (EW) procedures. 

What is the 

TMC flyer 

When is the 

TMC flyer sent 

TMC flyer and 

QR 7 

Eligibility 

Worker 

procedures 

The TMC flyer is sent out by the State to inform customers they may be able 

to work and continue to receive MC benefits even if they lose their eligibility 

to CalWORKs. 

Depending upon which state agency mails the flyer, customers will receive a 

different version of the flyer: 

If the sending agency is… Then the customer will receive 

flyer number… 

Department of Health Care Services MC 325. 

(DHCS), 

Department of Social Services (DSS), CW 103. 

The TMC flyer is sent to CalWORKs recipients at: 

• Approval, 

• Every six months CalWORKs remains active, and 

• Case discontinuance (for any reason). 

The TMC flyer is not intended to replace the QR 7. Customers must 

continue to complete and return the QR 7 as usual. The customer may 

choose to return the flyer upon receiving notice that his/her CalWORKs 

program has been discontinued. The returned flyer will serve as a request 

for a TMC evaluation. 

The EW will refer to the following chart upon receipt of a TMC flyer: 

If… Then… 

CalWORKs case is open, File flyer in the case file or image 

There is no CalWORKs or Medi-Cal 

case open, 

into C-IV. 

Forward flyer to the appropriate 

Medi-Cal EW. 

CWPHB #4605 (04/11) MEDI-CAL 15-10

Post Medi-Cal Aid Code 54 – Four Month Continuing 

Overview Four months of Post Medi-Cal is granted when the CalWORKs case is 

discontinued due to the receipt of or increase in child/spousal support. Aid 

code 54 is zero Share of Cost (SOC) Medi-Cal. 

The case must have received CalWORKs in at least three of the last six 

months immediately before discontinuance. 

Note: Aid code 54 eligibility begins the month following the month 

CalWORKs eligibility ended. 

CWPHB #4605 (04/11) MEDI-CAL 15-11

Continuing Medi-Cal Aid Code 6J 

Introduction Medi-Cal rules require when a CalWORKs customer is being discontinued 

because there is: 

Person (s) 

eligible for this 

continuing 

coverage 

Approving 

continuing 

benefits 

• No longer any linkage to a CalWORKs or other Medi-Cal program, and 

• The customer alleges he or she has a physical, mental, or emotional 

disability, 

Medi-Cal will continue pending a disability determination. Customers may 

receive Medi-Cal on the following aid codes: 

Aid Code Type 

6J Full Scope – Zero Share of Cost (SOC) 

6R Full Scope – SOC 

5J Restricted – Zero SOC 

5R Restricted - SOC 

A CalWORKs customer discontinued because the only eligible child has left 

the home may be eligible for Medi-Cal pending a disability determination if 

the customer claims a disability. 

Eligibility Workers (EWs) will take the following action to transfer customers 

to the correct Medi-Cal aid code. 

Step Action 

1 Enter the appropriate condition on the Medical Condition Detail 

page in C-IV. 

Note: Date must be within 30 days from the CalWORKs 

discontinuance to receive the appropriate disability determination 

aid code. 

2 Refer case to Medi-Cal Worker to obtain Department of Disability 

Service Division (DDSD) disability packet. 

Note: DDSD disability packet referrals are sent to the Oakland - State 

Programs (OAK-SP) branch at the following address: 

Oakland State Programs Branch 

P.O. Box 23645 

Oakland, CA 94623-9945 

The MC221 – Disability Determination and Transmittal is used when referring 

the DDSD disability packet. 

CWPHB #4605 (04/11) MEDI-CAL 15-12

Companion Cases 

Introduction A Medi-Cal companion case exists when part of the family receives 

CalWORKs and part receives Medi-Cal only. 

1931 

companion 

cases 


related cases 

Case number 

assignment 

Customers on Medi-Cal companion cases are “presumed eligible” for 1931 

Medi-Cal since their income/property was already used to determine 

eligibility for family members receiving CalWORKs. These include persons 

who: 

• Are excluded from receiving CalWORKs by regulation, such as ineligible 

noncitizens, 

• Exceed the CalWORKs time limits, 

• Are discontinued from CalWORKs for failure to cooperate with Welfare to 

Work (WTW) or Department of Child Support Services (DCSS) 

requirements, or 

• Are fleeing felons. 

The CalWORKs Eligibility Worker (EW) retains the Medi-Cal case for these 

individuals since no separate application, budgets, or eligibility determination 

of any kind is required. When the annual Re-Evaluation (RE) is completed 

for the CalWORKs case, the RE date on the Medi-Cal case is also updated, 

as a separate RE is not required. 

The following types of Medi-Cal cases are related to CalWORKs cases but 

the persons are not “presumed eligible”: 

• Children in the CalWORKs family age 18 or over and not eligible for 


• Caretaker relatives of CalWORKs children. 

A complete eligibility determination is required, including a separate 

Medi-Cal RE. 

The Medi-Cal case is assigned the same case number as the CalWORKs 

case, however, the Medi-Cal person(s) are be listed in a separate Medi-Cal 

program. 


CWPHB #4605 (04/11) MEDI-CAL 15-13

Companion Cases, Continued 

Children 

over 18 

Caretaker 

relatives 

Children who are age 18 or older and are not eligible for CalWORKs will 

have a separate Medi-Cal program. The separate Medi-Cal program is 

assigned to a Medi-Cal EW. 

The eligibility determination is completed as follows: 

• The CalWORKs family members are excluded from the Medi-Cal case, 

although a parent will be the payee. 

• Only the child’s income and property is used in the determination. 

If there is a “presumed eligible” family member and a child(ren) age 18 or 

older who is not eligible for CalWORKs, both persons must be placed in the 

same Medi-Cal program block. The Medi-Cal program is assigned to a 

Medi-Cal EW. 

Note: If the Medi-Cal program block only contains a “presumed eligible” 

family member, the CalWORKs EW assigned to the CalWORKs case carries 

the Medi-Cal program. 

A child on CalWORKs may establish linkage for a caretaker relative. The 

eligibility determination is completed as follows: 

• The child(ren) is excluded from the Medi-Cal case. 

• None of the child’s income or property is used in the determination. 

If a case contains a non-needy caretaker relative requesting Medi-Cal and 

child(ren) who are age 18 or older and are not eligible for CalWORKs, both 

the nonneedy caretaker and the child, must be placed in the same Medi-Cal 

program block in C-IV. The Medi-Cal program is assigned to a Medi-Cal EW. 

CWPHB #4605 (04/11) MEDI-CAL 15-14

Qualified Medicare Beneficiaries (QMB) 

Introduction This section explains what Qualified Medicare Beneficiaries (QMB) is, who is 

eligible to QMB and Eligibility Worker (EW) procedures. 

What is QMB QMB is a Federally mandated program for Medicare beneficiaries which 

provides payment of: 

Who is eligible 

to QMB 

• Medicare Part A premium when it is not free to the beneficiary, 

• Medicare Part B premium if the individual is not on regular Medi-Cal, and 

• Premiums, deductibles and coinsurance fees required by Medicare. 

All aged, blind or disabled (ABD) persons who receive, or are eligible to 

receive, Medicare Part A are potentially eligible for QMB. This includes 

persons receiving CalWORKs, Supplemental Security Income (SSI), or In- 

Home Supportive Services (IHSS). 


CWPHB #4605 (04/11) MEDI-CAL 15-15

Qualified Medicare Beneficiaries (QMB), Continued 

EW 

procedures 

At Intake, change, or annual Re-Evaluation (RE), CalWORKs EWs will follow 

the steps below to determine QMB eligibility. 

Step Action 

1 Review cases with income from Social Security for potential 

Medicare recipients including: 

• Persons over age 65 

• Disabled persons who have received Social Security benefits 

for 24 months, and 

• Persons receiving renal dialysis. 

2 

Is a potential QMB eligible 

person found… 

Then… 

Yes, Go to Step 2. 

No, Stop. Not eligible to QMB. 

Verify Medicare Part A eligibility on Medi-Cal Eligibility Data 

System (MEDS) INQB Screen. 

If the customer is Part A Medicare eligible – A manual QMB budget 

will need to be completed. C-IV will not auto test for QMB 

eligibility. If assistance is needed, contact a Medi-Cal EW III or 

EWS I to complete the QMB eligibility determination. 

3 Take the following action when QMB eligibility has been 

determined. 

If eligibility to QMB… Then… 

Exists, • Complete override in 

C-IV to add Medicare 

Premium Payment 

Program (MPPP) – Aid 

code 80. 

• Send manual Notice of 

Action (NOA) MC 239 J 

to advise customer of 

approval. 

Does not exist, Send manual NOA 

MC 239 K to advise 

customer of denial. 

CWPHB #4605 (04/11) MEDI-CAL 15-16

Accelerated Enrollment (AE) for Children 

Introduction When determining eligibility for additional children, the Eligibility Worker (EW) 

may discover that the applicant child has Accelerated Enrollment (AE) 

Medi-Cal. This section explains AE for children and what action the EW 

must take when determining CalWORKs eligibility for a child receiving AE 

Medi-Cal. 

Definition Accelerated Eligibility, or “AE”, is presumptive Medi-Cal eligibility granted by 

Single Point of Entry (SPE) in Sacramento. The purpose of AE is to provide 

temporary, full-scope, zero Share of Cost (SOC) coverage to children who: 

• Are under age 19, 

• Apply for Medi-Cal through SPE, 

• Are likely to be eligible for a zero SOC Medi-Cal program, and 

• Meet other conditions of eligibility, such as California residency. 

Effective dates 

for AE 

MEDS 

information 

If the child is eligible, AE begins the first day of the month in which SPE 

receives the application. Eligibility will continue until the Transitional 

Assistance Department (TAD) makes a final determination of eligibility and 

either approves or denies the CalWORKs or Medi-Cal application. TAD must 

make a final determination of eligibility prior to the end of the second month 

of AE eligibility on Medi-Cal Eligibility Data System (MEDS). 

MEDS will display AE aid codes in one of the special program segments. An 

AE record on MEDS will contain the following (will appear on the INQ1 or 

INQ2 MEDS screen). 

MEDS Field Description 

County ID The County ID for an AE child will be: 

• 36-8E-9+(CIN Number) 

• 36-8W-9+(CIN Number) 

• 36-5E-9+(CIN Number) 

Eligibility Status Code The ESC will be in the 001-499 range and will 

(ESC) 

Government 

Responsibility Code 

(GRC) 

Other Health Coverage 

(OHC) Information 

show in the HFAMILY special segment on MEDS. 

The GRC will show “1”- County Responsibility. 

The OHC field will not show any health coverage 

during the AE period unless it was reported on 

the application. 

Note: Due to the limited amount of information 

concerning OHC on the joint application, the most 

likely OHC code reported for AE will be “N” for no 

other health coverage, or “V” for any carrier. 


CWPHB #4605 (04/11) MEDI-CAL 15-17

Accelerated Enrollment (AE) for Children, Continued 

Terminating AE AE aid codes will only be terminated when MEDS receives information from 

the county that the child’s CalWORKs or Medi-Cal application has either 

been approved or denied. MEDS will discontinue AE benefits at the end of 

the calendar month in which the CalWORKs or Medi-Cal approval or denial 

action is reported to MEDS. A ten-day notice is not required for the 

termination of AE benefits. 

Denials/ 

discontinuances 


Action 

When an AE child is found to be ineligible for CalWORKs, the 

denial/discontinuance is reported to MEDS in order to terminate AE. When 

MEDS receives the denial/discontinuance transaction, MEDS will 

automatically terminate the AE benefits. 

Because AE is granted prior to an actual determination of eligibility by TAD: 

• Ten-day notice is not required to terminate eligibility, and, 

• The customer has no right to an administrative Appeals hearing when the 

benefit stops. 

Language explaining the transition from AE to ongoing Medi-Cal, or denial of 

the application, is included on all affected Notices of Action (NOAs). 

CWPHB #4605 (04/11) MEDI-CAL 15-18

Deemed Eligible (DE) Infants 

Introduction Infants born to mothers who are eligible for and receiving Medi-Cal at the 

time of birth may be enrolled in Medi-Cal without an application. This is 

referred to as Deemed Eligibility. 

CHDP Gateway 

– Deemed 

Eligible infants 

Child Health and Disability Prevention (CHDP) providers may enroll Deemed 

Eligible infants into temporary zero Share of Cost (SOC) Medi-Cal based on 

certain eligibility factors. This program is called CHDP Gateway for Deemed 

Eligible (DE) Infants. A separate Medi-Cal or Healthy Families application is 

not required. The DE infant will continue to receive zero SOC Medi-Cal 

benefits under CHDP Gateway pre-enrollment until the county adds the 

infant to the mother’s CalWORKs or Medi-Cal case. 

Aid Codes There are two aid codes that identify DE infants: 8U and 8V. These two aid 

codes are used for the purpose of providing deemed eligibility until the 

county can process the infant into a CalWORKs or regular Medi-Cal aid 

code. All infants deemed eligible through the CHDP process will be assigned 

aid code 8U without a SOC beginning in the month of the CHDP Gateway 

application since enrollment through CHDP Gateway can only be completed 

if the family’s income does not exceed 200% of the Federal Poverty Level 

(FPL). 

The following table contains specific information regarding these aid codes: 

Aid code Description 

8U • Full-scope, zero SOC Medi-Cal. 

• Infants born to mothers with zero SOC Medi-Cal. 

• Put into this category beginning with the birth 

month. 

• Posted in the MEDS segment type, “ACCEL”. 

8V • Full-scope Medi-Cal benefits with a SOC. 

• Infants born to mothers with SOC Medi-Cal in the 

month of infant’s birth and SOC was met. 

• Deemed SOC eligibility will be for history months 

only (months prior to application). 

• Infant’s SOC will be the same as the mother’s in 

the history month(s). 

• Medi-Cal aid code for application month and 

ongoing will be 8U. 

• Posted in MEDS primary segment. 


CWPHB #4605 (04/11) MEDI-CAL 15-19

Deemed Eligible (DE) Infants, Continued 

Report of birth 

of infant 

Eligibility 

worker (EW) 

processing 


The birth of the infant may be reported by the following: 

• MC330 – Newborn Referral form, 

• Phone call, 

• Letter, 

• MEDS Alert, or 

• Any other contact with the county. 

Only the following information regarding the infant must be provided to add 

the DE infant: 

• Name, 

• Date of birth, and 

• Gender. 

Note: The EW is required to establish eligibility for the DE infant no later 

than 10 days after the birth is reported. 

Eligibility Workers (EWs) processing responsibilities for DE are as follows: 

• Adding DE infants to their mother’s cases (including Maximum Family 

Grant (MFG) children who are DE infants), and 

• Reporting eligibility for Medi-Cal in the appropriate aid code back to the 

infant’s birth month, and 

• Sending a Notice of Action when the infant’s eligibility for Medi-Cal is 

approved or denied. 

REMINDER: DE infants are deemed eligible for one year as long as they 

continue to meet DE requirements. Any income increases are disregarded. 

Examples The following are processing examples: 

Example 1: 

Infant is added to mother’s 1931(b) Medi-Cal case. The EW would report 

eligibility on aid code 3N back to the infant’s birth month. 

Example 2: 

Infant is determined eligible for the Income Disregard Program (200%). The 

EW would report eligibility on aid code 47 back to the infant’s birth month. 

Example 3: 

Infant’s mother had a SOC (aid code 87) in the infant’s birth month, which 

has been certified. When the infant is added to the mother’s case 

(aid code 83), the infant’s SOC will be certified with the same date as his/her 

mother’s. For application month and ongoing, the infant is determined eligible 

for the Income Disregard Program (200%) and eligibility will be reported 

under aid code 47. 


CWPHB #4605 (04/11) MEDI-CAL 15-20


DE case 

processing – 

MEDS alert 

The EW must approve DE benefits for the infant no longer than 10 days after 

the alert is identified. The following are the required steps when establishing 

eligibility for a DE infant: 

Step Action 

1 Review MEDS and notate the correct: 

• Spelling of infant’s name, 

• Date of Birth, 

• Social Security Number (SSN) or Pseudo Number, and 

• Client Index Number (CIN). 

2 Review C-IV and determine the following: 

If newborn is… Then… 

Not reported and mother has 

an open CalWORKs case, 

Not reported and mother’s 

case was discontinued after 

the DE infants birth month 

and prior to his/her first 

birthday, 

Already Active on mother’s 

CalWORKs case and File 

Clearance discrepancy 

identified, 

• Add DE infant to a 

separate Medi-Cal 

program in C-IV. 

• Set RE date for the 

month/year of infants first 

birthday. 

• Complete appropriate 

C-IV pages. 

• Run EDBC for the 

Medi-Cal program. 

• Send appropriate Notice 

of Action (NOA). 

• Pend DE infant to a 

separate Medi-Cal 

program. 

• Set RE date for the 

month/year of infants first 

birthday. 

• Complete appropriate 

C-IV pages. 

• Run EDBC for the 


• Send appropriate NOA. 

Complete necessary forms 

and e-mail to the MEDS 

Coordinator box for chaining, 

linking, etc. 

Note: See ORHB page L-44. 

3 Set Task for infant’s first birthday and Journal action taken. 


CWPHB #4605 (04/11) MEDI-CAL 15-21


Discontinuing 

DE 

Terminating 

Gateway DE on 

MEDS 

RE-evaluations 

(RE) for DE 

infants 

If the infant has been determined eligible for Medi-Cal DE, that eligibility may 

only be discontinued for the following reasons: 

• Infant stops living with his/her mother. 

• Mother and infant move out of state. 

• Mother or other parent who lives with the infant requests the infant be 

discontinued. 

DE cannot be reestablished at a later date even if the infant returns to live 

with his/her mother or the return to California while the infant is under age 

one. 

MEDS will not terminate an infant’s Gateway DE on MEDS until the EW has 

completed its processing and reported the final determination to MEDS. To 

discontinue the DE aid codes, the denial or approval must be reported to 

MEDS. This occurs when an EDBC is run in C-IV to either approve or deny 

Medi-Cal eligibility for the DE infant and C-IV reports this information to 

MEDS. MEDS will discontinue the DE infant at the end of the month the 

action was reported to MEDS. 

Note: The EW must use the MEDS-ID or CIN that is associated with the DE 

aid code. Failure to do so will result in the DE aid code not discontinuing in 

MEDS and the DE infant continuing to be reported on the Exception Eligible 

Report (EER) as not having had eligibility determined by the county. 

In most situations, the family’s annual re-evaluation (RE) will occur during the 

infant’s DE period. The infant, as part of the family, will be given the same 

annual RE date as the rest of the family’s, even if the family’s RE date is 

before the infant’s first birthday. 

Should the family not complete their annual RE and the family’s case is 

discontinued, as long as the infant continues to meet DE requirements, the 

infant would remain eligible until their first birthday. If there are no other 

family members on Medi-Cal, the RE date should be changed to the month 

of the infant’s first birthday. A re-evaluation packet must be completed in 

order for the infant to continue Medi-Cal eligibility after his/her first birthday. 

CWPHB #4605 (04/11) MEDI-CAL 15-22

Exception Eligible Report – Deemed Eligible Infants 

Exception 

Eligible Report 

(EER) 

Reconciling DE 

alerts 

The Department of Health Care Services (DHCS) provides an Exception 

Eligible Report (EER) each month, displaying children with exception 

eligibility for the county. The consecutive months begin with the first month 

of the exception, extended or accelerated eligibility. The EER provides 

report categories with the following critical Deemed Eligible (DE) alert types: 

Alert Type Description Aid Code 

DE – CHDP 

QUEST 

• Infants enrolling through the 

CHDP Gateway who are less 

than 1-year old, whose mother 

was eligible for full scope 

certified SOC Medi-Cal (MC) 

during the month of the child’s 

birth. 

• The infant’s residence address 

on the submitted application 

does not match mom’s current 

residence address on MEDS. 

DE - CHDP • Infants enrolling through the 

CHDP Gateway who are less 

than 1-year old, whose mother 

was eligible for full scope no 

cost MC during the month of 

the child’s birth. 

• 8V – History 

months 

• 8U – Current 

and ongoing 

• 8U 

The report is utilized by all Eligibility Workers (EWs) to identify DE children 

and is available from MEDSDocs on My Easy Desk Source by the 27 th of 

each month. 

The MEDS EW will research each of the DE alerts on the EER and distribute 

as follows: 

If the mother… Then the MEDS EW will… 

Has an open case, 

Is on SSI/SSP and there are other 

family members on an open MC case, 

Is on SSI/SSP, 

Does not have an open case, 

Has a discontinued case after the DE 

infants birth month and prior to his/her 

first birthday, 

Send the alert to the assigned EW 

and his/her Supervisor and track 

for completion. 

Complete the TAD 278 ID and 

refer as a new intake MC 

application. 

Send the alert to the assigned EW 

and his/her Supervisor and track 

restoration of DE eligibility. 

The EW is required to determine eligibility for the DE infant no longer than 10 

days after the alert is identified. 

CWPHB #4605 (04/11) MEDI-CAL 15-23

California Children Services 

Introduction This section contains information regarding California Children Services and 

actions required by Transitional Assistance Department (TAD) Eligibility 

Workers (EWs) in the CCS application process. 

What is CCS? California Children Services (CCS) is a state program that helps children with 

certain diseases, physical limitations, or chronic health problems. CCS 

covers most problems that are physically disabling or that need to be treated 

with medicines, surgery, or rehabilitation. CCS covers children with problems 

such as: 

Application 

process 

AIDS Tumors Cancers 

Thyroid problems Hemophilia Hearing loss 

Sickle cell anemia Liver disease Broken bones 

Rheumatoid arthritis Severe burns Cleft lip/palate 

Severely crooked teeth Cerebral palsy Intestine disease 

Congenital heart Muscular dystrophy Uncontrolled seizures 

disease 

Problems caused by 

premature birth 

Serious chronic kidney 

problems 

Severe head, brain, or 

spinal cord injuries 

CCS has a 30-day timeframe to approve or deny an application. During the 

application process, customers are referred to apply for Medi-Cal. There is 

an outstation EW stationed at the CCS office (currently located at the 

Carousel Mall). This EW takes and processes new Medi-Cal applications for 

customers applying for CCS. When a CCS application is received for a child 

who is a member of an existing TAD case, this EW will request case actions 

from the currently assigned EW. 


CWPHB #4605 (04/11) MEDI-CAL 15-24

California Children Services, Continued 

CCS applicant 

in an active 

TAD case 

There are situations when the CCS applicant is a member of a family with an 

open case (Medi-Cal, CalWORKs) and is: 

• Not currently eligible, or 

• Is excluded, or 

• Is a deemed eligible infant needing to have benefits established. 

All staff involved in this process must cooperate to the fullest extent possible 

to ensure that the child is evaluated in a timely manner. Failure to take action 

may result in the child being denied critically needed benefits. 

The following table describes the request process: 

Role Responsibilities 

CCS EW • Sends an e-mail to assigned EW and his/her Eligibility 

Worker Supervisor (EWSI) requesting the CCS applicant 

child be evaluated for Medi-Cal, including a due date for 

the action to be completed. 

• Follows up on requested action due dates. 

• Whenever possible, assists the assigned EW with 

obtaining information/verification(s) from the customer. 

Assigned Assigned EW: 

EW • Acknowledges to CCS EW that request has been 

received. 

• Reviews case record to evaluate eligibility for child, as 

requested. 

• Advises CCS EW by phone or e-mail if any additional 

information/verification(s) is required. If CCS EW does not 

have the information/verification(s) available, the assigned 

EW will contact the customer per established procedures 

and request the information/verification(s). 

• Advises the CCS EW via e-mail when: 

− Evaluation of child’s eligibility has been completed. 

− An extension of the due date is required. 

− Assistance is needed to obtain 

information/verification(s) from the customer. 

EWSI • Ensures that the requested action is completed by the due 

date. 

Note: If the requested action is not completed by the requested due date, the 

CCS EW will notify the District Manager (DM), who will then be responsible 

for ensuring the requested action is completed. 


CWPHB #4605 (04/11) MEDI-CAL 15-25

California Children Services, Continued 

Deemed 

eligible (DE) 

infants 

Infants born to mothers who were eligible for and receiving Medi-Cal at the 

time of birth may be enrolled in Medi-Cal without any separate application 

through the month of their first birthday. This is referred to as deemed 

eligibility (DE). 

In order to facilitate the approval of benefits for the CCS applicant DE infant, 

the CCS Eligibility Worker (EW) will take the action to add the DE infant to 

the existing case. 

CWPHB #4613 (07/11) MEDI-CAL 15-26

Methods of Medi-Cal Card Issuance 

Introduction This section explains the types of Medi-Cal cards issued, when a plastic 

Benefit Identification Card (BIC) is to be issued, when temporary-use paper 

cards are to be issued, and Eligibility Worker (EW) procedures to issue 

cards. 


Medi-Cal 

cards 

When is a BIC 

card issued? 

What to do 

when a BIC is 

lost or stolen 

When is a 

paper card 

issued? 

Medi-Cal cards are issued through a statewide computer system called 

Medi-Cal Eligibility Data System (MEDS). 

There are two types of Medi-Cal cards: 

• Plastic Benefits Identification Card (BIC), mailed from Sacramento. 

• Temporary-use paper card, issued in the district office for emergency 

situations. 

Note: Temporary–use paper cards are valid for the month in which they are 

issued. 

A BIC card is issued at initial approval of eligibility. Because it is an 

identification card only, and not proof of Medi-Cal eligibility, a new card is not 

re-issued routinely when an individual reapplies after a break in aid, or 

transfers from one aid program to another. 

If the BIC card is lost, stolen, damaged, or the customer information is 

incorrect, the MEDS clerk may request a replacement card. 

A temporary-use paper card is issued for: 

• Emergency situations when a plastic BIC is not available 

• Pregnant women 

Note: Proof of need is not required. 


CWPHB #4605 (04/11) MEDI-CAL 15-27

Methods of Medi-Cal Card Issuance, Continued 

EW 

procedures 

for card 

issuance 

The following chart explains what type of Medi-Cal card to issue to 

customers. 

Situation Procedure 

Initial BIC Card 

(first-time eligibles) 

The BIC card is automatically requested when the 

case is processed. Advise customer to allow two or 

more weeks for the card to be mailed from 

Sacramento. 

Replacement BIC EW completes the TAD 110A to authorize, and has 

District MEDS clerk order the card from Sacramento 

Immediate Need EW completes TAD 110A requesting paper card. 

(paper) Cards 

CWPHB #4605 (04/11) MEDI-CAL 15-28

Letters of Authorization (LOA) 

Introduction A Letter of Authorization (LOA), the MC 180, is issued to allow the Medi-Cal 

provider to bill Medi-Cal for payment of medical services requested more 

than one year after the date of the service. This section explains when a 

LOA is issued, extenuating circumstances and Eligibility Worker (EW) 

procedures. 

When to issue 

a LOA 

Administrative 

error 


administrative 

error 

Extenuating 

circumstances 


extenuating 

circumstances 

There are specific circumstances when a LOA is issued: 

• SSI eligibility was approved for a retroactive period, but the Medi-Cal 

card was not issued, 

• Court orders issuance, 

• State hearing or other administrative hearing orders issuance, 

• State/county decision that an administrative (county) error occurred, or 

• Department of Health Services (DHS) requests the county to issue the 

LOA. 

An administrative error occurs when the customer does not receive a 

Medi-Cal Benefits Identification Card (BIC) due to an error caused by the 

county, or the benefits were not correctly established on Medi-Cal eligibility 

Data System (MEDS) and services could not be billed. 

An example of administrative error is when a customer reported a change of 

address and the EW did not change the address, and the customer did not 

receive a Medi-Cal card. 

Note: The customer’s failure to provide his/her BIC to the provider or the 

provider’s failure to bill timely are not considered administrative errors. 

If the request does not meet the above requirements, and the medical bill is 

creating a financial hardship, the EW should determine if there were 

“extenuating circumstances” – circumstances beyond the control of the 

county or the customer - which prevented the customer from giving his/her 

Medi-Cal card to the provider. 

If the EW determines that extenuating circumstances exist, District Managers 

(DMs) should contact the Program Development Division (PDD) for 

assistance in processing this request. PDD will contact Department of 

Health Care Services (DHCS) and provide all necessary documentation for a 

determination. DHCS will make the final decision on whether a LOA will be 

issued. 

An example of extenuating circumstances is when a medical condition, such 

as a brain tumor, impairs the customer’s ability to handle his/her affairs. 

CWPHB #4605 (04/11) MEDI-CAL 


15-29

Letters of Authorization (LOA), Continued 

EW procedures The EW will take the following steps when a request for a LOA is made. 

Step Action 

1 Determine if the customer’s situation meets one of the specific 

circumstances listed in the “When to issue a LOA” block of this 

chapter or extenuating circumstances. 

2 Obtain all necessary documentation from the customer. 

3 Obtain an original, individually numbered LOA (MC 180) for each 

provider from the district issuance Office Assistant (OA). 

4 Complete the following entries on the LOA: 

• Enter the date of the LOA issuance to the left of the “Document 

Number”. 

• Enter all information in the box in the upper right of the form. 

• Enter customer’s name and address in the space provided. 

• Enter customer’s name in the salutation. 

• Enter Mo/Yr authorized. Cross out any month not issued or 

completed. 

• Check appropriate box for the reason the LOA is issued (If 

Administrative error, enter full description of the error). 

5 Complete a Journal entry for LOA issuance. The Journal entry 

must include: 

• Reason for LOA, 

• MC 180 serial number issued, and 

• Months for which LOA is issued. 

6 Give MC 180 to an EWS I for review and to obtain a signature from 

the District Manager (DM) for authorization. If the LOA is approved 

for extenuating circumstances, see the “Extenuating 

circumstances“ block in this chapter for additional processing 

procedures 

Note: The DM must verify a Journal entry has been made prior 

to authorizing the LOA. 

7 Mail or give the LOA to the customer after the DM has approved 

the form. A copy of the LOA will be maintained in the case file. 

Note: Once the DM approves the LOA, it is returned to the Issuance OA, 

who completes the TAD MC 180 AL (LOA Approval Log). The Issuance OA 

then returns the signed LOA to the EWS I, who ensures the EW mails the 

completed form to the customer. 

CWPHB #4605 (04/11) MEDI-CAL 15-30

Retroactive Medi-Cal 

Introduction The customer may apply for retroactive (retro) Medi-Cal to cover medical 

expenses in all or any of the three months immediately prior to the month of 

application for CalWORKs. 

If retro Medi-Cal is not requested at the time of application, the customer has 

one year after the date of the medical service in which to apply. 

Eligibility 

requirements 

Eligibility 

Worker 

procedures 

This section explains the eligibility requirements, Eligibility Worker (EW) 

procedures and District procedure. 

In order to be eligible for retro Medi-Cal, the customer: 

• Must have received medical services which are covered by Medi-Cal, 

and 

• Must not have been denied Medi-Cal during the retro period, unless 

− It was a county error, or 

− Customer failed to cooperate due to circumstances beyond his/her 

control (hospitalization, etc.) 

Note: If eligibility is based on pregnancy or disability, verification is required 

that the condition existed during the retro period. 

The table below describes the procedures to follow when a customer 

requests retroactive Medi-Cal. 

Step Action 

1 Have the customer complete, sign and date the MC 210A. 

2 Verify all income for the retroactive month(s). 

Note: Customer should write “no change” if circumstances were the 

same in the retro month as in the application month. 

3 Verify changes in property for the retroactive month(s). 

Note: Customer should write “no change” if circumstances were the 

same in the retro month as in the application month. 

4 Send MC 210A and any verification to the Medi-Cal unit according to 

district policy. 

5 Journal which persons had medical expenses, what month(s) the 

expenses were incurred, and any other pertinent information. 

CWPHB #4605 (04/11) MEDI-CAL 15-31

Medi-Cal Hospice Care 

Introduction Hospice is a specialized program of care for the terminally ill person and 

his/her family. In order to be eligible for hospice services, a person must be 

certified terminally ill with a life expectancy of six months or less. 

What happens 

when a 

customer 

chooses 

hospice? 

This section explains what happens when a customer chooses to receive 

hospice services. 

When the customer chooses to receive hospice services, the hospice 

provider notifies the Department of Health Care Services (DHCS). DHCS 

makes the necessary changes to MEDS to indicate the person is eligible to 

hospice services only. All medical care must be arranged through the 

hospice provider. 

If the customer decides to discontinue hospice services, he/she must 

disenroll with the hospice provider. 

Note: The Eligibility Worker (EW) does not make any changes to the case 

when the customer chooses to receive his/her medical care through hospice. 

CWPHB #4605 (04/11) MEDI-CAL 15-32

Add Persons – Quarterly Reporting 

Introduction All customers who are determined eligible to receive CalWORKs are entitled 

to receive Medi-Cal from the date of request, even if cash benefits are not 

authorized until a later date. This section explains the process for issuing 

Medi-Cal. 

Effective date Although the CalWORKs Beginning Date of Aid (BDA) is not effective until 

the first of the month following the month in which the change is reported, or 

the first of the Quarterly Reporting (QR) Payment Quarter following the report 

on the QR 7, cash-linked Medi-Cal will be effective for the new Assistance 

Unit (AU) member effective the first of the month in which the change 

occurred, provided the customer met all CalWORKs eligibility conditions 

(financial and non-financial) and the AU reported the change timely. If the 

report is not timely, the BDA is the first of the month of report, unless the 

report is for a newborn and the newborn is deemed eligible. 

Timely vs. 

untimely 

Determining 

Medi-Cal 


In order for the report of a new person to be considered reported timely, the 

customer must report the new person no later than on the QR 7 submitted 

following the change or by the extended filing date for that QR 7. Reports 

received after the QR 7 following the change are considered untimely. 

Use the table below to assist in determining the cash-linked Medi-Cal BDA 

for an add person. 

If the add person is… And the change was… Then the cash-linked 

Newborn (including MFG 

child), 

Dad in a pregnant 

woman only (PWO) 

Medi-Cal BDA is… 

Reported timely, The first of the month 


Not reported timely, The first of the month 


birth, unless newborn 

is deemed eligible. 



case, Not reported timely, The first of the month 

Any other person, 



of change. 

Not reported timely, The first of the month 


CWPHB #4605 (04/11) MEDI-CAL 15-33



CHAPTER 16 

Court Orders 

Court Orders: Overview ...............................................................................................16-1 

Anderson v Saenz........................................................................................................16-2 

Andreyeva v Anderson.................................................................................................16-3 

Paoli v Anderson ..........................................................................................................16-4 

Quilla Beverly v Anderson............................................................................................16-5 

Nickols v Saenz............................................................................................................16-6 

Dominika S. v Saenz....................................................................................................16-8 

Kehrer v Saenz ............................................................................................................16-9 

CWPHB # 4605 (04/11) TABLE OF CONTENTS PAGE 1 OF 1

Overview 

Court Orders 

Background This chapter includes recent court decisions that require the Counties to take 

specific actions. For the purposes of this chapter, only current or recent 

court orders will be included. 

Historical records on previous court cases are kept at the Program 

Development Division (PDD). If you need to obtain information on previous 

court cases, contact the CalWORKs Program Specialist at the PDD. 


• ACL 98-55, 00-24, 00-31, 00-62, 00-78. 01-15, and 01-16 



Anderson v Saenz 16-2 

Andreyeva v Anderson 16-3 

Paoli v Anderson 16-4 

Quilla Beverly v Anderson 16-5 

Nickols v Saenz 16-6 

Dominika S. v Saenz 16-8 

Kehrer v Saenz 16-9 

CWPHB # 4605 (04/11) COURT ORDERS 16-1

Anderson v Saenz 

Overview Anderson v Saenz lawsuit challenged the policy of counting a vehicle as a 

resource when it is used to transport a physically disabled household 

member who receives SSI/SSP. 

The court ruled in favor of the plaintiff and has ordered Counties to pay 

retroactive benefits to families who were denied/discontinued from 

CalWORKs and/or CalFresh when a vehicle that was used to transport a 

physically disabled SSI/SSP household member was used in the resource 



• ACL 00-31 

Informing DSS mailed an informing/claim notice (TEMP 2181) to all potential claimants 

(individuals currently receiving SSI/SSP) the last week in May 2000. In 

addition to the mailing, the court required Counties to post the TEMP 2182 

poster in all lobby areas from June 1, 2000 through July 31, 2000. 

Claim Process All potential class members had until July 31, 2000 to submit a claim for 

retroactive benefits. 

All claim forms received in the district were sent to Judy Varela, PDD, mail 

code 0515. 


Andreyeva v Anderson 

Overview Andreyeva v Anderson challenged DSS’s authority to grant adjust aid paid 

pending (APP) overpayments that occurred between November 1, 1996 and 

December 31, 1997. 

The court ruled in favor of the plaintiffs and has ordered Counties to pay 

families for any APP overpayments that were grant adjusted. 


• ACL 00-62 

Informing DSS mailed a claim form (TEMP 2179) to potential class members the week 

of September 18, 2000 with instructions for the claimant to return the claim 

form to the Andreyeva coordinator. 

Claim 

processing 

All potential class members had until December 29,2000 to return Andreyeva 

claim forms, unless the County failed to send a Notice of Action (NOA) to 

approve or deny the claim by April 12, 2001. Then the claimant had until 

May 28, 2001 to return another claim form. 

All claim forms were sent to C.J. Houston, Andreyeva Coordinator, San 

Bernardino TAD, mail code 0080. 


Paoli v Anderson 

Overview The Paoli v Anderson lawsuit eliminated the lump sum regulations, including 

the Period of Ineligibility (POI), beginning November 1, 1997. The Court 

instructed counties to issue retroactive benefits for eligible recipients. 


Retroactive 

period 

• ACL 98-55 

The retroactive court order applied to any month from October 1, 1998 

through November 30, 1998. 

Claim period The claim period for retroactive benefits was August 15, 1998 through 

November 30, 1998. 

Informing 

notice 

Requesting a 

claim form 

Claim 

processing 

On August 15, 1998, a Paoli notice to request a claim form (Temp 2158) was 

mailed to all current CalWORKs recipients and individuals who were in a POI 

during the retroactive period. 

The informing notice explained to potential claimants that a claim form was 

required and instructions on where to obtain a claim form. 

The potential claimants could request a claim form (Temp 2159) in one of the 

following ways: 

• Completing the Temp 2158. 

• Coming into the office (each district office will have a small supply of 

claim forms). 

• Calling the CDSS toll-free number listed on the Temp 2158. 

All claims were forwarded to Judy Varela, PDD, mail code 0515 for 

processing. 


Quilla Beverly v Anderson 

Overview A lawsuit was filed based on counties policy regarding replacing a warrant, 

once it has been reported lost, stolen or destroyed. 

The court’s decision was that the counties MUST issue a replacement 

warrant within five working days after the individual/customer signs the stop 

payment, regardless of whether the county thinks the warrant has been 

forged or cashed by the individual/customer. 

This court decision applies to the following payments: 

CalWORKs (including vendor payments) 

Cal-Learn Bonuses 

Child Care 

Welfare-to-Work (WTW) supportive services 

Foster Care/KinGAP 


ACL 00-24 

Implementation Effective immediately, counties are to issue replacement warrants, within five 

working days after the individual signed the Stop Payment Declaration or 

Lost Warrant Replacement Affidavit, even if it has been determined the 

warrant was not lost, stolen or destroyed. 

If both the original warrant and replacement warrant are cashed, and the 

County believes that the individual cashed both warrants: 

Auditing will make all appropriate fraud referrals. 

If fraud has determined the individual/customer cashed both the original 

warrant and replacement warrant, an overpayment will be 

assessed/collected. In cases of fraud, IPV will be pursued. 

CWPHB #4656 (04/13) COURT ORDERS 16-5

Nickols v Saenz 

Overview The issues in the Nickols lawsuit were: 

• How CalWORKs applicants and recipients (including minor parents) were 

informed about the Maximum Family Grant (MFG) rule. 

• What constitutes a break in aid during the ten months prior to the baby’s 

birth. 

The court ruled in favor of the plaintiffs and has ordered counties to: 

• Remove the MFG status for any child born to a minor parent who is or 

was aided as dependent child (nested teen) back to September 1, 2000, 

or the baby's date of birth, which ever is later. 

• Count suspense and/or zero basic grant months towards the two 

consecutive months break in aid (This is applied prospectively from 

February 1, 2001). 


Identifying 

potential 

claimants 

Determining 

amount of retro 

payment 

• ACL 00-78 

The Nickols court case required counties to identify potential claimants. 

San Bernardino County obtained a list of all cases that contained a BIC 263 

in Data Group 42 in the Welfare Database (WD). 

When the list was received, the Eligibility Worker (EW) reviewed each case 

to see if the MFG child (BIC 263) is a child of a minor parent who: 

• Was a nested teen, or 

• Had now established his/her own case. 

The amount of the retroactive payment was the amount of the needs of the 

previously designated MFG child for each month from September 1, 2000, or 

the date of birth, whichever was later. The TAD 30 (CalWORKs manual 

budget) was used to determine the amount of the retroactive payment. 

The retroactive payment was paid to each Assistance Unit (AU), which met 

the Nickols order. 

Example: Minor parent was receiving aid as a dependent in her mother’s 

case. She had a baby June 28, 2000. The baby was determined to be an 

MFG child. The minor parent turned 18 in November 2000 and established 

her own AU (self and her MFG child) December 1, 2000 and continuing. 

Action to stop the MFG status was taken March 5, 2001. 



Nickols v Saenz, Continued 

Determining 

amount of retro 

payment, cont. 

DPSS 278 

document 

coding 

Notice of 

Actions (NOAs) 

Other 

information 

The retro payment was made as follows: 

• The senior parent received retro payment for September, October and 

November 2000. 

• The minor parent received retro payment for December 2000 and 

January, February, and March 2001. 

The DPSS 278 document used with the Welfare Database (WD) was coded 

as follows: 

• DG 12: Asterisk (*) MG 

• DG 42: Stop date BIC 263 8/00 or date of birth whichever is later 

• DG 52: Issue supplement for each month separately. Enter “NS” in the 

PAC. 

The Notice of Action (NOA), TEMP NA 306, was used to inform the recipient 

of the retro payment. 

• All cases were reviewed and appropriate action was taken no later than 

April 30, 2001. 

• The retro payment (except for money due for the current calendar month) 

was used to offset any existing overpayment. 

• For CalFresh, the retro payment was not considered as income, but as a 

resource. 


Dominika S. v Saenz 

Overview The Dominika S. v Saenz lawsuit challenged the policy regarding 

consideration of child support payments made to an unaided senior parent 

on behalf of the minor parent as income to the minor parent. 

The settlement provided child support payments made on behalf of the minor 

parent and intended to provide for the needs of the minor parent shall not be 

considered in determining the CalWORKs eligibility and the grant amount for 

the minor parent’s child. 


• ACL 01-15 

Policy change For CalWORKs eligibility and grant determination purposes, any child 

support paid to an unaided senior parent on behalf of a minor parent who 

resides with the unaided senior parent shall not be included as minor parent 

income in the “excluded parent computation.” 


and 



Action (NOAs) 

This change was effective with 02/01/2001 grant payments and eligibility 

determinations, as follows: 

• Intake: Cases approved after receipt of this handbook letter were to be 

processed using the new policy. 

• Carrier/Continuing: 

− Retroactive – Cases with minor parents and unaided senior parents 

were reviewed back to 02/01/2001, with any corrective payments due 

issued by 05/31/2001. (A list of all minor parent cases was issued to 

staff by 04/02/2001.) 

− Continuing/Ongoing – Ongoing cases are to continue to have child 

support payments made on behalf of the minor parent treated in 

accordance with this policy. 

Temporary Notices of Action (NOAs) were devised to be used to implement 

the provisions of the Dominika S. court order. The NOAs are: 

• TEMP NA 1221 – used to issue corrective underpayments retroactively to 

02/01/2001 

• TEMP NA 1222 – used to change aid prospectively for individuals 

affected by this court order. 

Note: These notices were available on FORMQuest. 


Kehrer v Saenz 

Overview The Kehrer v Saenz lawsuit challenged the policy regarding treatment of 

child support payments in CalWORKs cases for children subject to the 

Maximum Family Grant (MFG) rule. 

The settlement provided the following payments shall be exempt from 

consideration as income in the CalWORKs grant computation for cases 

subject to the MFG rule: 

• Child support payments from the absent parent for the MFG child, 

whether paid directly to the MFG child, the custodial parent, or through 

the District Attorney/Family Support Office. 

• Benefits from Social Security or other government programs based on 

the absent parent’s disability or retirement and paid to or on behalf of the 

MFG child, which satisfy, in whole or in part, the absent parent’s child 

support obligation. 


Change 


and 



Action (NOAs) 

• ACL 01-16 

This change was effective with 04/01/2001 grant payments and eligibility 

determinations, as follows: 

• Intake: Cases approved on or after 05/01/2001 were processed using 

the new policy. 

• Carrier/Continuing: 

− Retroactive – Cases with MFG children were reviewed back to 

02/01/2001, with any corrective payments due issued by 05/31/2001 

(A list of all MFG cases was issued to staff by 04/02/2001). 

− Continuing/Ongoing – Ongoing cases are to continue to have child 

support payments for MFG children treated in accordance with this 

policy. 

Temporary Notices of Action (NOAs) were devised to be used to implement 

the provisions of the Kehrer court order. The NOAs are: 

• TEMP NA 1224 – used to notify Assistance Units (AUs) of a change in 

their benefit level 

• TEMP NA 1223 – used to issue corrective underpayments retroactively to 

04/01/2001 

Note: These notices were available on FORMQuest. 




CHAPTER 17 

FRAUD/QC/APPEALS 

Fraud/QC/Appeals: Overview ..................................................................................... 17-1 

Program Integrity Division (PID) ................................................................................... 17-2 

Terms and Definitions .................................................................................................. 17-3 

PID – Fraud Investigation Unit (FIU) ............................................................................ 17-8 

Finding Discrepancies .................................................................................................. 17-9 

Resolving Discrepancies ............................................................................................ 17-11 

Fraud Detection .......................................................................................................... 17-13 

PID – Quality Review Unit (QRU) .............................................................................. 17-15 

Homecall Referrals Procedures ................................................................................. 17-16 

Income and Eligibility Verification System (IEVS) ...................................................... 17-17 

IEVS – Earned and Unearned Income Report Reconciliation .................................... 17-19 

Customer Failure to Cooperate with IEVS Process ................................................... 17-20 

Quality Control (QC) ................................................................................................... 17-22 

Customer Failure to Cooperate with Quality Control .................................................. 17-24 

Forged Warrants ........................................................................................................ 17-25 

PID – Appeals Unit ..................................................................................................... 17-26 




State Hearings ...........................................................................................................17-28 

Complaints .................................................................................................................17-30 

Intentional Program Violations (IPV) ..........................................................................17-31 

Fleeing Felons and Probation/Parole Violators..........................................................17-41 

Felony Drug Conviction..............................................................................................17-43 

CWPHB # 4605 (04/11) TABLE OF CONTENTS PAGE 2 OF 2

Overview 

Fraud/QC/Appeals 

Introduction Fraud prevention is the responsibility of all staff. The accuracy and honest 

administration of the public assistance programs administered by the 

Transitional Assistance Department (TAD) is also the responsibility of all 

staff. This Chapter offers a glossary of terms related to fraud prevention and 

program integrity. It explains the various aspects of identifying and referring 

discrepant information for investigation. In addition, this Chapter describes 

the major responsibilities, tasks, and procedures of the Program Integrity 

Division (PID), formerly known as the Fraud Prevention Bureau (FPB). 


• ACL 03-18 


• MPP 20-000, 21-000, and 22-000 

• EAS 82-832 



Program Integrity Division (PID) 17-2 

Terms and Definitions 17-3 

PID – Fraud Investigation Unit (FIU) 17-8 

Finding Discrepancies 17-9 

Resolving Discrepancies 17-11 

Fraud Detection 17-13 

PID – Quality Review Unit (QRU) 17-15 

Homecall Referrals Procedures 17-16 

Income and Eligibility Verification System (IEVS) 17-17 

PVS 40 17-18 

IEVS – Earned and Unearned Income Report Reconciliation 17-19 

Customer Failure to Cooperate with IEVS Process 17-20 

New Hire Run 17-21 

Quality Control (QC) 17-22 

Correcting QC Errors 17-23 

Customer Failure to Cooperate with Quality Control 17-24 

Forged Warrants 17-25 

PID – Appeals Unit 17-26 

State Hearings 17-28 

Complaints 17-30 

Intentional Program Violations (IPV) 17-31 

Fleeing Felons and Probation/Parole Violators 17-41 

Felony Drug Conviction 17-43 

CWPHB #4605 (04/11) FRAUD/QC/APPEALS 17-1

Program Integrity Division (PID) 

Overview The Program Integrity Division (PID) is a support department to the Human 

Services System (HSS) that is responsible for preventing, detecting, and 

prosecuting acts of fraud, accepting personnel and non-personnel 

complaints, reviewing customer disputed case actions, collecting overpaid 

benefits, and promoting and measuring the integrity of Transitional 

Assistance Department’s programs. 

PID Units PID consists of three units: 

• Fraud Investigation Unit (FIU) – Tasks include preventing, investigating, 

arresting, and assisting with the prosecution of acts of welfare and 

employee fraud. 

• Quality Review Unit (QRU) – Tasks include preventing and early 

detection of fraud, verifying income and property, and reviewing cases for 

accuracy and data collection as required by the Federal government. 

• Appeals Unit – Tasks include completing impartial reviews of case 

actions and inactions for dissatisfied customers, negotiating and 

preparing State Hearing requests, monitoring corrective actions, 

representing the County in Administrative Hearings, and accepting, 

acting upon, or referring complaints, including allegations of 

discrimination. 


Terms and Definitions 

Adequate 

notice 


Disqualification 

Hearing (ADH) 


Law Judge 

(ALJ) 

Aid Paid 

Pending (APP) 

Appeal (or Fair 

Hearing or 

State Hearing) 

A written notice informing the customer of the action the County intends to 

take, the reason for the intended action, the specific regulations supporting 

such action, an explanation of the customer’s right to request a State 

Hearing, and, if appropriate, the circumstances under which aid will be 

continued if a hearing is requested. 

A hearing requested by the County and conducted by the State Department 

of Social Services (DSS) to determine if an applicant or recipient of 

CalWORKs and/or CalFresh intentionally made a false or misleading 

statement, or misrepresented, concealed, or withheld facts. 

The person designated by DSS to be responsible for resolving case actions, 

resolving disputes between customers and the County (State Hearing), and 

conducting disqualification hearings, such as Intentional Program Violations 

(IPVs). 

Continuation of aid in the same amount the claimant would have received if 

the proposed action was not taken. 

See “State Hearing.” 

Appeals Unit The unit in the Program Integrity Division (PID) responsible for representing 

the County in State Hearings and Administrative Disqualification Hearing 

processes. 

C-IV A consortia automation system used by the County that contains customer 

program eligibility and benefit information. 

CDSS The California Department of Social Services, also known as DSS. 

Civil 

Rights/Non- 

Discrimination 

Policy 

Federal and State laws ensuring individuals have equal treatment and 

access to benefits and services. 




Claimant An applicant or recipient of public assistance programs who requests a State 

Hearing. 

Complaints A function of PID’s Appeals Unit, responsible for receiving complaints from 

customers and the public regarding the receipt or application for public 

assistance benefits and referring the complaints to the appropriate 

department for resolution. 

Custodian of 

Record 

A Quality Review Specialist (QRS) who is responsible for taking a 

subpoenaed case to court, and, when required, testifies as to its contents. 

Discrepancies Information written or stated by the applicant or recipient customer 

inconsistent or conflicting with third party information, the case record, 

verifications, and/or observations. 

Disqualification To make an individual ineligible for benefits due to failure to meet certain 

rules or regulations in the CalWORKs or CalFresh. 

Drug felon An individual who committed and was convicted of a felony drug charge 

12/31/1997 or later for CalWORKs and 08/22/1996 or later for CalFresh. 

Drug felons are permanently ineligible for CalWORKs and CalFresh benefits. 

Fair hearing (or 

Appeal or State 

Hearing) 

Fleeing felon 

and probation/ 

parole violator 

See “State Hearing.” 

An individual with an outstanding judicial bench warrant for his/her arrest or a 

felon, fleeing to avoid prosecution, custody, or confinement after conviction 

for a crime or attempt to commit a crime, or in violation of probation or parole. 

These individuals are ineligible for CalFresh and CalWORKs. 

Forged warrant A warrant endorsed and cashed by someone other than the payee. 

Fraud When an individual intentionally makes false statements or omits information 

in order to receive CalWORKs and/or CalFresh benefits. 




Fraud 

Investigation 

Unit (FIU) 

Good Cause 

(DCSS) 

Grant 

Adjustment 

The central unit in the Program Integrity Division (PID), responsible for 

investigating suspected CalWORKs, CalFresh, Child Care, and employee 

fraud, arresting fraud suspects and, as needed, coordinating activities with 

other law enforcement agencies. 

When a customer’s cooperation with the Department of Child Support 

Services (DCSS) will result in serious physical or emotional harm to the child, 

parent, or caretaker relative. 

The method of overpayment recovery that reduces the cash benefits by 5% 

or 10%, depending on the type of overpayment. 

Homecall Unit The central unit in PID’s Quality Review Unit (QRU) that conducts home 

interviews of applicants and recipients referred by Eligibility Worker (EWs) 

when case discrepancies are found, fraud is suspected, or for Drug Felons or 

Welfare-to-Work (WTW) sanctions. 

Income and 

Eligibility 

Verification 

System (IEVS) 

Intentional 

Program 

Violation (IPV) 

Overpayment 

(OP) 

A Federally mandated system, which compares income and eligibility 

information reported by other agencies, counties, and states to MEDS with 

case information on the County’s automation system (C-IV or Welfare 

Database). 

An applicant or recipient who intentionally withholds, conceals, or 

misrepresents facts pertinent to the eligibility of CalWORKs and/or CalFresh 

may be guilty of an Intentional Program Violation (IPV). A determination of 

an IPV can only be made by a court judgment, administrative disqualification 

hearing, or the applicant or recipient signing a disqualification consent 

agreement. 

The amount of CalWORKs grant the Assistance Unit (AU) received to which 

it was not eligible. 

Penalty The forfeiture of benefits due to a violation of the rules of CalWORKs or 

CalFresh regulations. 

Probation/ 

Parole violator 

See “Fleeing Felon.” 




Program 

Integrity 

Division (PID) 

Quality Control 

(QC) 

Quality Review 

Unit (QRU) 

QC (Yearly) 

review period 

The Division in HSS that includes the Quality Review Unit (QRU), the Fraud 

Investigation Unit (FIU), the Appeals Unit, and the Case Review Unit (CRU). 

PID was formerly known as the Fraud Prevention Bureau (FPB). 

The Federally mandated administrative system for documenting the extent of 

and reason for CalFresh errors and CalWORKs Welfare to Work participation 

information. 

The QRU is responsible for: 

• Completion of Federal/State case reviews – Quality Control (QC) 

• Reconciliation of income and property information from State reports with 

what the customer reported in the case record – IEVS 

• Verification, prevention, and early detection of Fraud – Homecalls 

• Determination of good cause for non-cooperation with the Department of 

Child Support Services (DCSS) 

• Completion of CalWORKs and TANF Time on Aid (TOA) reviews (see 

Chapter 18 of this handbook for complete information) 

October 1 st of one year through September 30 th of the following year. 

Review Period The month of the QC review and the two months preceding that month. 

Example: Review month is July. Review period is May, June, and July. 

Sanction Imposing a reduction in benefits due to a violation of a CalWORKs or 

CalFresh regulation. 

Snowballing 

overpayments 

State Hearing 

(or Appeal or 

Fair Hearing) 

“Snowballing” can occur when a new overpayment is computed in a month in 

which an existing overpayment is being adjusted through grant adjustment. 

A form of administrative hearing mandated by Federal and State law 

whereby a dissatisfied applicant or recipient customer may obtain an 

impartial review of a County action or inaction. 

Subpoena A notice commanding a person to appear in court to testify as a witness. A 

subpoena may also be used to request a case file for court proceedings 

other than for State Hearings (See Custodian of Record). 




Supplement Amount of CalWORKs grant to be issued to the Assistance Unit (AU) for the 

current calendar month, which was not previously issued or included with the 

payment issued for that month. 

Underpayment Amount of CalWORKs grant due to the AU for any month(s). 


PID – Fraud Investigation Unit (FIU) 

Overview The Fraud Investigation Unit (FIU) is comprised of recognized peace officers 

and support staff. FIU has the responsibility to investigate suspected 

CalWORKs, CalFresh, and Child Care fraud cases and, when necessary, file 

charges with the District Attorney’s office. 

Responsibilities The table below describes FIU’s responsibilities. 

Task Description 

Compliance Conducts homecalls in coordination with local law 

Checks enforcement agencies. 

Criminal Conducts desk and field investigations of suspected 

Investigations fraud: 

• Applicant and recipient customer CalWORKs and 

CalFresh fraud 

• Vendor fraud 

• Child Care provider (collaborator) and recipient 

customer fraud 

• Employee fraud 

• IHSS provider fraud 

Electronic Monitors EBT data for patterns or trends that could 

Benefit Transfer indicate fraudulent usage by vendors and customers. 

(EBT) 

Investigations 

IPV Prepares cases for Intentional Program Violation (IPV) 

hearings. 

New Employee Runs background checks on all new hires for felonies or 

Background other crimes deemed as unacceptable by Human 

Checks Resources. 

Serve Warrants Serves: 

• Arrest warrants for welfare fraud 

• Search warrants 

Subpoenas Serves subpoenas for: 

• District Attorney filings for welfare fraud 

• State Hearings 

Warrant Checks Runs warrant checks on reported applicant or recipient 

customer fleeing felons and convicted drug felons. 


Finding Discrepancies 

Overview Discrepancies are inconsistent or conflicting information in: 


discrepancies 

Discrepancies 

reported by 

Welfare-to- 

Work (WTW) 

program staff 

The applicant or recipient customer’s verbal or written statements; 

Third party information (IEVS, QC, complaints, etc.); 

Case record, documentation, or verification; and 

Eligibility Worker (EW) observations 

The EW should be alert to certain general situations that may indicate a 

discrepancy. He/she should use good judgment when deciding whether the 

customer’s explanation is reasonable. 

Some examples of clues to discrepancies are listed below. This list is not allinclusive. 

Incomplete or questionable information from the SAWS 2 (root questions) 

or DFA 285 A2. 

Statements offered in the interview that conflict or are inconsistent with 

other verbal or written statements or verifications. 

Rent and utilities are 80% or more of the total household income. 

Utility bills in another individual’s name and the Assistance Unit (AU) 

/Household lives alone. 

AU lives with relatives of the absent parent. 

One of the parents in a two-parent household refuses to cooperate with 

the Welfare-to-Work (WTW) program and then leaves the home. 

An address change is submitted during the application process and the 

household was not homeless. 

EWs may receive information regarding possible discrepancies from WTW 

staff. This information is received via e-mail or a communication form from 

the owning Employment Services Specialist (ESS). When such information 

is received, EWs must: 

Review the case, 

Take the appropriate action, and 

Notify the reporting ESS of the findings. 

Use the Step/Action chart on the next page to determine the correct actions 

to take regarding these discrepancies. 



Finding Discrepancies, Continued 

Resolving ESP 

discrepancies 

Use the chart below to determine the correct steps to take when WTW staff 

reports a possible discrepancy. 

Step Action 

1 EW receives information from WTW staff regarding a possible 

discrepancy. 

2 EW reviews the case record to determine if a discrepancy exists 

and, if so, whether it has been resolved. 

If… Then the EW will… 

No 

discrepancy 

exists 

Discrepancy 

was 

previously 

resolved 

Discrepancy 

needs to be 

resolved 

Narrate in the case Journal the information 

received from WTW staff and that no 

discrepancy was found, and 

Notify the reporting ESS of findings using 

the same method of communication by 

which the report was received. 


received from WTW staff and that the 

discrepancy was previously resolved, and 

Notify the reporting ESS of finding using 




received from WTW staff, 

Attempt to resolve the discrepancy (See 

Resolving Discrepancies in this Chapter), 

and 

Notify the reporting ESS of findings using 



Note: If a Homecall or Special Investigation referral is completed to assist in 

resolving the discrepancy, send a copy of the investigator’s findings to the 

referring WTW staff. 


Resolving Discrepancies 

Eligibility 

Worker (EW) 


Fact-finding 

interview 

Collateral 

Contact 

The Eligibility Worker (EW) will resolve discrepancies by following up on 

contradictory or inconsistent information found in the case record, customer’s 

statements, or information received from a third party. 

This section explains the various methods of resolving discrepancies and 

gives a description of what is involved for each one. 

When a discrepancy is discovered, the EW will conduct a fact-finding 

interview. During the fact-finding interview, the EW: 

• Explains the purpose of the interview. 

• Reviews the discrepant issues. 

• Reviews reporting responsibilities. 

• Explains the possible result of the change(s) reported and the changes 

not reported (e.g., FIU investigation, overpayment and overissuance, 

criminal responsibilities, etc.). 

After the interview, the EW will narrate in the case journal all facts discovered 

during the course of the interview and any actions taken. 

If the EW is unable to resolve the discrepancy during the fact-finding 

interview, the EW may attempt to resolve it by making collateral contact with 

a third party such as an employer, school, or landlord. 

A Release of Information form must be signed by the customer in order to 

make the contact. If the customer refuses to sign the Release of Information 

form, deny or discontinue CalWORKs for failure to cooperate in providing 

essential information. 

The EW will narrate in the case journal all facts discovered and any actions 

taken. 

Exception: A Release of Information form is not required: 

• To contact a school if a TAD 144: School Attendance Verification form is 

on file, or 

• For FIU to make collateral contacts. 



Resolving Discrepancies, Continued 

Referrals If, after completing the fact-finding interview and making a collateral contact, 

the EW still cannot resolve the discrepancy the EW will submit a Homecall or 

Special Investigation referral. Use the table below to determine which 

referral to submit: 

Customer 

disputed 

findings 

If the application date is… Then submit a… 

Within the past 60 days, Homecall referral. 

Older than 60 days, Special Investigation referral. 

Narrate in the case journal all facts discovered and actions taken. 

Under no circumstances will the TAD 48 (E/S): Declaration be used by itself 

to contradict a Fraud Investigator’s report, or facts or documentation obtained 

by a third party. 


Fraud Detection 

Overview Fraud exists when a person has: 

Fraud 

indicators 

Eligibility 

Worker (EW) 


• Knowingly, and with intent to deceive, made a false statement or 

misrepresentation to obtain benefits, continue benefits, increase benefits, 

or avoid a reduction of benefits. 

• Knowingly failed to disclose information that could result in denial, 

reduction, or discontinuance of aid. 

• Accepted benefits knowing he/she was not entitled to receive, or 

accepted any amount of benefits knowing it is more than what s/he was 

entitled to receive. 

Under California State regulations, the County is responsible for the 

prevention and identification of fraudulent receipt of public assistance funds 

and CalFresh benefits. 

HSS staff must take prompt and decisive steps to investigate and determine 

the facts regarding any situation suggesting that benefits received were 

based on incorrect, incomplete, or false information. 

Some of the indicators of possible fraud are when the applicant or recipient 

customer: 

• Provides documents that appear to be forged or altered, 

• Makes inconsistent statements or is evasive, 

• Is unable to provide verification or lacks important documentation, or 

• Reports shelter costs are current and shelter costs paid exceed income. 

The Eligibility Worker (EW) is responsible for determining facts by conducting 

a fact-finding interview, reviewing verifications, and making collateral 

contacts, as needed. 



Fraud Detection, Continued 

Fraud is 

suspected 

If fraud is suspected or detected, submit a Special Investigation referral for 

CalWORKs programs with an application date older than 60 days. One of 

the following conditions must be met before the referral is done: 

• The EW has completed a fact-finding interview without a satisfactory 

resolution and resources were used to verify information, 

• The statement written by the customer on the TAD 48 (E/S): Declaration 

could not be confirmed, 

• An overpayment caused by the recipient customer misrepresenting facts 

or making false statements for a minimum of a two-month period and 

totaling at least $400 occurred, or 

• The recipient customer is unable or refuses to provide requested 

verification or documents. 

Note: For suspected fraud within the first 60 days from the application date, 

submit a Homecall referral. 


PID – Quality Review Unit (QRU) 

Overview The Quality Review Unit (QRU) is comprised of Quality Review Specialists 

(QRSs) and fiscal and support staff. They provide a variety of support 

functions to HSS including completing quality control case reviews for DSS, 

conducting homecalls, comparing income information in the case record with 

information provided to the State, and identifying overpayments and 

overissuances and creating recovery account resulting from FIU 

investigations. 

Areas of 


The following table lists some of QRU’s responsibilities. 

Responsibility Description 

Custodian of 

Record 


TANF TOA 

reviews 

Acts as the Custodian of Record when a TAD case is 

required in court for any reason other than welfare fraud. 

The Custodian of Record requests the physical case file 

(or reviews the automated case record), takes it to court, 

and may be required to testify as to what is in the case 

record. 

Conducts CalWORKs and TANF 60-month Time Limit 

Time on Aid (TOA) reviews. See Chapter 18 of this 

handbook for complete information. 

Forged Warrants Determines whether or not the payee cashed a warrant 

they reported not receiving. 

DCSS Good Determines if good cause exists when a customer claims 

Cause good cause for not cooperating with the Department of 

Determination Child Support Services (DCSS). Refer to the Deprivation 

Chapter of this Handbook for more information. 

Homecalls Conducts interviews in customer homes to resolve 

discrepancies, to verify landlord information for vendor 

payments, and to discuss circumstances with 

Welfare-to-Work (WTW) sanctioned individuals. 

Income and Reconciles discrepant income and property information 

Eligibility reported to the State MEDS computer system from 

Verification various Federal and State reporting agencies and 

System (IEVS) matches the information with what is in C-IV. 

Internal Fraud Conducts desk audits and/or computer audits in 

Detection conjunction with the FIU unit in cases of suspected 

employee fraud. 

Intentional Prepares cases for Intentional Program Violation (IPV) 

Program 

Violations (IPVs) 

hearings. 

Overpayments Verifies and creates recovery accounts for overpayments 

and 

Overissuances 

and overissuances resulting from FIU investigations. 

Quality Control Completes Federally mandated reviews of cases for both 

Review (QC) Welfare-to-Work participation and CalFresh payment 

accuracy data collection. 


Homecall Referrals Procedures 

Introduction Homecall staff is responsible for early fraud detection and prevention, which 

includes discussing discrepant information with applicant and recipient 

customers and explaining the penalties for fraud. The Quality Review 

Specialist (QRS) serves as a liaison between the Eligibility Worker (EW) and 

the customer by providing the functions described on this page. 

Homecall 

referrals 

The QRS makes unannounced homecalls and interviews customers based 

on referrals made by EW staff. 

The QRS will: 

Clarify discrepancies or identify potential fraud. 

Promote fraud prevention by advising customers of their rights, reporting 

responsibilities, and program sanctions and penalties. 

Interview customers sanctioned by the Welfare-to-Work (WTW) program 

to encourage compliance to gather WTW information for the State. 

Collect landlord information for vendor payments. 

During the interview, the QRS will answer general questions but will refer the 

customer back to the EW for case-specific questions. 

Submit a Homecall referral for the following situations: 

Inter-county transfers (ICTs); 

New state arrival with no car or resources; 

No means of support 60 days prior to application; 

Receiving CalWORKs or applied for CalWORKs within the last 60 days; 

or 

Cash aid discontinued or denied for one of the following: 

– Employment or increased earnings, 

– Absent parent returned to the home, 

– Non-cooperation, or 

– Household request. 

When the EW suspects fraud or identifies a possible discrepancy, when 

submitting a Homecall referral, the EW will request verification of: 

Household composition, 

Income, 

Property, 

Residence, or 

Other information necessary to determine eligibility. 

The referral can be made by the Intake or Continuing EW on applications 

within the first 60 days from the application date. 


Income and Eligibility Verification System (IEVS) 

Overview The Income and Eligibility Verification System (IEVS) is a Federally 

mandated eligibility verification system. 

IEVS matches names, Social Security Numbers (SSNs), and birth dates of 

customers in C-IV against income information reported by various agencies 

to the California State Medi-Cal Eligibility Data System (MEDS) system. 

Various reports are generated based on the matched information, including: 

Payment Verification System (PVS) Report, 

Beneficiary Earnings Exchange Record (BEER), 

IEVS Earnings Report, 

Asset Match, 

New Hire Report (NHR), 

Duplicate AID Detection System (DADS), 

Fleeing Felon, 

Prisoner Match, 

Deceased Person Match, and 

IEVS Applicant abstract. 

Responsibility Eligibility Worker (EW) and Quality Review Specialist (QRS) staff are 

responsible for reconciling the IEVS reports (depending on the type of report) 

with information in the case record, which may include: 

EW/QRS 

reconciliation 

Contacting the customer or employer to resolve discrepancies, 

Recalculating benefits, 

Identifying overpayments and overissuances, and 

Narrating actions taken in the case Journal. 

EWs and QRSs are responsible for different reports. The table below 

identifies the staff responsible for each report: 

EW QRS 

IEVS Applicant Abstract IEVS Earnings Report 

PVS Asset Match 

NHR BEER 

DADS 

Fleeing Felon 

Prisoner Match 

Deceased Person Match 



Income and Eligibility Verification System (IEVS), Continued 

IEVS 

Applicant 

abstract 

EWs must reconcile all IEVS Applicant abstracts (previously the IEVS 410), 

which are used to verify customer information prior to approval of benefits. 

The customer’s information is matched with the following agencies: 

Employment Development Division (EDD) 

Social Security Administration (SSA) 

Franchise Tax Board (FTB) 

C-IV automatically requests an IEVS Applicant abstract each night for 

individuals pended in C-IV that day. If the individual is pended and processed 

within the same day, the EW must manually request IEVS information. 

A Task is automatically generated when an IEVS Applicant abstract is 

received in the C-IV case file. EWs must clear these Tasks and reconcile all 

IEVS Applicant Abstracts prior to approving an application or add person. 

Note: If an application/add person is processed prior to receipt of the IEVS 

Applicant abstract, then the EW must set the Income Change Task for 30 

days to process this report. 

PVS Report EWs must reconcile the PVS Report (previously the PVS 30/40), which 

contains the following information: 

New Hire 

Report (NHR) 

Payments made by EDD in the form of Unemployment Insurance 

Benefits (UIB) and Disability Insurance Benefits (DIB). 

Benefits paid by Social Security (when there is a change or new claim). 

PVS Reports are received on approximately the first day of each month; 

however, EWs must only compare the PVS information quarterly to the 

information reported by the customer on the QR 7 and/or at Recertification 

(RC). A 90-day PVS Task is automatically generated when there is an IEVS 

match for any customer; these Tasks must be reconciled daily. 

EWs must reconcile the NHR, which notifies the County of recipient 

customers who: 

Were hired or rehired within the last 30 days, 

Are over 18 years old, and 

Anticipate wages over $300 per month. 

NHRs are received on approximately the first day of each month; however, 

EWs must only compare the NHR quarterly to the information reported by the 

customer on the QR 7 and/or at Recertification (RC). A 90-day New Hire Task 

is automatically generated when there is an IEVS match for any customer; 

these Tasks must be reconciled daily. 

Reconciliation To reconcile the IEVS Applicant abstract, PVS Report, or NHR, and the 

related Tasks, reference Chapter M in the Operations and Reference 

Handbook (ORHB). Additional information regarding Tasks can be found in 

ORHB Chapter J. 


IEVS – Earned and Unearned Income Report Reconciliation 

Overview The reports in this handbook section are reconciled by the Quality Review 

Unit (QRU) only. 

Earned income 

reports 

Unearned 

income report 

Income and Eligibility Verification System (IEVS) earned income reports are 

reconciled by QRU staff and consist of: 

IEVS Earnings Report (also known as ECS) – contains information about 

earnings reported to the Employment Development Department (EDD). A 

report is automatically generated quarterly. 

Benefit Earnings Exchange Record (BEER) – a paper report reconciled 

monthly by QRU that contains information regarding out-of-state wages, 

military and Federal wages, and self-employment income reported to 

Social Security. 

Important: Although Eligibility Workers (EWs) have access to the Earned 

Income Report in C-IV, they should not act on any of the information or close 

the report. 

The Asset Match is an unearned income report that is reconciled by QRU 

staff and includes the following information: 

Bank account and stock information (such as interest and dividends) and 

awards and prizes (such as insurance settlements and lottery earnings) 

reported to the Internal Revenue Service (IRS). 

San Bernardino County unearned income (such as Child Care or 

Housing Authority) reported to the IRS. 

Interest and dividends reported to the Franchise Tax Board (FTB). 

Note: QRU receives the Asset Match as a paper report, generated on a 

yearly basis. 


Customer Failure to Cooperate with IEVS Process 

Customer 

failure to 


IEVS 

investigation 

The Quality Review Unit (QRU) will investigate any discrepancies found by 

Income and Eligibility Verification System (IEVS) reports. If the Assistance 

Unit (AU) fails to cooperate with an IEVS investigation, CalWORKs is not 

discontinued for this reason. 

For cases that have both CalWORKs and CalFresh, only the CalFresh 

portion is discontinued for non-cooperation, and CalWORKs remains open. 

See Chapter 13 – Fraud/QC/Appeals of the CalFresh Policy 

Handbook (CFPHB) for more information about the CalFresh discontinuance 

process. 


RESERVED 

FOR 

FUTURE USE 


Quality Control (QC) 

Overview Quality Control (QC) is a Federally mandated function for the CalWORKs 

and CalFresh programs. 

Corrective 

action 

CalFresh reviews are required by the Federal Government for payment 

accuracy, including the extent and reasons for errors in the determination 

of eligibility and benefit issuance. 

CalWORKs reviews are required for Welfare-to-Work (WtW) participation 

rate and data collection. Error documentation is not required for the 

Federal Government, but is required for California Department of Social 

Services (CDSS) and Transitional Assistance Department (TAD) 

corrective action purposes. 

The QC review period runs from October 1 through September 30 of 

each Federal fiscal year. During each month of the review period, cases 

are chosen at random by the state to be reviewed. 

Data collection is done through case reviews, customer interviews, and 

verification of all eligibility elements. 

Refer to the Operations and Reference Handbook (ORHB) for 

comprehensive information and instructions concerning the entire Quality 

Control Review process. 

If a QC error is identified for CalFresh, the Eligibility Worker (EW) must 

review the CalWORKs portion and take appropriate action to correct any 

related errors, if applicable. 


RESERVED 

FOR 

FUTURE USE 


Customer Failure to Cooperate with Quality Control 

Customer 

failure to 


QC 

Restoration/ 

Reapplication 

The entire family is ineligible for aid when an individual in the Assistance 

Unit (AU) fails, without good cause, to cooperate in a Quality Control (QC) 

review. 

When the AU/HH fails to cooperate with QC, the Quality Review 

Specialist (QRS) determines if good cause exists for failure to cooperate. 

If good cause exists, no further action is required. 

If good cause does not exist, the following process occurs: 


1 QRS: 

Sends the customer a timely discontinuance Notice of 

Action (NOA) for QC non-cooperation, which includes the 

expiration date of the penalty. 

Sets a Task for the discontinuance request. 

Completes a Journal entry. 

Note: The QRS will notify the Eligibility Worker (EW) of 

subsequent cooperation by sending the appropriate 

communication instrument. 

2 EW: 

Sets the non-cooperation penalty in C-IV in the 

Non-Compliance Detail page. 

Discontinues CalFresh for non-cooperation with QC. 

Rejects any NOA that may generate. 

If a customer reapplies for CalWORKs, and a QC non-cooperation penalty is 

still being applied, the application can be approved without QC cooperation. 

If the CalWORKs case also has CalFresh, the CalFresh cannot be approved 

until the household: 

Cooperates in completing the QC Review, or 

Reapplies after the penalty date stated on the QC non-cooperation NOA. 

Note: See Chapter 13 – Fraud/QC/Appeals of the CalFresh Policy 

Handbook (CFPHB) for more information about QC cooperation. 


Forged Warrants 

Overview When a warrant has been endorsed and cashed by someone other than the 

payee, it is considered to be forged. This section explains the procedures 

when a warrant has been forged. 

Forged warrant 

procedures 

When a stop payment is completed on a warrant and that warrant is paid, 

that warrant becomes a forged warrant. When this occurs the Quality 

Review Specialist (QRS): 

• Researches the driver’s license and/or social security numbers written on 

the warrant to verify the endorser’s name and to check for outstanding 

law enforcement warrants. 

• Compares the endorsements on both warrants for signature similarities. 

If… Then the QRS… 

The signatures belong to 

the payee, 

The signatures do not 

belong to the payee, 

• Requests the payee come into PID for an 

interview. 

• Interviews the payee. 

• If the payee admits to cashing both 

warrants or no contact was made: 

− Identifies an overpayment, and 

− Creates a recovery account. 

• Interviews the payee if living locally, or 

sends copy of the forged warrant to the 

payee if living in the high desert or out of 

county; and 

• Requests the payee sign a form swearing 

that the signature is not his/hers. 


PID – Appeals Unit 

Overview The Appeals Unit is a State-mandated program comprised of Appeals 

Specialists and support staff. The Appeals Specialists are responsible for 

reviewing complaints concerning case actions, personnel issues, suspected 

welfare fraud, and allegations of discrimination. This includes conducting 

investigations, preparing position statements, reviewing regulations, 

negotiating and preparing State Hearing request withdrawals, monitoring 

corrective actions, and representing the County in Administrative Hearings. 

Responsibilities The Appeals Unit is responsible for: 

• Civil Rights, 

• Public assistance and Social Service complaints, 

• Other complaints, 

• General Relief Hearings, and 

• State Administrative Hearing processes (Fair Hearing). 

Each task is described in the following blocks. 

Civil Rights The Appeals Unit ensures equal treatment and access to public assistance 

programs and benefits. This includes: 

Public 

assistance and 

Social Service 

complaints 

• Providing Civil Rights training to staff, 

• Conducting impartial investigations of discrimination complaints, and 

• Referring foreign language or hearing impaired interpreters to staff. 

The Appeals Unit receives and reviews complaints from customers and the 

public concerning case actions and discrimination allegations against an 

individual or department in relation to the following administered programs: 

• CalWORKs, 

• Medi-Cal, 

• CalFresh, 

• General Relief (GR), 

• Child Care, 

• Family Support Enforcement, 

• Fraud Investigation, 

• Welfare-to-Work (WtW), 

• Children’s Services, 

• Aging and Adult Services (DAAS), 

• In-Home Supportive Services (IHSS), and 

• Adoption Assistance. 



PID – Appeals Unit, Continued 

Other 

complaints 

General Relief 

hearings 

State Hearing 

process 

The Appeals Unit receives and reviews complaints and directs them to the 

appropriate department regarding personnel issues, Welfare Fraud and child 

or elder abuse. The Complaints Officer: 

• Accepts complaints/inquiries by telephone, office interview, or letter from 

various sources; and 

• Has the authority to secure immediate corrective action, or 

• Can direct the complaint to the appropriate department for review and 

investigation. 

An Appeals Specialist acts as Hearing Officer for General Relief (GR) 

hearing requests. The Hearing Officers conducts hearings, researches 

applicable regulations and prepares written decisions. 

The Appeals Unit acts as an advocate for customers and for the County, 

conducting impartial reviews of case actions or inactions and investigating 

the facts of the case. The Appeals Specialist proposes corrective action or 

prepares the County's Statement of Position, as appropriate. 


State Hearings 

Overview The Appeals Unit is responsible for providing an impartial review of case 

actions and inactions requested by dissatisfied applicant or recipient 

customers of public assistance programs. These dissatisfied customers are 

referred to as “claimants.” 

Time frames for 

filing 

Good cause 

exceptions to 

filing time 

frames 

Requesting a 

State Hearing 

Claimants may request a State Hearing within 90 days of any case action or 

inaction. The time frame begins with the date of the adequate Notice of 

Action (NOA) or, if inaction or no NOA was required, begins with the date of 

the action or the date the customer discovered the action. 

Claimants may request a rehearing of the State’s Hearing decision within 30 

days from the date the decision is received. 

Claimants may file a hearing request beyond the 90-day time period if good 

cause exists for filing the request late. The 90-day deadline to file an appeal 

may be extended to 180 days for good cause. The following is an example 

of good cause for filing a hearing request beyond the 90-day time period: 

Example: 

An adequate Notice of Action (NOA) was received in the claimant’s home on 

January 5. The claimant was hospitalized in serious condition at the time 

and did not return home until April 7. The claimant did not open the mail until 

April 8. Claimant disagreed with the action and filed the hearing request on 

April 12. Because a compelling reason beyond the customer’s control exists 

for filing the hearing request late good cause may be granted. 

Claimants may file a rehearing request within 180 days of the hearing 

decision if good cause exists for filing the request late. 

The Eligibility Worker (EW) is expected to assist the claimant as needed in 

requesting a State Hearing. Information on how to file for a hearing is 

included on the back of all NOAs. Requests may be made: 

• Verbally, by calling 1-800-952-5253, 

• In writing, by mailing to: 

PO Box 1409 


Note: The back of the NOA can be used, but is not required, or 

• In person, by taking the request to the Appeals Unit, located at: 

1111 East Mill Street, Suite 200 




State Hearings, Continued 

State 

regulations 

versus County 

policies 

Sometimes there is a difference between the State regulations and County 

procedures. Infrequently, EWs are required to take actions that are contrary 

to State policies. In these instances, the action may have been taken 

correctly per County procedures but, in review, the action must be changed 

because it did not follow State regulations. 

Example: 

County policy requires the customer to complete the QR 7 in ink. If the 

customer does not complete the QR 7 in ink by the extended filing date, 

CalWORKs and/or CalFresh are discontinued. If the customer files for a 

State Hearing, the Appeals Specialist will negotiate a Conditional Withdrawal. 

The completion of the QR 7 in ink is not a State requirement. 

If you have questions or need further clarification concerning Appeals 

corrective action requests or State Hearing determinations, please contact 

the Appeals Specialist. 

If you disagree with an Appeals request, refer to the O&R HB for specific 

Appeals/Fair Hearing procedures. 


Complaints 

Overview The Appeals Unit is responsible for ensuring the administration of public 

assistance and Social Services programs is nondiscriminatory and Federal 

and State regulations are followed. 

Making a 

complaint 

Complaint 

process 

Discrimination 

complaints 

Customers or the general public may make a complaint to the Appeals Unit: 

• Verbally, by calling (909) 252-4356, or 

• In writing, by mailing to: 

PID – Appeals Unit 

PO Box 1409 

San Bernardino, CA 92402, or 

• In person, by going in to the Appeals Unit, located at: 

1111 East Mill Street, Suite 200 


When a complaint is received, the Appeals Specialist attempts to resolve the 

complaint or, if appropriate, records the specifics of the complaints on the 

appropriate document. 

If the complaint is… Then the Appeals Specialist… 

A case action, Follows Appeals procedures. 

Personnel related, Completes the FPB 8 Complaint Report as a 

Confidential Personnel Complaint to the Deputy 

Director for investigation and possible 

corrective action. 

An instance of possible Submits a Special Investigation referral. 

fraud, 

An instance of child or 

elder abuse, 

Discrimination complaints may be made directly to: 

Completes the appropriate Social Service form. 

• The County Representative – Denise Shefchik, Supervising Appeals 

Specialist II, or 

• The State Government, or 

• The Federal Government. 

These complaints are investigated by the Appeals Unit. 

Refer to the Operations & Reference (O&R) Handbook for specific 

Complaints procedures. 


Intentional Program Violations (IPV) 

Introduction An Intentional Program Violation (IPV) is an intentional fraudulent act with the 

goal of establishing or maintaining eligibility for CalWORKs cash aid or for 

increasing or preventing a reduction in the aid payment. 

IPV 

determination 

process 

Who is 

disqualified? 

Sanction vs. 

financial 

penalty 

IPV acts include such things as: 

• False or misleading statements, or 

• Misrepresentation, concealment, or withholding of facts. 

A determination of an IPV is made using the following process: 

Step Action 

1 Inadvertent Household Error (IHE) overissuances discovered by 

the Eligibility Worker (EW) or the Quality Review Specialist (QRS) 

and cases investigated by the Fraud Investigation Unit (FIU) are 

reviewed for IPV criteria. 

2 The names of the persons who meet the IPV criteria are 

submitted to: 

• The District Attorney by FIU for prosecution, or 

• The State by the Appeals Unit for an Administrative 

Disqualification Hearing. 

Only the individual is disqualified when he/she has: 

• Signed a Waiver of Right to an Administrative Disqualification Hearing, 

• Signed a Disqualification Consent Agreement, or 

• Been convicted in a court or administrative hearing of an IPV. 

Other Assistance Unit (AU) members remain eligible to receive benefits. 

When an individual is found guilty of committing an IPV, the EW imposes a 

disqualification penalty. 

The type of disqualification penalty depends on the date the IPV was 

committed. 

If the IPV was Then the disqualification penalty is a… 

committed… 

Before 01/01/1998, Sanction requiring the removal of the individual 

from the Assistance Unit (AU). 

On or after 

Financial penalty allowing the individual to remain 

01/01/1998, 

in the AU, but requiring the removal of his/her 

monetary needs from the MAP amounts. 



Intentional Program Violations (IPV), Continued 

Length of 

disqualification 

The length of the disqualification can range anywhere from six months to 

permanent disqualification. The disqualification is contingent upon the type 

of offense and the number of prior IPVs the individual has been convicted of. 

The EW does not determine the length of the disqualification period. The 

Appeals Unit or FIU specifies the length of the disqualification period on the 

disqualification order. 





penalty chart 

When the determination of IPV is made by a federal or state court of an 

administrative disqualification hearing, the length of the CalWORKs 

disqualification varies according to the offense as follows: 

Offense Penalty 

Making fraudulent statements or representation regarding 

place of residence in order to receive assistance 

simultaneously from two or more states or counties 

Submitting false documents for nonexistent or ineligible 

children 

Receiving cash benefits in excess of $10,000 through 

First violation: 

Permanent disqualification 

fraudulent means 





Being convicted of a felony fraud for theft • Less than $2,000: 

Two years 

• $2,000, but less than 

$5,000: 

Five years 

• $5,000 or more: 

Permanent 


Being convicted of fraud for the third time Permanent disqualification 

Making a false or misleading statement or misrepresenting, • First violation: 

concealing, or withholding facts 

Six months 

• Second violation: 

Twelve months 

• Third violation: 

Permanent 


Committing any act intended to mislead, misrepresent, • First violation: 

conceal, or withhold facts or propound a falsity 

Six months 

• Second violation: 

Twelve months 


Permanent 


Submitting more than one application for: 

• First violation: 

• The same type of aid for the same period of time, 

Two years 

• For the purpose of receiving more than one grant of aid in • Second violation: 

order to establish or maintain the family’s eligibility for aid, Four years 

or 


• Increasing, or preventing a reduction in the amount of aid Permanent 

received. 





During the 

sanction or 


During the sanction or penalty period: 

If the IPV individual is… Then… 

Sanctioned, The financial needs of the individual will 

not be included in the CalWORKs grant. 

The IPV individual is not required to 

participate in WTW/CalWORKs activities. 

Penalized, The individual remains an AU member, 

and 

The individual’s financial needs are not 

included in the CalWORKs grant. 

In either a sanctioned or penalized IPV situation: 

The income and resources of the individual are considered when 

determining eligibility and benefit amount for the remaining AU members. 

The individual must continue to comply with all program requirements 

including: 

– Reporting and verification requirements 

– Cooperation with and participation in child support enforcement 

activities 

– Meeting immunization and school attendance requirements 

– Verification of Social Security numbers 

– Verification of age and citizenship 




Eligibility 

factors and 

other sanctions 

or penalties 

Because the financial needs of an individual cannot be reduced twice in the 

CalWORKs grant, the EW must decide what other eligibility factors, 

sanctions, or penalties are applied before the IPV disqualification is imposed. 

Remember sanctions or penalties that pertain to other AU members are 

applied independently (e.g., WTW sanction imposed upon the second parent 

in a two-parent household, MFG, DACS 25%, etc.). 

Note: The EW must follow 10-day notice guidelines and send the 

appropriate notice for any postponed action. 




Sanction / 

Penalty priority 

table 

The table below lists, in the order of priority, various eligibility factors or other 

sanctions or penalties to consider when preparing to initiate an IPV 

disqualification. 

Priority Situation 

1 st Factors of ineligibility supercede any sanction or financial penalty. 


An IPV sanction is in order and the 

individual has been previously 

discontinued because of: 

A felony drug conviction, 


A probation/parole violation 

The IPV sanction is postponed until the 

person is once again determined 

otherwise eligible for benefits. 

2 nd Sanctions are equal in status. An existing sanction supercedes a new sanction. 



individual already has another sanction 

imposed because of: 

WTW noncompliance, 

Failure to assign child support rights, 

SSN disqualification, or 

Failure to verify citizenship/alien 

status, 

The IPV sanction is postponed until the 

person is once again determined 

otherwise eligible for benefits. 

3 rd Sanctions supercede financial penalties. A new sanction overrides an existing financial 

penalty. 



individual has a financial penalty 

imposed upon them because of: 

Immunizations, or 

School attendance, 

The current financial penalty is placed 

“on hold” and the IPV sanction is 

imposed. The prior financial penalty is 

reinstated after the IPV sanction has 

ended. 

4 th An IPV financial penalty supercedes any other financial penalty imposed upon the IPV 

individual. 


An IPV financial penalty is in order and 

the individual already has a financial 

penalty imposed upon them because of: 

Immunizations, or 

School attendance, 

The current financial penalty is placed 

“on hold” and the IPV financial penalty is 

imposed. The prior financial penalty is 

reinstated after the IPV financial penalty 

has ended. 




Implementing 

an IPV sanction 

(IPV before 

01/01/1998) 

When a convicted IPV individual committed the fraudulent act prior to 

January 1,1998, the individual is no longer eligible to receive CalWORKs 

benefits. Upon receipt of an IPV disqualification order, impose a sanction as 

follows: 

Step Action 

1 Complete three copies of ABCD 239.7: Administrative 

Disqualification Notice no later than the next 10-day NOA 

deadline. 

• Mail the original to the IPV individual. 

• File one copy in the case record. 

• Hold one copy for PID (routing instructions included in Step 4). 

2 Discontinue the IPV individual at the end of the month in which a 

timely 10-day NOA can be given. 

NOTE: If the case has CalFresh, refer to the CalFresh Policy 

Handbook for the impact of this disqualification on the CalFresh 

benefits. 

3 Complete Section B of the TAD 377.7A: IPV Order. 

4 • Staple PID’s copy of the ABCD 239.7 to the back of the yellow 

copy of the TAD 377.7A and forward to the appropriate DM. 

• File the white copy of the TAD 377.7A on the top left side of 

the fiscal folder. 

5 Narrate the IPV information in the case journal. 

The IPV sanction must begin within 45 days from the date of the order. Any 

aid paid for the IPV individual past the 45 th day is an Administrative Error 

overpayment. 




Implementing 

an IPV financial 

penalty (IPV 

on/after 

01/01/1998) 


order received 

from another 

county 

When a convicted IPV individual committed the fraudulent act on or after 

January 1, 1998, the individual remains an eligible AU member; however, 

his/her monetary needs are not considered. Upon receipt of the IPV 

disqualification order, impose a financial penalty as follows: 

Step Action 

1 Complete three copies of the ABCD 239.7: Administration Notice 

absolutely no later than the next 10-day NOA deadline. 



• Hold one copy for PID (routing instructions included in step 4). 

2 Decrease the grant effective the first day of the month after which 

10-day NOA was given. 

Note: If the case has CalFresh, refer to the CalFresh Policy 


benefits. 

3 Complete Section B of the TAD 377.7A: IPV Order. 

4 Staple PID’s copy of the ABCD 239.7 to the back of the yellow 


File the white copy of the TAD 377.7A on the top left side of the 

fiscal folder. 

5 Narrate the IPV information in the case journal. 

The IPV financial penalty must begin within 45 days from the date of the 

order. Any aid paid for the IPV individual past the 45 th day is an 

Administrative Error overpayment. 

Upon receipt of an IPV disqualification order from another county, impose the 

proper disqualification. Forward completed copies of the IPV paperwork 

back to the originating county, not to the San Bernardino County Program 

Integrity Division (PID). 




IPV actions These steps must be followed by the EW to impose an IPV disqualification. 

When the 


in ZBG 

When the 


period ends 

Step Action 

1 Receives information the HH is subject to an IPV disqualification 

period from either; 

• TAD 377.7A IPV Disqualification Order from FIU or the 

Appeals Unit routed through the DM, or 

• IEVS printout showing any HH member should currently be 

2 

disqualified. 

Acts on information to impose an 

IPV disqualification. 

Apply to 

Open case of 

applicant 

Closed 

case 

Completes a DFA 377.7A NOA to 

advise HH of disqualification 

Discontinue/deny open or pending 

X 

X 

AU members convicted of an IPV. 

X 

Documents case journal. 

Completes bottom of TAD 377.7A: 

Disqualification Order and submits 

X X 

to DM for PID routing. 

X 

X 

When the combination of the family’s income and the imposition of the 

financial penalty results in a zero grant: 

• Do not discontinue CalWORKs. 

• Leave CalWORKs open at the zero grant level. 

• Do not count the months of zero grant eligibility toward the 

TANF/CalWORKs time limits. 

• Continue to record the appropriate participation and exception codes for 

TANF/CalWORKs time limit tracking. 

During the last month of disqualification, review the case for the disqualified 

individual’s eligibility to CalWORKs. 

If the individual is… Then… 

Listed on the 

Statement of Facts, 

Not listed on the 

Statement of Facts, 

• Verify all eligibility criteria have been met. 

• Add the individual the first of the following month. 

• Send an NOA to the family. 

• Narrate actions taken. 

• Contact the family to add the disqualified 

individual to the CalWORKs case. 

• Follow add person instructions in this Handbook. 




Closed 

programs and 

deferred 


Occasionally an individual is determined to have committed an IPV after 

his/her program has been closed. When this happens, the department 

defers the disqualification penalty until the individual reapplies and is 

determined otherwise eligible for aid. 

The tables below describe what action to take in these instances. 

Step Action 

1 Complete three copies of the Administrative Disqualification 

Notice (ABCD 239.7) immediately upon receipt of the 

disqualification order. 



• Hold one copy for PID (routing instructions included in Step 3). 

2 Complete Section B of the TAD 377.7A. 

3 • Staple PID’s copy of the ABCD 239.7 to the back of the yellow 


• File the white copy of the TAD 377.7A on the top left side of 

the fiscal folder. 

4 Narrate the case record with the IPV information. 

5 Send physical case file to closed files, unless directed to send 

elsewhere. 

Step Intake Action 

1 Upon subsequent restoration or reapplication, impose the 

disqualification penalty only if the IPV individual is determined 

“otherwise eligible.” 

If the 


penalty is a… 

Then… 

Sanction, Deny the individual. 

Financial penalty, • Approve the individual. 

• Remove the IPV individual’s needs 

Note: If the case has CalFresh, refer to the CalFresh Policy 


benefits. 

2 Inform FIU that the disqualification period has been imposed. 

• Call (909) 252-4365 and your call will be directed 

appropriately. 

3 Narrate the case record with the IPV information. 


Fleeing Felons and Probation/Parole Violators 

Overview Fleeing felons or probation/parole violators are not eligible to receive 

CalWORKs or CalFresh. They are self-identified by the Assistance Unit (AU), 

verbally or on the Statement of Facts (SAWS 2), or Quarterly Report (QR 7), 

or by random checks conducted by Quality Review Unit (QRU). 

Definitions An individual is considered a fleeing felon at the point the person is fleeing 

to avoid prosecution, custody, or confinement after conviction of a crime or 

attempt to commit a crime. 

Referral 

procedures 

QRU 


A person in violation of probation or parole is an individual who is in 

violation of a condition of probation or parole imposed under a federal or 

state law. The initial offense need not have been a felony. 

Applicants and recipients claiming they are not fleeing felons or 

probation/parole violators may be verified by QRU. The Eligibility Worker 

(EW) will submit a Special Investigation referral. 

When a Special Investigation referral is submitted, QRU is responsible for 


• Tracking the number of automated and manual referrals received and, 

within those categories, the number in which a criminal match occurred. 

• Researching and responding to automated report referrals and manual 

EW referrals on a daily basis. 

• Informing the Transitional Assistance Department (TAD) office when a 

match is found in the criminal system. 

• Reviewing the verification from a law enforcement agency for clearance 

of fleeing felon or probation/parole violator status and notifying the EW of 

the result. 



Fleeing Felons and Probation/Parole Violators, Continued 

EW 


The EW must review the Statement of Facts at Intake, add person 

application, and Re-Evaluation (RE), and the QR 7 upon receipt to determine 

if an individual is a fleeing felon or probation/parole violator. 

If… Then the EW will… 

Suspicion exists based on: Submit a Special Investigation referral. 

• Customer statement, 

• Complaint from public, 

• Another family member 

statement, or 

• Criminal history of family 

member(s), 

QRU clears the individual’s 

status, 

Determine eligibility for the individual. 

QRU determines the individual • Send the appropriate Notice of Action 

is a fleeing felon or 

(NOA) to the AU providing timely and 

probation/parole violator, 

adequate notice of ineligibility of the 

individual. 

• Deny or discontinue CalWORKs for 

the individual. 

• Identify any overpayments and create 

a recovery account, as needed. 


Felony Drug Conviction 

Overview Individuals of any age convicted of a felony crime that includes any element 

of possession, use, or distribution of drugs cannot receive CalWORKs or 

CalFresh. The same rule applies to people who have entered a plea of guilty 

or nolo contendere (“no contest”) to felony drug charges. 

Ineligibility date The effective date of ineligibility for CalWORKs is the first of the month 

following the conviction. The conviction for a drug felony must be after 

December 31, 1997. 

Identifying drug 

felons 

For CalFresh, the effective date of ineligibility is the first of the month 

following a felony conviction. The conviction must be for conduct occurring 

after August 22, 1996. Beginning 01/01/2005, some drug felons may be 

eligible to CalFresh. See the CalFresh Policy Handbook for complete 

information. 

Identify drug felons through the following means: 

If… Then… 

• Customer self-identifies on the 

Statement of Facts or QR 7, 

• Information is received from a 

source outside of TAD or PID 

concerning a felony drug 

conviction, or 

• Status of the individual is 

questionable, 

CDSS conducts a quarterly match 

of the C-IV system and the criminal 

justice system, 

The Eligibility Worker (EW) will 

submit a Special Investigation 

Referral for a felony warrant check 

and request both the date of the: 

• Felony conviction, and 

• Act (date crime committed). 

QRU will alert the CW of any 

confirmed match. 



Felony Drug Conviction, Continued 

Example 1 Situation - A customer with a felony conviction applied for CalFresh. The 

customer stated that the felony was for forgery. His record stated “felony 

conviction for obtaining a controlled substance by fraud”. The Department of 

Justice record does not state if it was for personal use or for sale; 

furthermore, the customer stated that he was writing prescriptions for his 

mother to obtain her pain medication. 

Action - The customer illegally obtained pain medication for his mother. This 

action makes the customer ineligible for CalFresh benefits due to being 

convicted of “furnishing, giving away, administering” a controlled substance 

by distributing or supplying the substance to his mother through forgery. 

Example 2 Situation - A customer was originally arrested for possession of a controlled 

substance for sale. At the time of sentencing, the original charge was 

dismissed pursuant to a plea bargain and the customer was convicted of 

H&S 11366 (maintaining a place for unlawfully selling, giving away, or using 

any controlled substance). 

EW 


Action - Since the conviction was a drug related felony that had as an 

element the distribution of a controlled substance, the customer is ineligible 

for CalFresh benefits. 

Note: Persons convicted of a felony involving an “element” of possession for 

distribution of a controlled substance are ineligible for CalWORKs. 

Take the following actions immediately when information is received that an 

AU member is a convicted drug felon: 

• Deny CalWORKs for the applicant customer, or 

• Discontinue CalWORKs for the recipient customer, and 

• Send the appropriate Notice of Action (NOA) to advise the AU of the 

action taken. 

Budgeting The income and resources of AU members excluded for felony drug 

convictions are counted in their entirety in CalWORKs. 

Refer to the Budgeting Chapter of this Handbook for procedures. 



Felony Drug Conviction, Continued 

Drug 

court/diversion 

program 

Failure to meet 

drug 

court/diversion 

program 

requirements 

Drug felony 

reduced to a 

misdemeanor 

or record 

expunged 

When an individual pleads guilty to a drug felony, the judge may withhold the 

entry of a guilty judgment if the person agrees to enter a drug court/diversion 

program. During this period, the person is not considered a convicted drug 

felon and is eligible to CalFresh and CalWORKs. 

If the person fails to meet all the program requirements, the judge will enter a 

judgment on the prior plea of guilty. The person is then a convicted drug 

felon. 

The date the judge enters the judgment (conviction) is the date the person is 

considered a convicted drug felon, no matter what date is used for the guilty 

plea. There is no overpayment for the months that the person’s guilty plea 

was deferred, as the person was not considered a convicted drug felon. 

Example: 

A recipient pleads guilty to a felony drug charge on July 19, 2003. The judge 

defers judgment if the individual participates in a drug diversion program. 

The customer agrees and enters the program. 

On November 15, 2003, the customer fails to meet program requirements. 

On December 14, 2003, the judge enters the judgment, accepting the earlier 

plea of guilty. At the judge’s discretion, the conviction is backdated to the 

date of the guilty plea (July 19, 2003). 

The customer has received CalWORKs benefits continuously since 

January 6, 2003. The customer was eligible for CalWORKs until the date the 

judge entered the judgment (December 14, 2003). There is no overpayment 

for the period of August 2003 through December 2003. 

If an individual’s drug felony is reduced to a misdemeanor, the individual is 

no longer considered a convicted felon from the date the felony is reduced to 

a misdemeanor or the date the record is expunged. 

If the individual is otherwise eligible, follow the add person instructions in the 

Application Chapter of this Handbook to add the person to CalWORKs. 




CHAPTER 18 

Time Limits 

Overview....................................................................................................18-1 

Section 1 Time Limits: Basic Information 

Section 2 Tracking 

Overview....................................................................................................18-2 

Definitions..................................................................................................18-3 

TANF and CalWORKs Clocks ...................................................................18-5 

Who is Tracked........................................................................................18-11 

CalWORKs Safety Net Program..............................................................18-14 

Overview..................................................................................................18-20 

What is Tracked.......................................................................................18-21 

Work Registration and Exception Codes .................................................18-26 

Changes in Work Registration and Exception Codes..............................18-27 

TANF Exemptions and Extenders ...........................................................18-29 

CalWORKs Exemptions and Extenders ..................................................18-30 

Section 3 Reviewing Time On Aid: General 

Overview..................................................................................................18-33 

Time On Aid Reviews ..............................................................................18-34 

Section 4 Time On Aid (TOA) Notices 

Overview..................................................................................................18-36 

Time On Aid (TOA) Notices .....................................................................18-37 




Section 5 Eligibility Worker Responsibilities 

Overview..................................................................................................18-40 

Eligibility Worker Time Limit Review Actions ...........................................18-41 

Time Limit Exemption Request................................................................18-43 

Exemption Request Determination ..........................................................18-44 

Section 6 Exemption and Exception Codes 

Overview..................................................................................................18-46 

TANF Exemptions....................................................................................18-47 

Work Registration and Exception Codes .................................................18-52 

Section 7 Time Limits Information for Time On Aid Reviews 

Section 8 When To Track 

Overview..................................................................................................18-55 

Basics of Time On Aid Reviews...............................................................18-56 

Time Limit Review Actions.......................................................................18-58 

Obtaining Information to Complete Time On Aid Reviews ......................18-61 

Overview ..................................................................................................18-64 

Time On Aid Review: Intake/Add Person Applications ...........................18-65 

Time On Aid Review: Re-Evaluation (RE) ..............................................18-69 

Time On Aid (TOA) Review: 

CalWORKs 42 nd and 46 th Month Reviews .........................................18-71 

Recording Database Information .............................................................18-74 

Identifying Extenders ...............................................................................18-80 

CalWORKs: Action On Timing Out .........................................................18-82 

Complete Time on Aid Reviews...............................................................18-85 


Overview 

Chapter 18 

Time Limits 

Introduction Welfare Reform imposed time limits on the receipt of cash assistance for 

parents and needy caretaker relatives of aided children. The limits apply to 

Temporary Assistance to Needy Families (TANF) funds received from other 

states and CalWORKs funds, both federal and state-funded, received in 

California. 

The time limits are often referred to as clocks. There are two different clocks, 

the TANF (federal) clock and the CalWORKs (state) clock. Effective 

7/1/2011, California enacted legislation which changes the maximum amount 

of time an individual can receive CalWORKs from 60 months to 48 months. 

Adults who have received their CalWORKs 48-months time limit are ineligible 

for cash aid. 

This chapter gives instructions and/or information regarding: 

• The federal TANF 60-month clock 

• The state CalWORKs 48-month clock 

• Tracking process and procedures 

• Time on Aid (TOA) reviews and notices 

• WDTIP TRAC system 

References The following references are applicable to the information in this chapter: 

• ACL 11-33 

• EAS 42-300, 42-301, 42-302, 42-710, 44-352 



Time Limits: Basic Information 18-2 

Tracking 18-20 

Reviewing Time On Aid: General 18-33 

Time on Aid (TOA) Notices 18-36 

Eligibility Worker Responsibilities 18-40 

Exemption and Exception Codes 18-46 

Time Limits Information for Time On Aid Reviews 18-55 

When to Track 18-64 

CWPHB #4608 (05/11) TIME LIMITS 18-1

Overview 

Time Limits: Basic Information 

Introduction This section covers basic information about Time Limits and tracking Time on 

Aid (TOA). 


• ACL 11-39 

• EAS 42-301, 42-302, 42-710 



Definitions 18-3 

TANF and CalWORKs Clocks 18-5 

Who is Tracked 18-11 

CalWORKs Safety Net Program 18-14 


Definitions 

Definitions Listed below are definitions of terms and forms that are commonly used in 

time tracking. 

Aid Received: Any month in which the adult(s) in an AU received cash aid. 

This includes the regular aid payment, supplemental payments, Immediate 

Need, RISPs (prior to Quarterly Reporting implementation), and Homeless 

Assistance. 

Assistance, CalWORKs: Cash aid, including special needs payments, 

vouchers, and diversion payments. 

Assistance, Transitional Assistance for Needy Families (TANF): Cash, 

payments, vouchers, and other forms of benefits designed to meet a family’s 

ongoing basic needs, including supportive services such as transportation 

and child care provided to families who are not employed. 

CalWORKs Clock: Effective 7/1/2011, 48-month cumulative life-time limit for 

adult recipients of cash aid, under CalWORKs (federal or state funded 

programs) or any other state’s program funded by the federal TANF program, 

effective 1/1/98. (Prior to 7/1/2011 the cumulative life-time limit for adults on 

CalWORKs was 60 months). 

Complete Time on Aid (TOA) Review: Review of TANF and CalWORKs 

time on aid for an adult, which includes a review of all physical case files in 

addition to a database review. This type of review is completed at appeal or 

customer request. 

Conversion: The process of counties sending necessary data to the Welfare 

Data Tracking Implementation Project (WDTIP) system. 

Countable Month: A month in which an adult received cash aid as an 

eligible AU member, which counts towards time limits. Each month that 

counts towards a clock is considered a “tick” of that clock. 

County TRAC: Tracking Recipients Across the County database system 

with information about an adult’s TOA in San Bernardino County, used prior 

to C-IV implementation. 

Exception Code: A state code that identifies the Welfare Data Tracking 

status of all cash aid adults. This code is linked to the Work Registration/ 

Participation Exemption Code and affects the TANF and CalWORKs clocks. 

Exempt Month: A month that does not count towards the time limits 

because an exemption applies that stops it from being counted. These 

months are also referred to as “non-countable months.” 



Definitions, Continued 

Definitions 

(continued) 

Extender: An exemption that can result in a customer remaining on aid 

beyond the CalWORKs time limit. All adults in an AU must meet extender 

criteria for aid to continue after the time limit has been met. 

Non-countable Month: A month that does not count towards the time limits 

because circumstances apply that stops it from being counted. These 

months are also referred to as “exempt months.” 

Overpayment Month (OPM): A month in which all cash aid received by an 

Assistance Unit (AU) has been determined to be an overpayment. These 

months are also referred to as “totally ineligible months.” 

TANF Clock: 60-month cumulative life-time limit for adult recipients of cash 

aid, under any program funded by the federal TANF program, effective 

12/1/96. 

Note: Other states may have federal TANF programs which began as early 

as 9/1/96. 

Quality Review (QR) Time Limit (TL) Unit: Specialized unit that completes 

all TOA reviews, including TANF and CalWORKs timing out reviews, and 

work related to those actions. Also responsible for TOA NOAs, makes 

corrections to time limit data in the C-IV and WDTIP TRAC systems, and 

handles TOA inquiries from other counties and states. 

Time Limits Data: TOA-related data for each person for whom a TOA 

review has been completed. The data is imaged in C-IV. 

Time on Aid Review: Review of TANF and CalWORKs time on aid for an 

adult using database information only. This type of review is completed at 

application, add adult, Re-evaluation (RE) (timed out adults only), and 42- 

and 46- months of CalWORKs receipt. 

Note: Any time limit reviews or corrective action requests resulting from an 

Appeals review must be sent to the Quality Review Unit (QRU) as a high 

priority with “Appeals TOA action” in the subject line of the email. 

WDTIP TRAC: Welfare Data Tracking Implementation Project Tracking 

Recipients Across California statewide system with information about an 

adult’s TOA in the state of California. 


TANF and CalWORKs Clocks 

Introduction This section provides basic information about the Transitional Assistance to 

Needy Families (TANF) and CalWORKs time limit clocks and the differences 

between them. 

Types of time 

limits – 

“clocks” 

Tracking time 

clocks 

TANF clock 

basics 

There are two time limits, or “clocks”, that apply to adult recipient customers: 

• Federal TANF 60-month clock. 

• State CalWORKs 48-month clock. 

Note: A third “clock”, the 18/24-month clock pertaining to Welfare to Work 

(WTW) became obsolete in 12/04. 

In California, TANF months are tracked from 12/96 forward and CalWORKs 

months are tracked from 1/98 forward. The TANF and CalWORKs clocks 

may overlap and, if they overlap, they are tracked at the same time. 

Counties must consider aid received in other California counties and other 

states when tracking the TANF and CalWORKs time clocks. 

Tracking TANF and CalWORKs time on aid is extremely important so that 

recipient customers may receive cash assistance for the full time period 

allotted to them. 

The TANF time limit applies to adults and minors who are heads of 

household or married to heads of household, and who receive cash aid for a 

cumulative total of 60 months. 

California began issuing TANF funds effective 12/1/96 and its TANF clock 

began on 12/1/96. The TANF clock became effective at different times in 

different states (see the “TANF implementation dates” block of this chapter 

for specific information). 



TANF and CalWORKs Clocks, Continued 

TANF funds 

received in 

another state 

TANF funds 

received in 

California, 

counted in 

another state 

When an adult customer moves into California from another state and 

applies for cash aid, TANF funds received from any other state must be 

included in the TANF 60-month time limit. A determination must be made 

about whether cash aid was received in another state and, if so, when that 

state implemented the federal TANF program. This is done by: 

• Asking the customer about aid received in another state during the Intake 

interview, and 

• Contacting other states to determine the number of months of 

TANF-funded aid received. 

Information about TANF funds received in other states must be entered in 

the C-IV and WDTIP TRAC systems. 

Note: The federal TANF time limit does not apply to those who are/were 

aided in any state-only program. 

When an adult customer who has received cash aid in California moves to 

another state, TANF funds received in California must be included in the 

TANF 60-month time limit in the other state. This includes any federally 

funded benefits received in California after the 12/1/96 implementation date. 

Requests from other states for information about cash aid received in 

California are referred to the Quality Review Unit (QRU) (See next block, 

“Verifying TANF funds for another state”). 

REMINDER: Aid code 35 cases changed from federal to state-only funding 

effective 10/1/99, and from state-only to federal funding effective 10/1/06. 

The following table explains when aid code 35 cases are included in the 

TANF 60-month time clock: 

Time Period TANF Clock Ticks 

9/99 and prior Yes 

10/99 - 9/06 No 

10/06 and later Yes 




Verifying TANF 

funds for 

another state 

When a former CalWORKs customer applies for aid in another state, and the 

other state requests information about the number of TANF funded months 

received in California, the county where the recipient last received TANF 

assistance is responsible for responding to the request for TANF time limit 

information. The last county of record has the responsibility of gathering the 

total number of TANF-funded months in the state, which may include 

contacting other counties to verify the TANF time limit information before 

responding to the request. 

Other states will use the State TANF Contact List, and the State contact will 

reference the County WDTIP Contact List maintained by the State. The 

County WDTIP Contact List cites Office Assistant (OA) personnel as the San 

Bernardino County contact. The OA forwards requests to the QRU for 

necessary action and response. 




TANF 


dates 

States implemented the TANF program at different times. The table below 

lists each state and its TANF implementation date: 

State Date Subject State Date Subject 

to TANF 

to TANF 

Alabama 11/15/96 Montana 2/1/97 

Alaska 7/1/97 Nebraska 12/1/96 

Arizona 10/1/02 Nevada 12/3/96 

Arkansas 7/1/97 New Hampshire 10/1/96 

California 12/1/96 New Jersey 2/1/97 

Colorado 7/1/97 New Mexico 7/1/97 

Colorado 7/1/97 New Mexico 7/1/97 

Connecticut 10/1/96 New York 12/2/96 

Delaware 3/10/97 North Carolina 1/1/97 

District of 3/1/97 North Dakota 7/1/97 

Columbia 

Florida 10/1/96 Ohio 10/1/96 

Georgia 1/1/97 Oklahoma 10/1/96 

Hawaii 7/1/97 Oregon 10/1/96 (See 

Note below.) 

Idaho 7/1/97 Pennsylvania 3/3/97 

Illinois 7/1/97 Rhode Island 3/1/97 

Indiana 10/1/96 South Carolina 10/12/96 

Iowa 1/1/97 South Dakota 12/1/96 

Kansas 10/1/96 Tennessee 10/1/96 

Kentucky 10/18/96 Texas 11/5/96 

Louisiana 1/1/97 Utah 10/1/96 

Maine 11/1/96 Vermont 9/20/96 

Maryland 12/9/96 Virginia 2/1/97 

Massachusetts 9/30/96 Washington 1/10/97 

Michigan 9/30/96 West Virginia 1/11/97 

Minnesota 7/1/97 Wisconsin 9/30/96 

Mississippi 10/1/96 Wyoming 1/1/97 

Missouri 12/1/96 

Note: Prior to 7/1/03, Oregon operated under a federal waiver which 

exempted individuals from the TANF time limit; therefore, months of TANF 

received in Oregon prior to 7/1/03 do not count toward the TANF time limit. 




TANF clock 

expires before 

the CalWORKs 

clock 

Aid codes for 

TANF timed-out 

cases 

Due to different implementation dates and exemptions in the TANF and 

CalWORKs programs, adults may reach the TANF 60-month time limit and 

still have CalWORKs months remaining. 

The CalWORKs time clock started in 1/98 and allows more exemptions than 

the TANF clock, so a customer may have CalWORKs months remaining after 

the federal TANF 60 cumulative month time clock has expired. Cases with 

adults who TANF time-out before using the full CalWORKs 48-month time 

limit must be paid from state-only funds for the remaining CalWORKs 

months. The customer then continues to receive cash aid until he or she 

has exhausted the 48 months of state CalWORKs funded cash assistance. 

The case must be transferred to state-only funding even if there are other 

adult recipients in the AU who have not yet reached the TANF 60-month time 

limit. 

Federal regulations state that an Assistance Unit (AU) that includes any adult 

who has met the TANF 60-month time limit is no longer eligible to receive 

federally funded aid (See next block for exception, effective 1/04). Separate 

aid codes are necessary to identify cases that have adults who have reached 

the TANF 60-month time limit and are now funded by state monies. 

Aid code 32 All-Family Case, from Aid code 30 All-Family Case - TANF 

timed-out and the head of household or spouse of the head of household 

has: 

• Received Federal TANF assistance for a total of 60 cumulative months, 

and 

• Continues to be eligible for CalWORKs assistance. 

Aid code 3W All-Family Case, from Aid code 3E All-Family Case - TANF 

timed-out mixed case and the head of household or spouse of the head of 

household has: 

• Received Federal TANF assistance for a total of 60 cumulative months, 

• Continues to be eligible for CalWORKs assistance, and the family 

includes at least one non-federally eligible individual (other than the 

TANF timed-out individual) who does not meet the federal requirements 

of a qualified alien and entered the U. S. on or after 8/22/96. 





funding, 

effective 1/04 


clock basics 


clock expires 

before the 

TANF clock 

Counting aid 

received in 

another state 

As explained in the TANF Exemptions and Extenders section of this 

Handbook Chapter, Federal regulations allow states to extend TANF-funded 

assistance beyond 60 months for up to 20% of the state’s TANF caseload. 

Aid code 32 and 3W payments were funded under this allowance with federal 

TANF funds, rather than state-only funds, from 1/04 through 6/09. Effective 

7/1/09, funding for aid code 32 and 3W payments are state-only funded. 

The state CalWORKs time limit applies to adults, 18 years of age or older, 

who receive cash aid for a cumulative total of 48 months (60 months prior to 

July 1, 2011). This time limit does not apply to children or minor parents (age 

18 and younger). 

CalWORKs assistance can be federally funded or state funded. 

The CalWORKs clock tracks federal and state-only aid received in California 

and federally funded TANF aid received in other states effective 1/1/98. 

Because of the different implementation dates and because more 

exemptions apply to the CalWORKs clock than to the TANF clock, it is 

possible for cases to be tracked under both programs at the same time and 

have additional CalWORKs months available after the TANF period expires. 

Once an adult recipient has received 60 cumulative months of federal 

TANF/CalWORKs cash aid, his or her case is transferred to state-only 

CalWORKs funding for any remaining months of the 48 cumulative month 

state funded time period. This applies even if there are other adult recipients 

in the AU who have not yet reached their 60-month TANF time limit. 

Because the CalWORKs clock “ticks” when TANF aid is received (unless a 

CalWORKs exemption applies), but the federal TANF clock does not “tick” 

when aid is received under a state-only aid code (example: aid code 35 from 

10/99 through 9/06), it is possible for an adult to reach the CalWORKs time 

limit and still have TANF months remaining. 

Adults in California are no longer eligible to receive cash aid when the 

CalWORKs 48-month time limit is reached, regardless of the aid code under 

which the aid was paid. However, adults with remaining TANF months 

available may receive aid in another state. 

When an adult moves into California from another state, TANF aid received 

from any other state must be included in the CalWORKs 48-month time limit, 

as well as in the TANF time limit. State-only funds issued by another state 

are not included in the CalWORKs clock. 


Who is Tracked 

Introduction In California, information about time on aid is available on the Welfare Data 

Tracking Implementation Project Tracking Recipients Across California 

(WDTIP TRAC) system for all adults who have received CalWORKs and 

Transitional Assistance for Needy Families (TANF) cash aid payments, 

including Immediate Need payments, at any time from 12/1/96 (9/1/96 for 

out-of-state months, if applicable) through the current month. 

Ongoing 

tracking 

Who isn’t 

tracked 

Time on Aid (TOA) is tracked and reviewed on a continuing basis for eligible 

adults who are currently receiving aid under the following aid codes: 

• 3J, 3K, 3M, 3U, 3L, 3E, 3X, 3Y 

• 9F, 9U (recorded on TRAC as 30, 35) 

• 30, 35 

• 32, 3W 

• 3G, 3H 

Sometimes, there are adults included in a case record who are not currently 

included in the AU or receiving cash aid. These adults are ineligible for cash 

aid for reasons such as: 

• Receipt of SSI 

• Non-citizen status 

• Non-needy caretaker relative 

• Over the age limit for a child 

• Sanction (WTW) 

• Drug/fleeing felon 

• Penalty (Found in old case records – adults out of AU prior to 

development of computer Budget Item Codes (BIC) for penalties) 

If an ineligible adult received aid at any time after 12/96, information about 

his/her time on aid will be recorded in the WDTIP TRAC system. Ongoing 

tracking and TOA reviews are not required. 

Ineligible adults who become eligible for cash aid must be tracked, with 

information included in the TRAC system on a continuing basis (Examples: 

Non-needy caretaker relative becomes needy or WTW-sanctioned person 

cures sanction). 



Who is Tracked, Continued 

Adults 

discontinued 

for reaching 

time limits 

Timed out aid 

codes 

Correct aid 

codes 

Adults who are discontinued due to reaching the CalWORKs 48-month time 

limit and have children receiving aid must have a TOA review completed at 

annual Re-Evaluation (RE) (see When to Track section of this handbook 

chapter). This is done to determine if any months of aid included in the 

adult's 48-month time limit have been "bought back", or "unticked", due to the 

following: 

• Child support collected since time of discontinuance that repays months 

of aid, or 

• Totally ineligible Overpayment Months (OPMs) computed since time of 

discontinuance that makes months of aid technically ineligible. 

Cases with timed-out adults are aided under the following aid codes: 

• 32 

• 35 

• 3W 

• 3A 

• 3C 

It is important that TOA be counted to the correct aid code. The correct aid 

code is the one under which a case was eligible, even if aid was paid under a 

different aid code. The correct aid code is recorded in C-IV and the WDTIP 

TRAC system. The aid code determines which time clock, TANF and /or 

CalWORKs, “ticks” for a period of aid. 

Example 1: Aid was issued on aid code 30 for 6/98 and 7/98. Later, an aid 

code 35 program was opened with erroneous claiming for 6/98 and 7/98. 

Information is entered in C-IV and the WDTIP TRAC system under aid code 

35 for 6/98 and 7/98. 

Example 2: Aid was issued on aid code 33 for 10/98-3/99. The caretaker 

relative was aided as a needy caretaker relative but the program was never 

transferred to the correct aid code 30. Information is entered in C-IV and the 

WDTIP TRAC system under aid code 30 for 10/98-3/99. 

Example 3: Aid was issued on aid code 30 for 12/96-5/02, and then on aid 

code 32 for 6/02 and continuing. The program should have been transferred 

to aid code 32 effective 12/01, with erroneous claiming done for 12/01 

through 5/02. Information is entered in C-IV and the WDTIP TRAC system 

under aid code 30 for 12/96-11/01 and under aid code 32 for 12/01 and 

continuing. The correct aid code is to be entered in the "Correct Category" 

space on the TAD 60. 



Who is Tracked, Continued 

Aid code 33 

tracking 

Cases with an aid code 33 were tracked on C-IV and WDTIP TRAC from 

12/96-10/99. Any aid paid under aid code 33 after 11/1/99 will be applied to 

the correct aid code, rather than the erroneous aid code 33, in both the C-IV 

and WDTIP TRAC systems. 

The Quality Review Unit (QRU) should always review aid code 33 data as, 

especially in the Archive System, cases may not have been aided under the 

correct aid code and TOA needs to be considered for all aided adults, 

regardless of the code under which aid was paid. 


CalWORKs Safety Net Program 

Overview Effective 7/1/2011, adults who reach the CalWORKs 48-month time limit are 

no longer eligible to receive cash aid. However, children remain eligible for 

CalWORKs after adult recipients have “timed out”. When all adults in the 

Assistance Unit (AU) have reached the CalWORKs 48-month time limit, the 

children continue to receive cash aid under the Safety Net program. 

Safety Net aid 

codes 



codes when 


60-month time 

limit is reached 

prior to 

7/1/2011 

Note: Prior to 7/1/2011, the CalWORKs time limit was 60 months. 

Two aid codes have been established for cases in which all potentially 

eligible adults have reached the CalWORKs time limit without meeting a time 

extender and the children remain eligible. 

• Aid code 3A All-Family child-Only Case, from Aid code 30, 32, 3E, 3L, 

and 3W All-Family Cases. These cases are funded with segregated 

state funds. 

• Aid code 3C Two-Parent child-only Case, from Aid code 35, 3M and 

3U Two-Parent Cases. These cases are funded with Separate State 

Program (SSP) funds. 

Examples of Safety Net aid codes when an adult reaches the CalWORKs 

60-month time limit prior to 7/1/2011 are: 

Example 1: Mother, Father, and two children have received CalWORKs 

since 1/1/03. The case is on an aid code 35, two-parent case with 

unemployment deprivation. Mother reaches her CalWORKs 60-month time 

limit effective 12/31/07. Father received Social Security Disability from 5/04 

through 9/04, so his CalWORKs clock did not tick for those months and, 

therefore, he will not reach his CalWORKs 60-month time limit until 5/31/08. 

Mother is discontinued from CalWORKs effective 12/31/07, and the case 

remains on an aid code 35 through 5/08, when Father times out and the case 

is transferred to the Safety Net program aid code 3C. 

Example 2: Mother and two children have received CalWORKs since 

12/1/05. The case is on an aid code 32 case with absence deprivation. 

Mother reaches her CalWORKs 60-month time limit effective 12/31/09. 

Mother is discontinued from CalWORKs effective 12/31/09, and the case is 

transferred to the Safety Net program aid code 3A. 

Example 3: Grandmother has received CalWORKs as the needy caretaker 

for her two grandchildren since 1/1/06. The case is currently an aid code 30 

case with absence deprivation. Grandmother reaches her CalWORKs 60 

month time limit effective 12/31/10. Grandmother is discontinued from 

CalWORKs effective 12/31/10, and the case is transferred to the Safety Net 

program aid code 3A with Exempt MAP, and Grandmother is now considered 

a non-needy caretaker. 



CalWORKs Safety Net Program, Continued 



codes when 


48-month time 

limit is 

reached 

(effective 

7/1/2011) 

Cases not 

meeting the 

Safety Net case 

definition 

Annual 

Reporting for 

Safety Net 

cases 

Example 1: Mother, Father, and two children have received CalWORKs 

since 8/1/07. The case is on an aid code 35, two-parent case with 

unemployment deprivation. Mother will reach her CalWORKs 48-month time 

limit effective 7/31/11. Father received Social Security Disability from 1/08 

through 2/08, so his CalWORKs clock did not tick for those months and, 

therefore, he will not reach his CalWORKs 48-month time limit until 9/30/11. 

Mother is discontinued from CalWORKs effective 7/31/11, and the case 

remains on an aid code 35 through 9/11, when Father times out and the case 

is transferred to the Safety Net program aid code 3C. 

Example 2: Mother and two children have received CalWORKs since 

7/1/07. The case is currently an aid code 30 case with absence deprivation. 

Mother will reach her CalWORKs 48-month time limit effective 6/30/11. 

Mother is discontinued from CalWORKs effective 6/30/11, and the case is 

transferred to the Safety Net program aid code 3A. 

Example 3: Mother and two children received TANF from another state from 

4/07 through 5/11, and CalWORKs in 6/11 on aid code 30. As of 6/11, 

mother has received a total of 51 months towards the CalWORKs time limit. 

Mother is discontinued effective 6/30/11 because her time on aid has 

exceeded the CalWORKs 48-month time limit which is effective 7/1/11. The 

case is transferred to the Safety Net program aid code 3A. 

Cases that do not meet the Safety Net case definition are not transferred to a 

Safety Net aid code and continue to receive cash aid in the existing aid code. 

These cases are: 

All-Family Cases Aid code 30, 32, 3E, 3L, and 3W with two aided 

adults and only one adult has reached the CalWORKs time limit. 

Two-Parent Cases Aid code 35, 3M, and 3U in which only one adult 

has reached the CalWORKs month time limit. 

Zero-Parent Cases Aid code 33 in which the parent(s) or caretaker(s) is 

excluded from or ineligible for cash assistance. 

Effective 10/1/12, Safety Net cases are subject to Annual Reporting (AR) and 

are referred to as Annual Reporting/Child Only (AR/CO) cases. Refer to the 

“Reporting” and “Budgeting” chapters in this handbook for more information 

regarding AR/CO cases. 



CalWORKs Safety Net Program, Continued 

Aid code 

comparison 

chart 

The following chart lists different case types of CalWORKs programs and the 

aid codes that apply to them before and after reaching the TANF time limit, 

and after meeting the CalWORKs 48-month time limit without meeting time 

limit extender criteria. 

Description Aid Code 

Before Time 

Limits 

TANF Timed- 

Out Aid Code 

Safety Net Aid 

Code (CalWORKs 

Timed-Out) 

All children federally eligible 

ZERO-PARENT 

33 33 N/A 

No child is federally eligible 3G 3G N/A 

• At least one child 

federally eligible, and 

3H 3H N/A 

• At least one child not 

federally eligible 

ALL-FAMILY 

One parent 30 32 3A 

No TANF or 

CalWORKs time left 

One needy caretaker relative 30 32 3A 

No TANF or 

CalWORKs time left, 

Exempt MAP 

Two parent, deprivation is 

30 32 3A 

absence, incapacity or death 

No TANF or 


(both parents are 

timed out) 

Legal non-citizen 

3L N/A – 3L 

3A 

• No one is federally 

eligible 

Adult never 

received TANF 

No CalWORKs time 

left 

Legal non-citizen – Mixed 

3W 

• One fed person/one nonfed 

adult 

3E 

Federal adult 

TANF times 

out 

3A 

No TANF or 

• One fed person/no fed 

adult 

3E N/A – 3E 

Adult never 

received TANF 


TWO-PARENT (UNEMPLOYMENT DEPRIVATION) 

Both parents citizens 35 N/A – 35 

Adult never 

received 60 

TANF months 


3M N/A - 35 


eligible 

Legal non-citizen – Mixed 

3U N/A – 3U 

3C 

(both parents are 

timed out) 

• 

• 

One fed child/one 

non-fed adult 

Adult never 

received TANF 


RESERVED 

FOR 

FUTURE USE 


RESERVED 

FOR 

FUTURE USE 


RESERVED 

FOR 

FUTURE USE 


Overview 

Section 2 

Tracking 

Introduction This section provides information about months that are and are not included 

in the Time Limit tracking process, and additional information that must be 

evaluated for effects on Time on Aid (TOA) reviews. 

References The following references are applicable to the information in this chapter: 

EAS 42-302, 44-352, 82-832 



What is Tracked 18-21 

Work Registration and Exception Codes 18-26 

Changes in Work Registration and Exception Codes 18-27 

TANF Exemptions and Extenders 18-29 

CalWORKs Exemptions and Extenders 18-30 


What is Tracked 

Overview This section provides information about what months are and are not 

included in the Time Limit tracking process, and additional information that 

must be evaluated for effects on Time on Aid (TOA) reviews. 


information 

tracked 

Other 

information 

tracked 

Zero grant 

months 

In general, all months in which an adult receives or is eligible for cash aid are 

tracked for time limit purposes. Information tracked includes: 

• Time on aid, including all months/years aid is received from 12/96 

forward 

• Program of aid received, either Transitional Assistance for Needy 

Families (TANF) or CalWORKs, determined by the aid code under which 

aid is paid 

• Total number of TANF months of aid received since 12/96 (some states 

began TANF programs as early as 9/96) 

• Total number of CalWORKs months of aid received since 1/98 

• Non-California TANF cash aid received 

Several additional types of tracked information must be evaluated to 

determine the effect on the TANF and CalWORKs time clock total count. 

These situations include: 

• Zero grant months 

• Suspense months (Prior to Quarterly Reporting implementation) 

• Diversion payments 

• Overpayment months (OPMs) 

• Child support application 

Work registration and exception codes are also identified and tracked. Refer 

to the “Work Registration and Exception Codes” section in this chapter for 


Months in which a case is active but a recipient customer does not receive a 

cash aid payment, “Zero Basic Grant” (ZBG) months, do not count towards 

the CalWORKs 48-month time limit, but participation and exception codes 

must still be recorded. These months are counted towards the TANF 60 

month time limit, as they are considered eligible months. 

ZBG months include the following: 

• Grant was less than $10, so no grant was issued 

• Entire grant amount was kept as an overpayment adjustment 

• Grant amount was reduced to zero due to a penalty 



What is Tracked, Continued 

Suspense 

months 

Zero Basic 

Grant (ZBG) 

months versus 

suspense 

months 

Suspense months occurred under Monthly Reporting when a circumstance 

made a case financially ineligible but was not expected to continue, so the 

case was not discontinued and a cash aid payment was not issued. This 

most often occurred when a third or fifth pay check was received in a month, 

causing the net income to exceed MAP. 

Suspense months are considered ineligible months and do not count towards 

the TANF or the CalWORKs 48-month time limits. Suspense months are 

considered only when a Complete TOA review is completed. 

Although ZBG months and suspense months result in no cash aid payment 

being issued in a month, they are treated differently in the TANF and 

CalWORKs clocks. 

ZBG month: Considered as an eligible month and counts as a month of aid 

for TANF, but not for CalWORKs. 

Suspense month (Prior to Quarterly Reporting implementation): 

Considered an ineligible month and does not count as a month of aid for 

TANF or CalWORKs. 

Both ZBG and suspense months are currently reflected in the Welfare Data 

Tracking Implementation Project Tracking Recipients Across California 

(WDTIP TRAC) system "ESUM" screen with code 377. These months must 

be correctly identified at time of the complete case review, and must be 

corrected on WDTIP TRAC. 

Suspense months are technically considered ineligible months and must be 

built into the WDTIP TRAC system as periods of non-participation. 




Diversion Based on the TANF definition of assistance (benefits designed to meet 

ongoing needs), most (if not all) CalWORKs diversion payments will be 

excluded from the TANF time limit count. They will, however, count towards 

the CalWORKs time limit. 

Diversion 

Example 

A diversion payment counts against the CalWORKs 48-month clock for the 

adult customers in a case for the month in which the payment was made, 

unless the customer meets an exemption for all or part of the diversion 

period. Refer to the Applications Chapter of this Handbook for specific 

instructions regarding the establishment of the diversion period. 

If the customer reapplies for cash aid during the diversion period, he or she 

may choose to repay the diversion amount or to count the total diversion 

period against the time limit. 

If the customer chooses to … Then… 

Have the amount of the Diversion 

payment recouped from the cash 

grant, 

Count the total Diversion period 

against the time limit, 

The Quality Review Unit removes the 

Diversion payment issuance month 

from the time limit count. 

• Count all full months of the 

Diversion period against the time 

limits count, and 

• Count any month where a regular 

cash payment is issued for the 

same month as one included in 

the Diversion period again; this 

means that the clock “ticks 

twice”, so to speak, for the same 

month. 

A customer is issued a Diversion payment of $2067.00 in February. The 

$2067.00 amount is divided by $661.00 (MAP for an AU of three at the time 

of Diversion), resulting in a three-month Diversion period for February, 

March, and April. The customer reapplies for and receives regular cash aid in 

April, and chooses not to have the Diversion payment recouped. February, 

March, and April are counted against the time limit because the customer 

reapplied for aid during the Diversion period and April is counted again 

(twice) because a regular cash aid payment was issued for a month included 

in the Diversion period. 




Overpayment 

months 

Months in which an entire month's grant is determined to be an overpayment 

are considered totally ineligible OPMs. OPMs are not included in the TANF 

or CalWORKs clocks if the overpayment has been repaid in full because, 

once repaid, aid was technically not received. 

San Bernardino County’s policy is to "untick" all OPMs, whether or not the 

overpayment has been repaid. This policy may result in months being 

"unticked" that would have been included in the count of both the TANF and 

the CalWORKs clocks. This policy will benefit rather than harm the customer. 

Months in which a portion of a month's grant is determined to be an 

overpayment are called partial overpayments. Months with partial 

overpayments are included in both the TANF and the CalWORKs clocks, 

whether or not the overpayment has been repaid. This rule applies even if 

the partial overpayment was calculated based on aid received for an adult 

who should have been discontinued, for any reason. 

Child Support Regulations require that any month in which cash aid is fully reimbursed as a 

result of child support collection, whether collected in a particular month or 

any subsequent month, shall be exempt from the CalWORKs 48-month time 

limit. CalWORKs months exempted due to child support recoupment do 

count in the TANF clock. 

All child support recoupment, including collections for a current month, 

arrearages, and lump sum payments, collected from 1/98 forward, are added 

together and applied to repay cash aid payments as follows: 

• Total child support received is applied to each month of aid, starting with 

the earliest month/year cash aid was received by the AU from 1/98 

forward, 

• Each month of aid that is fully reimbursed by child support is exempt and 

not counted to the CalWORKs clock of any aided adult(s) is exempt and 


not counted to the CalWORKs clock of any aided adult(s) in the AU, 

• Child support recoupment amount is applied to all month(s) of aid 

whether or not the month has been exempted for any other reason, 

including any month(s) not included in a CalWORKs clock because an 

adult was not aided for any reason, and 

• Any child support amount that remains but is not enough to reimburse a 

month's aid amount is to be carried forward and added to subsequent 

child support recoupments until enough child support is accumulated to 

"untick" a subsequent month of cash aid. 

Exception: Child support is not applied to totally ineligible OPMs, because 

OPMs are considered non-participation months 

and, technically, no aid was paid or received. 




Other codes in 

WDTIP TRAC 

WDTIP TRAC includes informational codes, in addition to those identified in 

the previous blocks. Complete information regarding all codes can be found 

on the WDTIP website located at: 

www.wdtip.ca.gov/docs/Reference/TRAC Reference Codes v23.pdf 


Work Registration and Exception Codes 

Introduction This section includes information about work registration and exception 

codes, and how they are identified and coded in the tracking system. 

Work 

registration 

codes and the 

tracking 

calendar 

Welfare Data Tracking Implementation Project Tracking Recipients Across 

California (WDTIP TRAC) uses three-digit work registration and exception 

codes. Work registration/exception information recorded in C-IV is translated 

and recorded in WDTIP TRAC according to the state three-digit codes. Work 

registration/exemption information must be updated whenever a change 

occurs. 

Prior to C-IV, if no change occurred after exemption information was entered 

in the County TRAC database no new entry was required; the previous code 

continued to be applied until a change was made. This is different in C-IV. 

Work registration/exemption information is entered into C-IV for periods of 

time affected, with a begin and end month, or for one month at a time. If the 

end date passes and a code is not updated or re-entered, the code expires 

and is no longer applied. 

Since the WDTIP TRAC system will count months of aid and apply them 

towards the 48-month time limit according to the information/codes recorded, 

it is important that all work registration, exemption, and exception codes are 

accurate and valid. 


Changes in Work Registration and Exception Codes 

Introduction This section includes information regarding how to apply changes in work 

registration and exception codes, and gives examples of missing verification 

and how those situations are handled. 


of changes 

When there is a change in the work registration code and/or the exception 

code, it is important that Welfare Data Tracking Implementation Project 

Tracking Recipients Across California (WDTIP TRAC) accurately reflects the 

month and year that the change was effective. 

If a code changes from a countable to a non-countable code or from a 

non-countable to a countable code anytime in a month, the non-countable 

exemption code is applied to the entire month. 

The date of onset is used to determine the beginning month of a medical 

exemption, for time limit purposes, unless the date of onset is questionable. 

Example 1: CW 61 on file indicates the customer was disabled and unable 

to work with an onset date of 5/23/07 and an expected duration of six 

months. Code 302 (disability) will be recorded effective 5/07 through 10/07. 

Example 2: CW 61 on file indicates the customer was disabled and unable 

to work with an onset date of 5/23/07 and an expected end date of 8/23/07. 

Code 302 (disability) will be recorded effective 5/07 through 8/07. 

Example 3: CW 61 on file is dated 2/06 and states the customer has a 

medical condition with an onset date of 2/06, but is able to work full-time, and 

customer was active with WTW. Customer provides a subsequent CW 61 in 

6/07 that indicates condition is chronic and customer is not able to work, with 

the same onset date of 2/06. The date the current CW 61 was completed 

should be used as the first month of the exemption for being unable to work, 

since a prior CW 61 was provided with the same onset date. 



Changes in Work Registration and Exception Codes, Continued 


code changes 

Work registration and exception codes may change many times during the 

time period being reviewed. When a code changes, there should be 

information in the case record that indicates why the code changed. If there 

is no information or verification regarding a code in the case record, the 

exemption code is not applied. 

Example 1: A code 302 (disability) is recorded for 2/07-current month. 

There should be a CW 61 Medical Report form or verification of Social 

Security Disability (SSD) received in the case record. If there is no medical 

verification, the medical exemption code is not applied. 

Example 2: A code 305 (care of another in the home) is recorded for 9/06- 

2/07. There should be CW 61 Medical Report or PLAN 112 C-IV for the time 

period on file in the case record. If there is no verification of caring for a 

person in the home, the months are not considered exempt. 


TANF Exemptions and Extenders 

Introduction This section explains TANF time limit exemptions and extenders. The Indian 

Country areas that meet exemption criteria for specified years are listed in 

the “Living in Indian Country exemption” section of this handbook chapter. 

TANF time limit 

exemptions 

TANF time limit 

extenders – 

hardship, 

battered or 

cruelty 

The TANF clock does not “tick” (months are exempt, or non-countable) when 

an individual is: 

• An adult or minor who is not the head of household or married to the 

head of household and receiving TANF funded aid in his or her parent’s 

AU. 

• Living in Indian Country, as defined by federal law, or an Alaskan Native 

village with at least 50% unemployment. 

TANF funds may continue to be paid beyond 60 months due to “hardship,” as 

defined by the state, or if the family includes an adult who has been battered 

or subjected to extreme cruelty for up to 20% of the state’s TANF caseload. 

California determined that aid code 32 and 3W payments issued for the 

months 1/04 through 6/09 were to be funded under the “hardship” allowance 

with federal TANF funds, rather than state-only funds. This is a fiscal issue 

only, and aid codes are not changed nor are extender codes used. These 

cases are identified by aid code only. Both the TANF and CalWORKs clocks 

will tick for this time period. 

Aid code 32 and 3W payments issued for the months 7/09 and ongoing are 

funded with state-only funds and only the CalWORKs clock will tick. 


CalWORKs Exemptions and Extenders 

Introduction This section explains CalWORKs time limit exemptions and extenders which 

do not “tick” the CalWORKs clock. 


exemptions 

Applying 

exemptions to 

aid received in 

another state 

The CalWORKs clock does not “tick” (months are exempt, or non-countable) 

when an individual meets any of the following exemptions while receiving aid 

in California: 

Teen parent up to age 20 

Living in Indian Country or an Alaskan native village with a 50 percent 

unemployment rate (see “Living in Indian Country exemption” block 

located in the “Exemption and Exception Codes” section of this handbook 

chapter) 

Aid fully reimbursed by child support 

60 years of age or older 

Providing care for an ill or incapacitated person residing in the home, and 

caretaking responsibilities impair the ability to be employed or participate 

in Welfare-to-Work (WTW) program activities 

Aided non-parent caretaker of a dependent child of the court or a child 

who is at risk of placement in foster care, with caretaking responsibilities 

that impair the ability to be employed or participate in WTW activities 

Disabled, expected to last at least 30 days 

Domestic abuse good cause 

Grant amount of less than $10 (for any reason) 

Unaided (excluded from the AU) for reasons other than reaching a time 

limit (includes WTW sanction, drug/fleeing felon, and other excluded 

persons) 

Receiving only supportive services (e.g., Child Care, transportation, etc.) 

Note: State codes corresponding to reasons above are listed in the “Work 

Registration and Exception Codes” block located in the “Exemption and 

Exception Codes” section of this handbook chapter. 

Transitional Assistance for Needy Families (TANF) aid received from any 

other state must be included in the CalWORKs 48-month time limit as well as 

in the TANF time limit. State-only funds issued by another state are not 

included in the CalWORKs clock. In recording months of aid received in other 

states, counties will apply only the following exemptions to the CalWORKs 

48-month time limit: 

The individual was living in Indian Country or an Alaskan Native village 

with at least 50% unemployment (See “Living in Indian Country 

exemption” block located in the “Exemption and Exception Codes” 

section of this handbook chapter). 

Aid fully reimbursed by child support 



CalWORKs Exemptions and Extenders, Continued 


time limit 

extenders and 

State codes 

When are 

criteria 

applied? 

CalWORKs funds may continue to be paid for an individual who has been 

aided as an adult for 48 months when all aided parents, stepparents, and/or 

needy caretaker relatives residing in the home of the aided child(ren) meet 

any of the following conditions (or any combination of conditions): 

Condition State Code 

Disabled, receiving SDI, TDI, IHSS, or SSP benefits 

and the disability impairs his or her ability to work 

600 

Note: A CW 61 is not sufficient verification for this code 

to be applied; disability related payments must be 

received. 

60 years of age or older 601 

Aided nonparent caretaker of a dependent child of the 602 

court or a child who is at risk of placement in foster 

care, with caretaking responsibilities that impair the 

ability to be employed or participate in WTW activities 

Providing care for an ill or incapacitated person residing 

in the home, and caretaking responsibilities impair the 

ability to be employed or participate in WTW activities 

Unable to maintain employment or participate in WTW 

activities, based on the county’s (WTW) assessment 

and finding that the individual has a history of 

participation and full cooperation in WTW activities 

Domestic abuse good cause (other aided adults do not 

have to meet extender criteria for the domestic abuse 

victim to receive the extension) 

Unaided (excluded from the AU) for reasons other than 

reaching time limit (includes WTW sanction, 

drug/fleeing felon, and other excluded persons) 

Extenders may be applied at the time an adult(s) reaches the 48-month time 

limit, or at any time after discontinuance for reaching the time limit. If criteria 

are met, adult(s) discontinued for reaching the time limit will be added back 

into the CalWORKs program, following Beginning Date of Aid rules (see the 

BDA chart in the following section). 

Several of the extender criteria are also considered as exemptions/ 

exceptions. If one adult has timed-out and meets an extender criteria, and 

another adult in the AU is meeting an exemption/exception criteria that is 

also considered an extender, the timed-out adult will be added back into the 

CalWORKs program for as long as all adults continue to meet the extender 

criteria. 

CWPHB #4656 (04/13) TIME LIMITS 18-31 

603 

604 

605 

N/A 


CalWORKs Exemptions and Extenders, Continued 

Extender 

determination 

Extender aid 

code 

The determination as to whether extender criteria apply in a case will be 

made at the time of a regular Time on Aid (TOA) review, at the customer’s 

request, or when information becomes available to the County worker. 

If a case appears to meet extender criteria, the Eligibility Worker (EW) will 

request the Quality Review Unit (QRU) complete a TOA review. The EW will 

complete the PS 02 – PII Email Attachment Form and e-mail the form to the 

Time Limit Review Inbox. 

Cases that continue to be aided beyond the CalWORKs 48-month time limit 

based on extender criteria remain eligible as state-only cases and are 

claimed under the appropriate state-only aid code based on TANF 60-month 

time limit expiration: 

32 

3W 

35 (State-only funding from 10/99 through 9/06) 

Note: For aid payments issued 1/04 through 6/09, TANF extender criteria 

apply to aid code 32 and 3W cash aid. Effective 10/06, TANF extender 

criteria apply to aid code 35 cash aid. 


Overview 

Section 3 

Reviewing Time On Aid: General 

Introduction This section provides general information on Time On Aid (TOA) reviews and 

filing the TOA information in time limit folders. 



Time On Aid Reviews 18-34 


Time On Aid Reviews 

Introduction Quality Review Unit (QRU) staff located in the District offices complete Time 

On Aid (TOA) reviews. In addition QRU staff run, accept and save EDBCs 

for certain TOA actions in the C-IV system. 

The Eligibility Worker (EW) has the final authority and responsibility to 

determine the case is ready-to-work. All case results, except TOA-related 

results, remain the EW’s responsibility. The determination of TOA-related 

results is the responsibility of QRU staff. 

Aid will not be authorized for a case or an additional adult until QRU has 

completed the TOA review. This includes continuing worker’s actions to add 

adults back into an Assistance Unit (AU) when a new application is not 

required (Example: Welfare to Work (WTW) sanction is cured). 

TOA process The following table describes the actions required by the EW and QRU staff 

to complete the TOA process for intake and additional person 

actions/approvals. 


1 EW: 

• Determines there is an adult in the family who needs a TOA 

review and 

• Sends the completed PS 02, PII Email Attachment Form to the 

Time Limit Review Inbox to request a TOA review. 

2 QRU staff: 

• Completes TOA review, 

• Sends TOA information to be imaged, and 

• Sends an email to notify the EW of the completion of the TOA 

review. 

3 EW takes the following action when the “completed TOA review” 

email is received from QRU: 

Step Action 

1 Completes case processing but does not accept EDBC. 

2 Sends case to appropriate Eligibility Worker Supervisor 

(EWS I)/EW III for review. 

3 Makes corrections to case based on review from Step 

2, if necessary or goes to Step 4. 

4 Runs, Accepts and Saves EDBC. 



Time On Aid Reviews, Continued 

Timeframes for 

TOA reviews 

QRU staff will complete TOA reviews at: 

• Intake and Add Person applications or actions 

• Re-Evaluation (RE) – Timed-out adults only 

• CalWORKs 42 nd and 48 th month 

Additionally, a complete TOA review will be completed by QRU when the 

customer: 

• Makes a TOA review request 

• Files a State Appeals Hearing Request 

The complete TOA review requires a review of all appropriate databases for 

cash aid received from 12/96 to current month. 

The TAD 60 Federal TANF & State CalWORKs Time Limit Tracking form will 

be completed and used to transfer information to the C-IV system, and to 

determine the total months of aid received. The TAD 60 is imaged into the 

C-IV system, to reference when changes to the tracking calendar are 

required in the future. 


Overview 

Section 4 

Time On Aid (TOA) Notices 

Introduction This section gives a list of Time On Aid (TOA) Notices of Action (NOAs) that 

are available, and a description of the use of each notice. 

References The following references are applicable to information included in this 

section: 

• ACIN I-90-02 



Time On Aid (TOA) Notices 18-37 


Time On Aid (TOA) Notices 

Overview C-IV creates Notices of Action (NOA) in batch for various time limit related 

actions, and other notices are generated in the system by the worker at the 

time of review. 

Automated 

TOA NOAs sent 

in batch 

Batch NOA 


Not all NOAs issued by the State are included in C-IV. C-IV uses language 

from some of the NOAs and includes “messages” made up from Time on Aid 

(TOA) NOAs in other notices that are generated in the system. 

This section gives a list of all TOA NOAs issued by the State, with a 

description of when they are used. 

The C-IV system automatically generates and sends three of the TOA NOAs 

in batch. Batch notices are all issued and mailed out centrally, on 

approximately the fifth calendar day of every month. 

Approval NOAs are sent on the fifth day of the month following the approval 

month. Re-Evaluation (RE) NOAs are sent on the fifth day of the RE month. 

Any changes made to TOA information prior to the issuance of the batch 

NOA will be reflected in the NOA. 

Example: EDBC is saved and accepted for intake approval on 1/7/07. The 

adult in the case meets no Time Limit exemption criteria on 1/7/07, so no 

Time Limit Detail page entries are necessary. On 1/20/07, the adult 

customer provides a CW 61 verifying a medical exemption code 302 for 1/07- 

11/07. The QRU worker inputs the exemption code detail into C-IV on 

1/21/07. When the approval batch NOA issues on 2/5/07, the exemption data 

entered on 1/21/07 will be included. 

The TOA NOAs sent in batch are the: 

• NA 040-107A 

• NA 040-107B 

• NA 040-107F 

Batch TOA NOAs are effective with the date of C-IV conversion to WDTIP 

TRAC. Prior to successful conversion, TOA NOAs did not auto-generate and 

batch issue, and manual generation of NOAs was necessary. 

CW 2184 The CW 2184 CalWORKs 48-Month Time Limit notice is required to be given 

to customers at approval of application, RE, and with any TOA NOA. This 

notice is not currently included in the C-IV forms inventory; therefore, the 

Quality Review Unit (QRU) must send a County printed copy of this notice 

whenever a TOA review that generates a NOA is completed. 



Time On Aid (TOA) Notices, Continued 

TOA Notices Time on Aid (TOA) Notices of Action (NOAs) are listed in the table below. 

Notice Number Notice Title Use 

NA 040-107A 

NA 040-107A (SP) 

NA 040-107B 

NA 040-107B (SP) 

NA 040-107C 

NA 040-107C (SP) 

NA 040-107E 

NA 040-107E (SP) 

NA 040-107F 

NA 040-107F (SP) 

TOA – No 

Previous 

Notice/12 Months 

or Less 

TOA – APP/RE – 

Previous Notice 

TOA 42-46 

Months 

TOA – 

Change/Partial 

Disc – 48 th Month 

on Aid 

TOA – Extended 

Beyond 48 

Months of Aid 

• Use to inform an adult recipient of the total 

number of months, when 

• No previous TOA NOA has been issued, 

and 

• The recipient received aid for 12 months 

or less. 

• Auto-generated by C-IV one time only at 

application approval or RE EDBC; sent in 

batch. 

• Use at Re-evaluation (RE) and application 

to inform an adult recipient of the total 

number of months he/she has received 

cash aid, and 

• The recipient has been issued a previous 

TOA NOA. 

• Auto-generated by C-IV at RE EDBC or 

restoration EDBC; sent in batch. 

• Use at 42 nd /46 th month to inform an adult 

recipient of the total number of months 

he/she has received cash aid, and 


TOA NOA. 

• User generated from C-IV Time Limit 

Detail page; can be printed and mailed 

centrally or locally. 

• Use at 48 th month on aid to inform an adult 

recipient he/she has reached the 48month 

time limit and is no longer eligible for aid, 

but 

• The children will continue to receive aid, 

and 


TOA NOA. 

• Message added to benefit change NOA. 

• Use at 48 th month on aid to inform an adult 

recipient he/she has reached the 48month 

time limit, but 

• Continues on aid because he/she meets 

an extender criterion, and 


TOA NOA. 

• Auto-generated by C-IV at EDBC. 



Time On Aid (TOA) Notices, Continued 

Notice Number Notice Title Use 

NA 040-107G 

NA 040-107G (SP) 

NA 040-107H 

NA 040-107H (SP) 

NA 040-107I 

NA 040-107I (SP) 

NA 040-107J 

NA 040-107J (SP) 

NA 040-107.1 

NA 040-107.1 (SP) 

NA 040-107.2 

NA 040-107.2 (SP) 

TOA – 

Discontinue – 

48 th Month on Aid 

TOA – 48 th Month 

on Aid – 

MFG Child Only 

TOA – 48 th 

Month on Aid – 

No Eligible Child 

TOA – Partial 

Approval – 

Timed Out Adult 

Continuation 

Page – TOA 

Child Support 

Exemption 

Continuation 

Page – TOA Child 

Support 

Exemption 

Subsequent 

• Use at 48 th month on aid to inform an 

adult recipient he/she has reached the 

48-month time limit, and 

• The family is no longer eligible for aid 

because the income exceeds MAP, and 


TOA NOA. 

• Message added to discontinuance NOA. 




• Is no longer eligible for aid because the 

only child is an MFG child, and 


TOA NOA. 

• Message added to approval/benefit 

change NOA. 




• The family is no longer eligible because 

there is no eligible child in the home, and 


TOA NOA. 

• Message added to discontinuance NOA. 

• Use to approve cash aid and deny any 

member(s) of the AU who is a 

CalWORKs timed-out adult. 

• Message added to approval/benefit 

change NOA. 

• Use to inform an adult recipient of the 

number of months that are exempt due to 

the child support reimbursement of aid, 

when no previous TOA NOA has been 

issued. 

• Message added to all other NOAs when a 

child support exemption is applied. 

• Use at Re-Evaluation (RE) and 

application to inform an adult recipient of 

the number of months that are exempt 

due to the child support collection 

reimbursement of aid, and when the 

recipient has been issued a previous 

TOA NOA. 

• Message added to all other NOAs when a 

child support exemption is applied. 


Overview 

Section 5 

Eligibility Worker Responsibilities 

Introduction This section provides information about time limit tracking actions for which 

the Eligibility Worker (EW) is responsible. 



Eligibility Worker Time Limit Review Actions 18-41 

Time Limit Exemption Request 18-43 

Exemption Request Determination 18-44 


Eligibility Worker Time Limit Review Actions 

Introduction The Eligibility Worker (EW) is responsible for certain case actions prior to 

and following the completion of a Time on Aid (TOA) review by the Quality 

Review Unit (QRU). This section provides information regarding those 

actions as well as actions the EW is required to take when timed-out adults 

become disabled. 

EW action - 

before TOA 

review 

EW action – 

after TOA 

review 

Before sending a PS 02 Personally Identifiable Information (PII) via e-mail to 

the Time Limit Review Inbox (see the “TOA process” block in this chapter of 

the handbook), the EW must complete the following steps: 

Step Action 

1 Ensure the case is ready to work and all eligibility criteria have 

been met. 

2 Complete a Journal entry with a short description of the reason for 

the referral for a TOA review. 

Include the following in the Journal entry: 

• Special instructions to the QRU 

• Expected outcome for family/AU composition and aid code. 

3 Complete PS 02 form and e-mail to the Time Limit Review InBox to 

request a TOA review. 

After QRU has completed the TOA review and has notified the EW of the 

TOA completion, the EW is responsible for completion of the case 

processing. The table below describes the process to follow: 


1 The EW gives the case to the Eligibility Worker 

Supervisor (EWS I)/EWIII to review. 

2 The EWS I/EW III returns the case to the EW at the completion of 

the review. 

3 The EW completes any corrections required and runs and accepts 

EDBC. 

4 The EW reviews approval and Time Limit Notice of Action (NOAs). 

Note: Information needed to verify Time Limit NOA information is 

documented in the Journal entry completed by QRU. 



Eligibility Worker Time Limit Review Actions, Continued 

EW 


Timed-out 

Adults 

receiving 

disability 

EW action 

when case is 

with QRU 

Other 

information 

The EW is responsible for the following TOA related actions: 

Add Person: 

Inform QRU by sending a PS 02 form to the Time Limit Review InBox 

when an adult is added to the case. A TOA review must be 

completed prior to authorizing aid for the additional adult. 

RE: 

Include the CW 2184-Time on Aid Informing Notice in the RE packets 

and journal that the notice was sent. 

Inform the customer of his/her time on aid by using the NOA 

generated by C-IV. 

TANF timing out cases: 

When the Task for 58 th TANF month appears, delete the Task and set 

a new task for the 60 th TANF month on aid as a reminder to run 

EDBC in the 60 th month. 

Note: Running EDBC in the 48 th month will establish the correct aid code for 

the case. 

42 nd CalWORKs month tasks: 

Delete the 42 nd CalWORKs month tasks. 

Work registration codes: 

Keep the work registration/exemption code current in C-IV. 

Note: The Employment Service Specialist (ESS) is also responsible for 

keeping the work registration/exemption code current in C-IV. 

An adult who timed-out of CalWORKs may become disabled during his/her 

period of ineligibility. If the adult begins to receive State Disability Insurance 

(SDI) or Worker’s Compensation, the case must be referred to QRU for an 

extender determination. 

EWs continue to be responsible for all necessary case action, other than time 

limit related action, while a case is in TOA review with the QRU. EWs are to 

act as follows: 

If a QR 7 is received, contact the Time Limit Quality Review Supervisor. 

Process the QR 7 and enter any income information in the C-IV 

system, and advise QRU of the action taken. 

If other action becomes necessary, contact the QRU before acting. 

Note: Do not issue any additional benefits without contacting the QRU first. 

The EW is responsible for responding to TOA questions from customers. 


Time Limit Exemption Request 

Introduction A recipient customer can request an exemption or exception to the 

CalWORKs 48-month time limit at any time. The Eligibility Worker (EW) will 

handle these requests by following the process provided in this section. 

Method of 

exemption 

request 

Action when 

exemption 

request is 

received 

A recipient customer can request an exemption either: 

• Verbally, or 

• In writing. 

When a recipient customer requests an exemption the EW will act as follows: 

• Immediately send or give the CW 2186A CalWORKs and WtW Time 

Limit Exemption Request Form to the recipient customer with a VER 100 

request for information form. The VER 100 will request the return of the 

CW 2186A within 10 calendar days, 

• Document the request in the case record, 

• Ensure a copy of VER 100 is part of the case record documents, and 

• Journal receipt of the request and all actions taken. 


Exemption Request Determination 

Determination 

of exemption 

QRU and the 

exemption 

eligibility 

review 

Once the CW 2186A has been sent to the recipient customer, the Eligibility 

Worker (EW) will take the following steps to determine whether an exemption 

will be applied: 

Step Action 

1 Determine whether the CW 2186A was returned within 15 days of 

the date of request of the exemption or within 10 days of being 

provided to the customer, and: 

2 

If… Then… 

Yes, Go to step 2. 

No, Deny the request for exemption for failure to return 

the CW 2186A. 

• Send a CW 2186B CalWORKs and Welfare To 

Work (WtW) Time Limit Exemption Determination 

informing the customer of the denial of the 

requested exemption. 

• Document determination in the case record. 

Include all necessary documentation in the case 

Journal and image into C-IV. 

Determine if documentation has been provided or exists in the 

case record to support the exemption determination, and: 

If… Then… 

Yes, Go to step 3. 

No, Request additional verification from the customer, 

using the VER 100, with a due date 10 days from date 

VER 100 is mailed. 

3 Complete the PS 02 form to request an exemption eligibility 

review and send to the Time Limit Review Inbox. 

The Quality Review Unit (QRU) will take the following steps when an 

exemption eligibility review has been completed: 

• Send a CW 2186B CalWORKs and WTW Time Limit Exemption 

Determination informing the customer of approval or denial of the 

requested exemption. 

• Document determination in the case Journal and file copy of notice with 

supporting documentation in C-IV. 

• Notify EW of the determination for appropriate action to be taken. 



Exemption Request Determination, Continued 

Documentation/ 

Verification 

Exemption 

determination 

time frame 

All available case information must be researched before additional 

verification is requested from the recipient customer. 

The County must inform the recipient customer, in writing, of the result of the 

exemption determination within 15 calendar days from the date of receipt of 

the request. The 15-day time limit may be extended if the completion of the 

determination is delayed because of circumstances beyond the control of the 

County. 

Examples of delays beyond control of the County include: 

• Customer’s inability to provide necessary verification 

• Delay of a physician to provide necessary information 

Note: Any delay in making the exemption determination must be specifically 

documented in the case Journal as appropriate. 


Overview 

Section 6 

Exemption and Exception Codes 

Introduction This section identifies the Indian country areas meeting the TANF exemption 

criteria, and lists the Work Registration Exemption and Exception Codes 

used to “untick” the CalWORKs clock and track other information. 



TANF Exemptions 18-47 

Work Registration and Exception Codes 18-52 


TANF Exemptions 

Introduction The TANF clock does not “tick” (months are exempt or non-countable) when 

an individual is: 

Living in Indian 

Country 

exemption 

An adult or minor who is not the head of household or married to the 

head of household and receiving TANF funded aid in his or her parent’s 

AU, or 

Living in Indian Country where the unemployment rate is 50% or higher. 

The following table identifies Indian Country meeting the exemption criteria 

for the specified years. 

Indian Country Zip County Years with 50% 

Code 

Unemployment 

Bear River Band of Rohnerville 95551 Humboldt 2002, 2003, 2004, 

Rancheria 

2008, 2009, 2010, 2011 

Berry Creek Rancheria 95966 Butte 1996 through 2002, 

2005, 2006, 2007 

Big Pine Paiute Tribe of Owens 

Valley (BPPT) 

93513 Inyo 2006, 2007, 2008, 2009 

Big Pine Reservation 95313 Stanislaus 1996 through 2001 

Big Sandy Rancheria 93602 Fresno 2003, 2008, 2010, 2011 

Big Valley Rancheria 95453 Lake 2008, 2009, 2010, 2011 

Bishop Pauite Tribe 93515 Inyo 2009 

Blue Lake Rancheria 95525 Humboldt 2002, 2003 

Bridgeport Indian Colony 93517 Mono 2005, 2006, 2007, 2008 

Cahto Tribe of Laytonville/Cahto 95454 Mendocino 2002, 2003, 2004, 

Tribe of Laytonville Rancheria 

2009, 2010, 2011 

Cahuilla Band of Indians 92539 Riverside 2006, 2007 

California Valley Miwok Tribe 95210/ San Joaquin 2006, 2007, 2008, 

95212 

2009, 2010, 2011 

Campo Band Mission Indians/ 

Campo Kumeyaay Nation 

91906 San Diego 2008, 2009 

Cedarville Rancheria 96101 Modoc 1996 through 2002, 

2005, 2006, 2007, 

2008, 2009 

Chemehuevi Reservation 92363 San 

Bernardino 

2002, 2003 

Cher Ae Heights Indian 

Community of Trinidad Rancheria 

95570 Humboldt 2008, 2010 

Cloverdale Rancheria of Pomo 

Indians 

95425 Sonoma 2009 

Cold Springs Rancheria 93667 Fresno 2008, 2009, 2010, 2011 



TANF Exemptions, Continued 

Living in Indian Country exemption (continued) 


Code 

Unemployment 

Colusa Rancheria 95932 Colusa 1996 through 2001 

Colusa Rancheria/Cachil Dehe 

Band of Wintu Indians of the 

Colusa Indian Community 

95932 Colusa 2007 

Concow-Maidu Mooretown 95932 Butte 1996 through 2001 

Cortina Band of Indians 95987 Colusa 2004 

Cortina Indian Rancheria/Wintun 

Tribe 

95987 Colusa 2007, 2008, 2010 

Coyote Valley Tribal Council 95470 Mendocino 2002 

Coyote Valley Band of Pomo 

Indians 

95470 Mendocino 2005, 2008, 2010 

Elem Indian Colony/Elem Pomo 

Tribe 

95423 Lake 2008, 2009 

Elk Valley Rancheria 95531 Del Norte 2007 

Enterprise Rancheria 95965/ 

95966 

Butte 1996 through 2001, 2009 

Enterprise Rancheria Estom 

Yumeka Maidu Tribe 

95996 Butte 2010 

Ewiiaapaayp Band of Kumeyaay 

Indians 

91901 San Diego 2006, 2007 

Fort Bidwell Indian Reservation 96112 Modoc 2007, 2009, 2011 

Fort Bidwell Paiute Reservation 96112 Modoc 2005 

Fort Independence Indian 

Reservation 

93526 Inyo 2011 

Fort Yuma Reservation/Fort 85366 Imperial 1996 through 2001, 

Yuma Indian Reservation 

2002, 2005 

Greenville Rancheria 95947 Plumas 2005 

Grindstone Indian Rancheria 95939 Glenn 2005 

Guidiville Band of Pomo Indians 95481 Mendocino 2010, 2011 

Guidiville Rancheria/Guidiville 95481/ Mendocino 1996 through 2001, 

Indian Rancheria 

95482/ 

95531 

2002, 2006, 2007 

Habematolel Pomo of Upper 

Lake Rancheria 

95485 Lake 2006, 2007 

Hoopa Valley Indian 

95546 Humboldt 2002, 2003, 2004, 2007, 

Reservation/Hoopa Valley Tribe 

2008, 2009, 2010, 2011 

Iipay Nation of Santa Ysabel 92070 San Diego 2008 

Inaja-Cosmit Band of Mission 92027/ San Diego 2005, 2008, 2010 

Indians 

92025 

Indian Canyon Band 

Coastanoan/Mutsen Indians 

95024 San Benito 2002 

Ione Band of Miwok Indians 95640 Amador 2006, 2007 

Jamul Indian Village 91935 San Diego 2007, 2010 

CWPHB #4640 (08/12) TIME LIMITS 


18-48




Code 

Unemployment 

Karuk Reservation/Karuk Tribe of 96039 Siskiyou 1996 throuth2001, 

California 

2004, 2006, 2007, 

2009, 2010, 2011 

95556 Humboldt 2006, 2007, 2010, 

2011 

La Jolla Band of Luiseno Indians 92061 San Diego 2002, 2009 

La Posta Band of Mission Indians 91905 San Diego 2005 

Lone Pine Reservation 93545 Inyo 1996 through 2001 

Lone Pine Paiute-Shoshone 

Reservation 

93545 Inyo 2008, 2011 

Lookout Rancheria 96101 Modoc 1996 through 2001 

Los Coyotes Reservation/Los 92086 San Diego 1996, 2002, 2003, 

Coyotes Band of Indians 

2005, 2006, 2007, 

2009, 2010, 2011 

Manchester-Point Arena Band of 95468 Mendocino 2004, 2006, 2007, 

Pomo Indians 

2008, 2009, 2010, 

2011 

Manzanita Band of the Kumeyaay 

Nation 

91905 San Diego 2004 

Mechoopda Indian Tribe of Chico 95926 Butte 2004, 2007, 2008, 

Rancheria 

2009, 2010, 2011 

Mesa Grande Band/ Mesa Grande 

Band of Mission Indians 

92070 San Diego 2003, 2005 

Middletown Rancheria 95461 Lake 1996 through 2001, 

2006, 2007 

Mooretown Rancheria/Mooretown 

Rancheria of Maidu Indians of CA 

95966 Butte 2003, 2004, 2009 

North Fork Rancheria 93643 Madera 2004 

Pala Band of Mission Indians 92059 San Diego 2009 

Paskenta Band of Nomlaki Indians 95963 Glenn 2008, 2009 

Pauma Band of Mission Indians 92061 San Diego 2004 

Picayune Rancheria of Chukchansi 

Indians 

93614 Madera 2002, 2010 

Pinoleville Indian Reservation 95482 Mendocino 2004, 2005 

Pomo Nation/Pinoleville Pomo 

Nation 

95482 Mendocino 2007, 2009, 2010 

Potter Valley Tribe 95482 Mendocino 2002, 2004, 2007 

Quartz Valley 96032 Lake 1996 through 2001 

Quartz Valley Indian Reservation 96032 Siskiyou 2006, 2007, 2009 

Ramona Band of Cahuilla Indians / 

Ramona Band of Cahuilla 

92539 Riverside 2004, 2005 

Redding Rancheria Tribe 96001 Shasta 2005 






Code 

Unemployment 

Redwood Valley Rancheria 95470 Mendocino 2002, 2006, 2007 

Resighini Rancheria 95548 Del Norte 2002, 2003, 2004, 

2005, 2006, 2007, 

2008, 2011 

Rincon Reservation 92082 San Diego 1996 through 2001 

Rincon Band of Luiseno Indians 92082 San Diego 2008, 2010 

Robinson Rancheria/ Robinson 

Rancheria of Pomo Indians 

95464 Lake 2002, 2005, 2007 

Rohnerville Rancheria- Bear River 

Band 

95551 Humboldt 2007 

Round Valley Indian Tribes/Round 95428 Mendocino 2003, 2004, 2005, 

Valley Indian Reservation 

2011 

Santa Ynez Indian Reservation/Santa 93460 Santa 2007, 2010, 2011 

Ynez Chumash Indian Reservation 

Barbara 

Santa Ysabel Band of Diegueno 92070 San Diego 2002, 2003 

Indians 

Scotts Valley Band of Pomo Indians 95453 Lake 2006, 2010 

Sherwood Valley Rancheria 95490 Mendocino 2008, 2009 

Shingle Springs 95682 El Dorado 2004 

Smith River Rancheria 95567 Del Norte 2002, 2003, 2011 

Stewarts Point Rancheria 95403 Sonoma 2002, 2006, 2007, 

2009, 

Stewarts Point Rancheria, Kashia 95403 Sonoma 2007, 2010 

Band of Pomo Indians 

Sulphur Bank Rancheria 95451 Lake 1996 through 2001 

Susanville Indian Rancheria 96130 Lassen 2009 

Table Bluff Rancheria-Wiyot Tribe 95551 Humboldt 2007, 2010 

Table Bluff Reservation 95551 Humboldt 2002, 2003, 2004 

Timbisha Shoshone Tribe 92328 Inyo 2003, 2004, 2011 

Trinidad Rancheria 95570 Humboldt 2002, 2003, 2006 

Tule River Reservation /Tule River 93258 Tulare 1996 through 2001, 

2005, 2009, 2010, 

2011 

United Auburn Indian Community 95658 Placer 2002 

Upper Lake Rancheria 95485 Lake 2003 

Utu Utu Gwaitu Paiute Tribe of 

Benton Paiute Reservation/Rancheria 

93512 Mono 2008, 2009 






Code 

Unemployment 

Valley Band of Pomo Indians 95453 Lake 2007 

Wiyot Tribe at Table Bluff Reservation 95551 Humboldt 2006, 2007, 2009 

Woodfords Indian Colony 96120 Alpine 2003 

Woodfords Washoe Community 96120 Alpine 2008, 2009 

Council/Washoe Tribe of NV& CA – 

96121 Alpine 2010 

Woodfords Community 

Yurok Indian Reservation /Yurok 

Reservation/Yurok Tribe 

95548 Del Norte 2002, 2003, 2008, 

2009 

95546/ Humboldt/ 2005, 2006, 2007, 

95548 Del Norte 2010, 2011 

If an individual disagrees with the information in the chart and can provide 

documentation from a Native American Tribe that he/she lived in Indian 

Country where the unemployment rate was at least 50%, he/she also 

qualifies for this time limit exemption. 


Work Registration and Exception Codes 

Introduction This section provides information about the State three-digit exception codes 

that correspond to work registration information and other required 

information. 

Codes 

originating 

from work 

registration 

The following table includes: 

• State three-digit exception codes that correspond to work registration 

information 

• Type of verification needed 

• Countable or non-countable time clock information 

State Code 

200 – WTW sanction 

Note: 200,201, and 202 were used 

for first, second, and third instance 

WTW sanctions prior to 7/12/06. 

302 – 

• Disability to last at least 30 days 

or receiving disability-related 

income: 

− Social Security Disability 

− State Disability Income 

− Worker’s Compensation 

Verification 

Needed 

TANF 

Clock 

Ticks 


Clock Ticks 

WTW Journal No No 

CW 61 Medical 

Report form, 

doctor's 

statement, or 

verification of 

payment 

Yes No 

303 – Age 60 and over Birth verification Yes No 

304 – Non-parent caretaker of ward Court Order or Yes No 

of court or at risk of Foster Care and verification from 

this responsibility impairs ability to Department of 

work/participate in WTW 

Children’s 


305 – Care of another in the home CW 61 Medical 

Report, or PLAN 

112 CIV 

Yes No 

306 

CW 61 Medical Yes Yes 

• 

• 

Pregnant, 12/96-12/97, 

Pregnant and medically unable 

to work, 1/98 and ongoing 

Report form, 

doctor’s written 

statement, or 

VER 105 



Work Registration and Exception Codes, Continued 

Codes originating from work registration, (Continued) 


codes 

State Code Verification 

needed 

TANF 

Clock 

Ticks 


Clock Ticks 

307 – Cal-Learn non-head of 

household 

CL 700 No No 

308 – Pregnant or parenting teen CL 27 or Yes No 

aided in own AU/Cal-Learn CL 700 

309 – Caring for a child less than: Birth 

Yes Yes 

3 years old, 12/96-12/97 verification 

12 months old, 1/98 and ongoing 

310 – Caring for a child less than: Birth 

Yes Yes 

Five months old and 309 

exemption previously applied, 

12/96-12/97 

verification 

Six months old and 309 

exemption previously applied, 

1/98 and ongoing 

314 – Full Time VISTA Volunteer WTW 

Journal or 

pay stub 

Yes Yes 

316 - Caring for: 

Birth 

Yes No 

Child ages 12-23 months, or verification 

Two children under six years of 

age 

318 – Caring for a child birth - 23 Birth 

Yes No 

months of age (effective 1/1/13) Verification 

407 – Good cause for lack of WTW Yes No (prior to 

supportive services 

Journal 

3/1/13) 

Yes 

(effective 

3/1/13) 

Work registration exemption codes must be verified. If there is nothing in the 

CalWORKs case record to support an exemption code, the Quality Review 

Unit (QRU) will research Welfare-to-Work (WTW) records for information and 

verification. If there is no evidence in WTW records to support the exemption 

code, it will not be applied. 



Work Registration and Exception Codes, Continued 

Additional 

codes tracked 

by County Staff 

In addition to the previous codes, state codes must be entered for the 

following additional information: 

Exception Code Verification 

Needed 

203 – Fleeing felon and/or 

probation/parole violator 

204 – Drug-related felony 

conviction 

206 – Aided adult in AU with DPSS/CL 700 

sanctioned Cal-Learn teen or SSG/CL 700 

Note: Months in which Cal- 

Learn sanctions apply are not 

federally funded; this code 

indicates state only claiming for 

the affected months. 

313 – Living in Indian Country 

or an Alaskan native village 

with 50% unemployment 

376 – Month in which Child 

Support repaid aid received 

377 – Less than $10 grant 

month 

403 – Good cause for domestic 

violence 

700 – A totally ineligible 

overpayment month which has 

been repaid 

Note: San Bernardino County 

will use this code for all 

overpayment months to be 

“unticked” whether or not 

collected in full. 

701 – A totally ineligible 

overpayment month in which 

supportive services were paid, 

and the cash aid has been 

repaid but the supportive 

services have not been repaid 

Note: San Bernardino County 

does not use this code, as it 

does not compute supportive 

service overpayments 

WDE66 report 

or C-IV 

recovery 

account 

transaction 

summary 

TANF Clock CalWORKs 

Ticks Clock Ticks 

No No 

No No 

No Yes 

No No 

Yes No 

Yes No 

WTW narrative Yes No 

No No 

CWPHB #4656 (04/13) TIME LIMITS 18-54 

Yes 

No

Overview 

Section 7 

Time Limits Information for Time On Aid Reviews 

Introduction This section provides information to the Quality Review Unit (QRU) on how to 

obtain information necessary to complete a Time on Aid (TOA) review. 

References Welfare Data Tracking Implementation Project Tracking Recipients Across 

California (WDTIP TRAC) User’s Manual 



Basics of Time On Aid Reviews 18-56 

Time Limit Review Actions 18-58 

Obtaining Information to Complete Time On Aid Reviews 18-61 


Basics of Time On Aid Reviews 

General 

information 

Tracking 

systems 

A Time on Aid (TOA) review will be completed by the Quality Review Unit 

(QRU) at the following times: 

Approval of application – Intake and additional adult(s) 

Re-Evaluations (RE) (timed out adults only) 

42 nd month of CalWORKs aid 

48 th month of CalWORKs aid 

The reviews done at these times will be completed using available 

information from the web-based applications developed for Welfare 

Database (WD) Archive information and County Tracking Recipients Across 

the County (TRAC) screens, Welfare-to-Work (WTW) program GAIN 

Employment Management System (GEMS) database, and C-IV. The TAD 

60 Federal TANF & State CalWORKs Time Limit Tracking form will be 

completed and used to transfer information to C-IV and WDTIP TRAC 

systems, and to determine the total months of aid received. Specific 

procedures for these reviews are located in the “When to Track” section of 

this chapter. 

Database reviews are included as part of the Complete Time on Aid (TOA) 

Review process (See Complete TOA Reviews section of this chapter). 

The Transitional Assistance for Needy Families (TANF) 60-month and 

CalWORKs 48-month time limits were originally tracked on the WD Archive 

and County TRAC system, which tracked time on aid in San Bernardino 

County, and on the state WDTIP TRAC system, which tracks time on aid in 

the state of California. The WD Archive database and County TRAC system 

remain available for review in a web application. 

Time limits are now tracked in C-IV, in the Time Limit pages, and on the state 

WDTIP TRAC system. Data entered into C-IV is transferred to the state 

WDTIP TRAC system. 

There is no system that tracks time on aid nationally. 



Basics of Time On Aid Reviews, Continued 

Tracking 

process 

Information is entered into the state WDTIP TRAC system through 

automated conversion of data entered into C-IV and direct entry/input into the 


Most data is entered into the WDTIP TRAC system through C-IV. 

Corrections to data already in the WDTIP TRAC system are made through 

entries in the Time Limit pages in C-IV, or through manual entries into the 


Specific information regarding manual entries to the WDTIP TRAC system is 

located in the WDTIP User Guide, located in the Handbooks section on the 

Human Services (HS) intranet website. 


Time Limit Review Actions 

Introduction The Quality Review Unit (QRU) is responsible for completing Time on Aid 

(TOA) reviews. This section provides information about the tasks involved in 

completing the reviews and when the reviews are completed. 

QRU 


The QRU is responsible for the following tasks associated with Time Limit 

tracking: 

• Contact other county/state contacts regarding TOA if questionable at time 

of review. 

• TOA contact for other counties and states 

− Answer questions regarding time limit information in the State WDTIP 

system from other counties and states 

• Complete TOA reviews for: 

− New and Additional Person applications 

− Limited Re-Evaluations (RE) 

− TANF 58 th month 

− CalWORKs 42-month 

− CalWORKs 48-month 

• Make corrections to county data in C-IV and State WDTIP TRAC 

Systems, if necessary. 

• Make Journal entries to indicate review completed TAD 60 imaged in 

C-IV. 

• Set tasks for anticipated 48 th month of aid within next six months. 

• Complete the following at discontinuance of timed-out adult(s): 

− Review aid code for transfer to Safety Net aid code 

− Review for correct cash aid payment amount 

− Review CalFresh for transfer to non-CE household and correct 

benefit amount 

− Review for 3N Medi-Cal 

− Create Recovery account for overpayment, if necessary 

− Save and Accept EDBC(s) to discontinue timed-out adult 

• Make Journal entries for last month/year that cash aid was paid for an 

adult discontinued for reaching the CalWORKs 48-month limit. 

• Complete reviews for: 

− Customer requests 

− State Appeals Hearing requests 

• Complete Aid Paid Pending (APP) actions for timed-out discontinuances. 

• Complete Appeals corrective actions. 

• Send appropriate Notice of action (NOA) if not generated by C-IV. 



Time Limit Review Actions, Continued 

QRU action - 

TOA review 

TOA reviews must be completed by the end of the next business day once 

received from the EW. The actions required by the QRU to complete TOA 

reviews are included in the table below. 

Step Action 

1 Review the “Referred to QRU – Time Limit Review” Journal entry. 

2 Complete the TOA Review, including updating the Time Limit 

pages in C-IV. 

3 Determine the correct aid code. 

4 Complete a Journal entry using the PID Time Limits Review 

Journal template, and Short Description of “Time Limit Review 

Completed”. 

Include the following in the Journal: 

• All pertinent TOA information for the adult(s), 

• Appropriate aid code, 

• Information that should be included on the Notice of Action 

(NOA), and 

• Any special instructions for the EW. 

Example: If the customer is timing out in the first three months of 

aid, the QRU provides instructions for the EW. 

5 Send CW 2184 to customer, and send Time Limits information to 

be imaged. 

6 Advise the EW via email that the TOA review has been completed. 



Time Limit Review Actions, Continued 

QRU review 

times 

42-month 

reports and 

Tasks 

CalWORKs cases will be reviewed by the QRU at the following times: 

• Intake or additional person: A TOA review must be completed for each 

adult applying for assistance at intake or on an additional adult 

application. 

• Annual Re-evaluation (RE): A TOA review will only be completed on 

cases that include a timed out individual or cases aided under the Safety 

Net program (Aid code 3A or 3C). 

• CalWORKs timing out-42 nd CalWORKs month: A TOA review will be 

done for each aided adult that has used 42 months of CalWORKs aid. 

− A monthly report will be generated for adults who have received 42 

months of CalWORKs aid. 

− 42- and 46-month tasks will be set on respective cases by the State 

WDTIP system. 

The QRU will review the report and the Tasks for persons identified as 

reaching the 42 nd or 46 th month of CalWORKs aid. The need for a TOA 

review will be determined as follows: 

If the adult listed on the 

report is… 

Currently receiving aid in 

San Bernardino County, 

No longer receiving aid in San 

Bernardino County, 

Then a TOA review… 

Is necessary. 

Is not necessary. 


Obtaining Information to Complete Time On Aid Reviews 

Introduction This section informs the Quality Review Unit (QRU) where information can 

be obtained to complete a Time on Aid (TOA) review. 

Time Limits 

data 

QRU detail 

pages in C-IV 

Time Limits data for previous TOA reviews including TAD 60s, CW 61s, and 

TOA Notices of Action (NOAs) is imaged in C-IV. 

The QRU detail pages located in C-IV summarize information obtained at 

previous time limit reviews. These pages are available for review by all 

Quality Review Specialists (QRS). 

C-IV Journals C-IV Journal entries by Eligibility Workers (EW) and Employment Services 

Specialists (ESSs) may provide information regarding exemption 

determinations. 

Welfare Data 

Tracking 

Implementation 

Project (WDTIP) 

Tracking 

Recipients 

Across 

California 

(TRAC) 

The Welfare Data Tracking Implementation Project (WDTIP) Tracking 

Recipients Across California (TRAC) is a statewide system developed to 

track cash aid time limits and eligibility for cash aid benefits. It is a separate 

data warehouse that is accessed through the Medi-Cal Eligibility Data 

System (MEDS). Data that is tracked and stored in this system include: 

• Time limits 

• Work registration/exemption codes 

• Cal-Learn Penalties 

• Immunization Penalties 

• School Attendance Penalties 

• Fraud Penalties 

• WTW Sanctions 

• Diversion payments 

• Non California program participation 

• Supportive services only payments 

• Child support reimbursements 

Information on the WDTIP system is accessible and used by all counties in 

California, so it is critical that the information provided is accurate. 

Note: If any discrepancy is identified in the data on the WDTIP TRAC 

system with data input by another county, the reviewer will contact the county 

in question to resolve the discrepancy. 



Obtaining Information to Complete Time On Aid Reviews, 

Continued 

Welfare Data 

Base Archive 

C-IV recovery 

accounts 

The Welfare Data Base Archive, also known as Legacy, contains all aid 

payment information prior to 10/04 implementation of C-IV. Any aid received 

on a case and any overpayments applied to a case between 12/96 and 9/04 

are listed in the Welfare Data Base Archive. 

Overpayments identified after 10/04 can be found on the C-IV Recovery 

Account Search page. 

WDTRAC The WDTRAC data base, previously called County TRAC, contains historical 

WDTIP/Time Limit information dating from 9/24/04 and prior. This is old 

information converted from the archived welfare database. 

Child Support 

Collected and 

Used to Offset 

Report 

(Control D: 

WDE66 report) 

Child Support 

Collection 

The Child Support Collected and Used to Offset Report (WDE66) lists all 

child support collected and offset on cases for the period 1/98 through 9/04. 

Child Support received by the County from 1/98 forward is added together 

and applied to the case record to reimburse cash aid as follows: 

• Effective with the earliest month/year cash aid was received by the AU 

from 1/98 forward, 


not counted to the CalWORKs clock of any aided adult(s) in the AU 

(These months do count in the TANF clock), 

• Child support recoupment amount is applied to all month(s) of aid 

received, whether or not the month has been exempted for any other 

reason, including any month(s) not included in a CalWORKs clock 

because an adult was not aided for any reason, 

• Any child support amount that remains but is not enough to reimburse a 

month's aid amount is to be carried forward and added to subsequent 

child support recoupments until enough child support is accumulated to 

"untick" a subsequent month of case aid, and 

• Child support is applied to the adult’s AU, even if aid was received under 

different case numbers. 

Exception: Child support is not applied to totally ineligible overpayment 

months (OPMs), because OPMs are considered ineligible months and, 

technically, no aid was paid or received. 

Any Child Support reimbursement made after 10/04 can be found on the 

C-IV Child Support Collection List page. 



Obtaining Information to Complete Time On Aid Reviews, 

Continued 

GAIN 

Employment 

Management 

System (GEMS) 

The GAIN Employment Management System (GEMS) was used by 

Employment Services prior to the implementation of C-IV in 9/04 to record 

case information. QRU will review GEMS narratives for 

exemptions/extenders due to: 

• Cal-Learn 

• Domestic Violence 

• Disability 

• The care of another in the home 


Overview 

Section 8 

When to Track 

Introduction This section provides information on when to track time on aid for adults and 

the procedures necessary to complete an accurate review. 

References The following references are applicable to information included in this 

section: 

• EAS 40-107 



Time On Aid Review: Intake/Add Person Applications 18-65 

Time On Aid Review: Re-Evaluation (RE) 18-69 

Time On Aid Review: CalWORKs 42 nd and 48 th Month 

18-71 

Reviews 

Recording Database Information 18-74 

Identifying Extenders 18-80 

CalWORKs: Action On Timing Out 18-82 

Complete Time On Aid Reviews 18-85 


Time On Aid Review: Intake/Add Person Applications 

Introduction The Quality Review Unit (QRU) will review intake cases and add person 

(adults) applications prior to the Eligibility Worker (EW) running EDBC to 

determine time on aid of the adult and the correct aid code. This includes 

Continuing Workers’ actions to add adults back into an AU without taking a 

new application (Example: Welfare-to-Work (WTW) sanction is cured). 

Time frames of 

processing 

intake 

applications 

In addition to potentially eligible adults, there are instances when previous 

Time On Aid (TOA) must be looked at for currently ineligible adults in order to 

determine the correct aid code. These ineligible adults include: 

• Non-Needy Caretaker (NNC) 

• Supplemental Security Income (SSI) recipient 

• Uncured WTW sanctions 

• Transitional Assistance for Needy Families (TANF) or CalWORKs timed 

out 

The following are time frames for the QRU to review new and add person 

applications. If the case is Immediate Need (IN) or Homeless Assistance 

(HA), the EW will identify “IN” or “HA” on the front of the case, to ensure that 

the TOA review is completed within the given time frames. 

Case Action Processing Time Frame 

Immediate Need (IN)/Expedited 

Determination of Eligibility (EDE) 

Same day 

Homeless Assistance – Permanent Same day 

Regular case processing By close of the next business day 

Note: Immediate need $200 payment cases are not reviewed until the case 

is actually approved for aid, and are then reviewed according to the regular 

case time frame listed above. 



Time On Aid Review: Intake/Add Person Applications, 

Continued 

Intake/Add 

Person TOA 

review 

procedures 

If the intake case was recently discontinued or the adult being added to a 

case was previously on aid, QRU will try to locate the previous time limits 

data. A new review will need to be completed if the previous time limits data 

cannot be located or is not imaged. 

Once all potentially eligible adults and any ineligible adults needing a review 

are identified, the QRU will take the following steps to complete the TOA 

review: 

Step Action 

1 Research each adult by Social Security Number and case number in 

each data base reviewed and verified adult was aided on correct aid 

codes. 

2 Review previous time limit Journal entries and/or last Focused Review 

from Quality Review Detail pages. 

3 Review application, WTW, and Intake Journal entries for any possible aid 

in another state. Contact the other state to verify months of aid received 

4 Record months of aid on TAD 60. 

Note: Record aid received in another state on page one of the TAD 60. 

5 On the WDTIP database: 

Check for months of aid and exemptions received in other counties or 

states. 

Note: Do not use WDTIP to verify San Bernardino County months of aid. 

6 Complete the Welfare Database Archive review for months 12/96 through 

11/04 and identify the following: 

• Months adult received aid 

• ZBG months 

• OPMs 

• Child Support trans codes 

7 Review WDTRAC, if necessary. 

8 Review C-IV by Case Number and Social Security Number to verify 

months of aid that the adult received since 9/04. 

Note: If an adult has an Immunization or School Attendance penalty, or 

an Intentional Program Violation (IPV) in any months, those months will 

tick. 

9 Review recovery accounts in C-IV for full overpayment months (OPMs). 

10 Verify and obtain printouts for Child Support received if applicable. 

• Search Control D by all applicable case numbers 

• Search C-IV Recovery Account page by case numbers for accounts 

created after 9/24/04. 

11 Complete the Child Support worksheet if: 

• Child Support is in Control D or C-IV 

• OPMs exist during months of Child Support offset months 

Note: Do not include MFG, or SSI CS collected from C-IV printouts. 




Continued 

Intake/Add Person TOA review procedures (continued) 

Erroneous 

claimed 

months 

Months 

received 

exceeds 


time limit 

Step Action 

12 Review GEMS from 1/98 forward for: 

References to CW 61s, doctor’s statements, off work orders, or 

receipt of SDI 

References to good cause determination for domestic violence 

Note: Request CW 61s from WTW if not located in case or imaged. 

13 Review the following in C-IV for possible medical exemptions/extenders 

and Good Cause for domestic violence: 

WTW Journals from 9/04 to present 

Income List page for receipt of SDI or Worker’s compensation 

WTW History page 

Medical Condition page 

Work Registration page 

14 Enter all information on the TAD 60 and verify that the information 

matches the C-IV Time Limits Detail page. 

Note: When changing San Bernardino County information on the Time 

Limit pages, use Add Reason Send to WDTIP. Other C-IV counties 

information is not to be changed. Contact the appropriate county for 

corrections. 

15 Make changes to C-IV and/or WDTIP if necessary. 

If C-IV is… Then… 

Correct and WDTIP is incorrect, Change WDTIP at the time of the 

review to match C-IV. 

Correct and WDTIP is correct, No changes are necessary. 

Incorrect, Make necessary changes to 

C-IV. 

QRU will enter the correct aid code for each month on the TAD 60 and on the 

Time Limit page. If aid was paid on the wrong aid code in C-IV, QRU will 

re-run EDBC for those months to correct the aid code. If EDBC results in a 

dollar difference EDBC will not be accepted. The Eligibility Worker (EW) will 

be advised to correct the aid code. 

If the adult receives aid for months exceeding the CalWORKs time limit in 

San Bernardino County, overpayments will be computed for those months in 

which the adult was overpaid. The TAD 60 and C-IV Time Limit pages 

should reflect a 3A aid code for the overpaid months. 

Exception: Overpayments will not be computed for adults receiving more 

than 48 months of aid but less than 61 months as of 7/1/2011 due solely to 

the CalWORKs time limit change from 60 months to 48 months. 




Continued 

After the review 

is completed 

County WDTIP 

contact list 

Out of state 

contact list 

When the review is completed, the QRU will take the following action: 

Step Action 

1 Complete a Journal entry using the Program Integrity Division (PID) 

Journal template, and Short Description of “Time Limit Review 

Completed” including the following: 

• All pertinent TOA information for the adults 

• Appropriate aid code, information to be included on the Notice of 

Action (NOA), and 

• Any special instructions to the EW. 

2 Complete the Quality Review Record 

3 Send the CW 2184 to the customer. 

4 Advise EW via email that review has been completed. 



Correct and WDTIP is incorrect, Change WDTIP at the time of the 

review to match C-IV. 

Correct and WDTIP is correct, No changes are necessary. 


C-IV. 

A WDTIP Contact List is available on the TAD Intranet site. The list contains 

contacts for all California counties, for responses to other counties' inquiries 

about information included on the state WDTIP TRAC system. 

The QRU will use the list to contact other counties to clarify information at 

Time on Aid (TOA) review. 

Inquiries to San Bernardino County from other counties will be referred to the 

QRU. 

A TANF Time Limits Contact List is available on the TAD Intranet site. The 

list contains contacts for all states, and is used to: 

• Obtain information about aid received in other states at application in 

California, and 

• Respond to other states' questions about TANF-funded assistance 

received in California. 

The QRU will use the list to make out of state contacts at intake or when 

information is questionable. Information regarding federal TANF TOA must 

be verified if, at any time there is an indication a customer has received aid in 

another state. (See “TANF funds received in another state” block in this 

chapter of the handbook). 


Time On Aid Review: Re-Evaluation (RE) 

Introduction The Legislation, Research and Quality Support Services Unit (LRQ) will 

provide a report of timed out adults at Re-Evaluation (RE) to Quality Review 

Unit (QRU) staff each month. QRU will review all timed-out adults. 

Ineligible adults and non timed-out adults will not be tracked. 

Time frame for 

processing REs 

RE TOA review 

not completed 

Timed out 

adults 

Time on Aid (TOA) reviews for timed out adults will be completed by the end 

of the month in which the RE is due. 

If the Eligibility Worker (EW) processes the RE for a case record that 

includes a timed-out individual, and there is no indication that a TOA review 

was completed, the 

EW will take all necessary action to complete the RE and request the QRU to 

complete the TOA review. 

When a timed out adult has been identified from the RE timed out adult 

report, the QRU will review for the following: 

If adult was timed out and 

Then… 

discontinued by… 

The Time Limit Unit, Review for Overpayment Months (OPMs), 

child support offset, and current extenders 

since the last TOA review. 

EW running EDBC or C-IV Batch A 48-month review is necessary. See 

EDBC, 

42/48 month TOA review procedures 

block in this chapter of the handbook. 

Note: If any new OPMs, child support offset, or current extenders are 

identified, the adult may need to be added back to an otherwise eligible cash 

aid program. 



Time On Aid Review: Re-Evaluation (RE), Continued 

RE TOA review 

procedure 

The QRU will take the following steps to complete an RE TOA review when a 

timed out adult has been identified. 

Step Action 

1 Locate the previous imaged time limits data if case has had a 

previous time limit review. Complete a new review if the time limits 

data is not located. 

2 Review WDTIP system for aid and exemptions received in other 

counties or states, and to ensure that San Bernardino County 

information is correct. 

3 Review data bases for OPMs, CS offset, and current extenders to 

determine if any months of aid have been bought back, and update 

TAD 60 if necessary. 



Correct and WDTIP is Change WDTIP at the time of 

incorrect, 

the review to match C-IV. 

Correct and WDTIP is 

correct, 

No changes are necessary. 


C-IV. 

5 Add the adult back to the case if appropriate (see Beginning Date 

of Aid chart – Add person section in this chapter of the handbook). 

6 Complete a Journal entry using the PID Time Limit review Journal 

template, and Short Description of “Time Limit Review Completed”. 

7 Hold time limit information for two days if changes were made to 

the C-IV Time Limit page to ensure that C-IV and WDTIP 

interfaced and matched. 

If the information in C-IV 

and WDTIP… 

Then… 

Matches, Go to step 8. 

Does not match, • Call in a trouble ticket 

advising C-IV did not 

interface with WDTIP. 

• Journal the trouble ticket 

and reason. 

• Journal response received 

from the trouble ticket call 

back. 

• Make manual corrections in 

WDTIP after the trouble 

ticket call back, if necessary. 

8 Send time limit information to be imaged. 


Time On Aid (TOA) Review: CalWORKs 42 nd and 48 th Month 

Reviews 

Introduction A report of adults using 42 or more months of CalWORKs will be provided to 

QRU staff each month. QRU will review Time on Aid (TOA) for the adults 

who have used 42 or more months of CalWORKs to obtain an accurate 

count of CalWORKs time remaining. After completing the TOA review, a 

TOA Notice of Action (NOA) is sent to the customer. 

42/48-month 

review 

procedures 

QRU will also review TOA when an aided adult has received 48 months of 

CalWORKs aid. QRU will determine: 

• If the adult meets a time limit extender (See CalWORKs Extenders 

section of this handbook chapter) 

• What penalties stop or continue 

• Correct aid code 

• CalFresh requirements 

QRU will take the following steps to complete the 42- and 48- months TOA 

reviews. 

Step Action 

1 Locate the previous the imaged TAD 60 if the case has had a 

previous time limit review. 

Note: Complete a new TAD 60 if the previous TAD 60 is not 

imaged. 

2 Review WDTIP for aid and exemptions received in other counties 

or states, and to ensure that San Bernardino County information is 

correct. 

Note: Do not use WDTIP to verify San Bernardino County 

months. 

3 Review all previous Time Limit Journals. 

4 Review data bases for OPMs, CS offset, and 

exemptions/extenders to determine if any months of aid have been 

bought back, and update the TAD 60. 

5 Obtain printouts from the Child Support WDE66 report from 

Control D and C-IV Recovery Account pages if child support has 

been received, and complete the child support worksheet if: 

• Child Support information is in both WDE66 and C-IV Recovery 

account. 

• There are full overpayment months (OPMs) during months of 

child support offset months. 

Note: Do not include child support collected for MFG or SSI 

children. 




Reviews, Continued 

42/48-month review procedures (continued) 

When adult has 

received 42 


months 

Step Action 

6 Request CW 61s from ESP if medical exemptions apply and the 

CW61s are not in the case or imaged. 

Note: If the CW 61 is not available, the QRS must document why it 

is not available in the Time Limit Journal. 

7 Verify that all information on the TAD 60 matches the C-IV Time 

Limit Detail pages. 

If the TAD 60 information… Then… 

Matches the C-IV Time Limit 

Detail pages, 

Go to step 8. 

Does not match the C-IV Correct C-IV Time Limit 

Time Limit Detail pages, Detail pages. 

Note: Do not change other 

C-IV County information. 

Contact the appropriate 

county for corrections. 

8 Correct any months that are erroneously claimed: 

Re-run EDBC for the month(s) aid was paid on the wrong aid 

code. 

Update the C-IV Time Limit Detail Pages with the correct aid 

code for each month that was erroneously claimed. 

Note: Do not accept EDBC if there is a dollar difference – notify the 

EW to correct the claiming. 

9 Send a CW 2184 to customer. 

When the adult has received 42 CalWORKs months, a 42 months NOA must 

be sent. This NOA is generated from the Cash Aid /WTW Time Limit Month 

list page. The QRU will take the following steps: 

Step Action 

1 Save any changes made to the Time Limit Detail pages. 

Note: If no changes are made, click on the Save button. 

2 Select “42 months Reached” in the drop-down box for “Generate 

NOA”. 

3 Click on the “Generate NOA” button to generate the NOA. 




Reviews, Continued 

After 

completing 

review 

Once the 42/48 month review has been completed, the QRU will take the 

following action. 

Step Action 

1 Complete a Journal entry using the Program Integrity Division 

(PID) Time Limit review Journal template, and Short Description of 

“Time Limit Review Completed”. 

2 Hold time limit information for two days if changes were made to 

the C-IV Time Limit page and/or WDTIP to ensure that C-IV and 

WDTIP interfaced and matched. 

If the information in C-IV 

and WDTIP… 

Then… 

Matches, Go to Step 3. 

Does not match, • Call in a trouble ticket 

advising C-IV did not 

interface with WDTIP. 

• Journal the trouble ticket 

and reason. 

• Journal response received 

from the trouble ticket call 

back. 

• Make manual corrections in 

WDTIP after the trouble 

ticket call back, if necessary. 

3 Send Time Limit information to be imaged, and validate that the 

information was imaged when returned. 


Recording Database Information 

Introduction Certain information obtained from the Time on Aid (TOA) review will need to 

be recorded on the TAD 60. This section provides detailed information on 

how to record child support reimbursement, OPMs, ZBGs, and suspense 

months on the TAD 60. 



Recording Database Information, Continued 

C/S offset and 

OPM in same 

month or C/S 

received after 

10/04 

The Control D WDE66 report does not consider Overpayment Months 

(OPMs) when unticking months that appear to have been repaid by Child 

Support (CS) collection, and has not been updated since C-IV conversion in 

9/04. 

Follow the steps below to untick months based on CS when an OPM 

occurred from 1/98 forward, or when cash aid was received from 10/04 

forward. 

Step Action 

1 Access the Excel budget for: Time Limits – CS months Determination 

(Time Limit CS Calendar). 

2 Complete the Excel program heading and child support information 

recording the total amount of the CS collected from the WDE66 report and 

C-IV in the “CS POOL“ space. 

3 Beginning with the earliest month/year aid was received from 1/98 

forward, refer to the Ledger Data information in the Legacy database and 

the Issuance History pages in the C-IV system, and complete cash aid 

information on the Time Limits - CS Months Determination Worksheet by 

entering the following information: 

• Month/year 

• Cash aid payment amount paid, including any supplemental amounts 

Note: Enter a zero payment amount for any month/year considered a 

total overpayment month (OPM). OPMs are considered non-participation 

months and, therefore, technically no aid was paid or received. 

If CS received is… Then… 

Greater than the aid 

payment received for 

a month, 

Less than the aid 

payment received for 

a month, 

• The aid amount will be subtracted from 

the “CS Pool” and the balance will be 

computed/updated. 

• A “Y” will be entered in the “Untick 

(Y/N)” space. 

• Enter a check mark in the “CS” space 

on the TAD 60. 

• Repeat this step for the next 

month/year of cash aid payment. 

• “No” will be entered in the “Untick” 

(Y/N) space. 

• The remaining CS balance from the 

“CS Prev Bal” space will b entered in 

the “CS Pool Bal” space on the Excel 

budget. 

4 Print out copies of any Excel budgets completed, and file or image with 

Time Limits information. 

5 Complete the Time Limits Detail page in the C-IV system for all months 

with a “Y” in the “Untick Y/N” space on the Excel budget. 




Time Limit 

screen/WDTIP 

TRAC review 

After the initial Archive database and C-IV research of aid payments, OPMs 

and CS, the C-IV Time Limit and WDTIP TRAC screens must be reviewed to 

determine if the data recorded reflects all County payment information from 

the (Welfare Archive Database) WD. 

Step Action 

1 Compare program participation data with data obtained from the Ledger 

Data and Issuance History and recorded on pages two through four of the 

TAD 60, and 

If data… Then… 

Matches, Go to step 2. 

Does not match, Make any entries necessary to 

correct the data. 

2 Compare the “ZBG/377” data on the TAD 60 and make any entries 

necessary to correct the data (see the “Recording ZBG months” block 

of this handbook chapter). 

Enter a check mark in the ZBG/377 space on the TAD 60 for any 

months listed from 1/98 forward that are not already identified. 

3 Compare the “CS” data on the TAD 60 and make entries necessary to 

correct the data. 

4 Review the C-IV system and GEMS database for exemption code 

information, including any information regarding exemption 

determinations applied by WTW but not communicated to the EW (e.g. 

Medical exemption, domestic abuse good cause, etc.). Compare the 

exemption code data for any of the following codes, that do not tick the 

TANF and CalWORKs clocks in the "Exemption Code" space on the TAD 

60: 

206 

313 

700 

TANF CalWORKs 

302 

303 

304 

305 

307 

308 

313 

316 

318 (effective 

2/1/13) 

401 

403 

407 (from 

8/09 through 

2/28/13) 

700 

5 Check that the following match the TAD 60: 

Months of program participation 

Exemption codes 

6 Enter the total number of TANF and CalWORKs months in the 

appropriate boxes on page one of the TAD 60. 




TAD 60 total 

months 

information 

After reviewing the Time Limit screens, complete the TAD 60 as follows: 

Step Action 

1 Total the TANF and CalWORKs months from the “Countable Month” lines for all 

years included and enter the totals on the “TAD 60 Total Countable Months: 

TANF/CalWORKs” lines on pages two through four of the TAD 60. 

• Enter the total TANF and CalWORKs months in the spaces provided for “TAD 

60 months:” on page one of the TAD 60. 

2 Go to the PSUM screen in WDTIP and determine if any TANF and/or CalWORKs 

months were received in another county, and: 

• Enter the total TANF and CalWORKs months in the spaces provided for “Other 

County months:” on page one of the TAD 60. 

3 Go to the UNCP screen in WDTIP and determine if any TANF and/or CalWORKs 

months were received in another state, and 

• Enter the total TANF and CalWORKs months in the space provided for “Other 

State months:” on page one of the TAD 60. 

4 Go to the Time Limit Detail page in C-IV, and enter the total: 

• TANF months received/counted in the space provided for “C-IV months:” on 

page one of the TAD 60. 

o The amount should match the total number of all months entered in the 

spaces for “TAD 60 months”, “Other County months”, and “Other State 

months”. 

• CalWORKs months received/counted in the space provided for “C-IV months:” 

on page one of the TAD 60. 

o The amount should match the total number of all months entered in the 

spaces for “TAD 60 months”, “Other County months”, and “Other State 

months”. 

5 Go to the TSUM screen in WDTIP TRAC and record the total number of TANF and 

CalWORKs months in the “WDTIP months:” spaces provided on page one of the 

TAD 60. 

If the total number of 

months is… 

Greater than the 

number of months in 

the C-IV system, 

Less than the number 

of months in the C-IV 

system, 

Then… 

Look at the IDET, TCAL, and KCAL screens to 

determine if there is time on aid considered, that is 

not reflected in C-IV and: 

• If yes, determine if the information needs to 

be corrected on WDTIP or the TAD 60. 

− If other county information is 

questionable, contact the other county. 

• If no, contact the Help Desk to determine 

what is causing the difference. 

Contact the Help Desk to determine what is 

causing the difference. 

Note: Changes made to C-IV Time Limit screens according to the TOA review will 

not be reflected on the WDTIP TRAC system for a minimum of two days. 




TANF months 

on TRAC more 

than 60 

OPMs in TANF 

months – adult 

already TANF 

timed-out 

When a Time Limits review is completed, the QRU reviewer needs to look at 

the TANF information on TRAC and enter it on page one of the TAD 60. If 

the TRAC information shows more than 60 TANF months once all 

adjustments are made (See "TAD 60 total months information" block of this 

handbook section) the reviewer is to take the following action: 

Step Action 

1 Update any necessary time limit information in C-IV. 

2 Run EDBC for all months paid on the wrong aid code, and review 

for correct aid code. 

• If running EDBC still reflects the wrong aid code, override 

EDBC for all affected months with the correct aid code. 

3 Save and accept EDBC once correct results are confirmed. 

4 Journal action(s) taken in the case including the following: 

• Specify the last month/year of TANF eligibility, 

• Specify the month/year the new aid code is effective, 

• Specify the new aid code, and 

• Enter pertinent information regarding erroneous claiming, if 

applicable. 

OPM data entered at the TOA review will change the number of TANF and 

CalWORKs months on the C-IV and WDTIP TRAC systems. This will result 

in an increase to the number of remaining months of aid. 

OPM data may also result in additional months of TANF aid becoming 

available to an adult who has already been assigned a state-only aid code, 

due to the expiration of the TANF 60-month time limit. If this occurs, action 

must be taken as follows: 

Step Action 

1 Enter OPM months in the C-IV system. 

2 Run EDBC for affected months and continuing and review for 

correct aid code. 

• Save and accept EDBC when correct results are confirmed. 

3 Journal all action taken including the following: 

• Specify the OPM months identified, 

• Specify the month/year the new aid code is effective, 

• Specify the new aid code, and 

• Enter pertinent information regarding erroneous claiming, if 

applicable. 




Recording ZBG 

months 

Recording 

suspense 

months 

If the case review indicates a month is a ZBG month, the Quality Review Unit 

will take the following steps: 

Step Action 

1 Enter a check mark in the “ZBG/377” space on the TAD 60. 

2 Go to C-IV Time Limit pages and ensure the information is 

included and: 

If the ZBG month is… Then… 

Included, Go to step 3. 

Not included, Edit information by adding 

ZBG month, as necessary: 

3 Go to WDTIP TRAC system and check the “ESUM” screen for 

ZBG month, identified with code 377. Any conflicting information 

should be reported to the C-IV Help Desk. 

Note: ZBG aid/disc entries made to C-IV time Limit screens will 

not be reflected on the State WDTIP TRAC system for a minimum 

of two days. 

When a month, prior to Quarterly Reporting implementation, is identified as a 

suspense month, the QRU will take the following steps: 

Step Action 

1 Enter a check mark in the “Suspense Month” space on the 

TAD 60. 

2 Go to the C-IV Time Limit pages and ensure the information is 

included and: 

If the Suspense month is… Then… 

Included, Go to step 3. 

Not included, Edit information by adding 

Suspense Month, as 

necessary. 

3 Go to state WDTIP TRAC and check the TCAL and KCAL screens 

to ensure suspense months are not indicated as aid received 

months. Any conflicting information should be reported to the C-IV 

Help Desk. 

Note: Suspense month entries made to C-IV Time Limit screen 

will not be reflected on the State WDTIP TRAC system for a 

minimum of two days. 


Identifying Extenders 

Introduction This section explains the action taken when the Quality Review Unit (QRU) 

identifies CalWORKs extenders when reviewing Time on Aid (TOA) for adults 

reaching their 48-month CalWORKs time limit. 

Extender 

criteria met 

after 


QRU action on 

extenders 

Adults who have been discontinued from cash aid due to reaching the 

CalWORKs 48-month time limit will be added back, if otherwise eligible, to 

cash aid if the extender criteria are met/applied at any time after 


When the QRU receives a case with a possible extender criteria met, the 

QRU will determine whether all aided parents, stepparents, and/or needy 

caretaker relatives meet the time extender criteria, and: 

If extender criteria 

are… 

Then the QRU will… 

Met, • Enter the appropriate extender code 

information into the Time Limit pages of the 

C-IV system. 

• Add the adult(s) to the AU. 

• Reinstate any penalties associated with the 

timed-out adult: 

− School attendance penalties 

− Immunization penalties 

− Intentional program Violation (IPV) 

• Run EDBC and check for 

− Correct state-only aid code 

− Correct CalFresh household determination 

of: 

Categorically eligible (CE), 

Non Assistance (NA) CalFresh, or 

Public Assistance (PA) non-CE, 

Discontinuance of 3N Medi-Cal. 

• Save and accept EDBC. 

• Send all appropriate Notices of Action (NOAs), 

if not generated by approval action. 

• Journal determination made. 

Not met, Journal determination made. 



Identifying Extenders, Continued 



Add person 

Add person 

results in 

AR/CO case 

transitioning to 

QR 

The following chart gives the CalWORKs Beginning Date of Aid (BDA) for 

adding previously timed out adults to CalWORKs when extender criteria have 

been met, child support reimbursement results in additional months of aid, or 

when an erroneous discontinuance has occurred. 

If adding the timed-out adult to Then the BDA is effective… 

CalWORKs due to… 

Meeting extender criteria, First of the month following the 

month the determination of meeting 

extender criteria was made. 

Child Support reimbursement, First of the month following the 

month the determination of child 

support reimbursement was made. 

Erroneous discontinuance, The first of the month following the 


When the CalWORKs case transfers from a Safety Net case to a non-Safety 

Net case due to the addition of the timed-out adult, the case transitions from 

Annual Reporting (AR) to Quarterly Reporting (QR). In many cases, the 

timed-out adult is added back for one or two months (for example, child 

support reimbursement results in two additional months of aid for the timedout 

adult). When the associated CalFresh Change Reporting (CR) household 

has earned income and has a six month certification period, the following will 

be completed: 


1 The Quality Review Unit (QRU) will: 

Complete Time Limit Review, 

Run Eligibility Determination and Benefit Calculation 

(EDBC) to add the person back to the case, and 

E-mail the EW/ Master Assignment Queue (MAQ) Inbox to 

review the reporting status for CalWORKs and CalFresh. 

2 The EW/MAQ will: 

Not change the six month CalFresh certification period to 

twelve months, and. 




Identifying Extenders, Continued 

Extender 

criteria no 

longer met 

Once an extender criterion is met, it must continue to be met in order for the 

adult(s) to continue to receive cash aid. At any time the criteria are no longer 

met, the adult(s) must be discontinued from cash aid at the end of the month 

after appropriate 10-day notice is given, and the aid code must be changed 

to the appropriate Safety Net aid code. 

Example: Recipient customer reached her 60-month time limit (prior to the 

CalWORKs 48-month time limit change effective 7/1/11) at the end of 12/06, 

and then met extender criteria a month later because she became disabled 

and began receiving SDI. She was added back to the cash aid case 

effective 2/07. On 3/23/07, the father of the aided children returned to the 

home. Father has no remaining CalWORKs months and he does not meet 

any extender criteria. Mom is no longer eligible to receive cash aid effective 

3/31/07; however, there is not time for 10-day notice. A notice of action 

(NOA) is sent for mom’s discontinuance effective 4/30/07, the case is 

transferred to Safety Net aid code 3C effective 5/1/07, and an overpayment 

is computed for mom’s portion of the 4/07 grant. 

If a case appears to no longer meet extender criteria, the case is referred to 

the QRU for necessary action. The EW will: 

Send the time limit review request to the Time Limit In-box using the 

PS02, and 

Notate “please check extender criteria”. 

CWPHB #4652 (05/13) TIME LIMITS 18-81.1

CalWORKs: Action On Timing Out 

Introduction This section provides information on what action the Quality Review Unit 

(QRU) will take when an adult reaches the CalWORKs time limit and is not 

eligible to any extenders. 

End of 

CalWORKs 48 

months 

When an adult has reached the CalWORKs time limit, QRU will take the 

following steps: 

Step Action 

1 Run EDBC for the month following the 48 th month to discontinue the adult. 

2 Review EDBC for correct: 

Aid code: 

– If all adults have reached the CalWORKs time limit the correct 

Safety Net aid code is assigned (See the CalWORKs Safety Net 

Program section of this Handbook Chapter). 

Cash aid benefit amount including stopping of any penalties 

associated with the timed-out adult: 

– School attendance penalties 

– Immunization penalties 

– Intentional Program Violation (IPV) 

Note: 25% child support penalty continues. 

CalFresh household determination 

Medi-Cal program determination: 

– 3N for timed-out adult 

– Medi-Cal only for Assistance Unit (AU) if discontinuing the adult 

makes the case financially ineligible 

Note: If C-IV fails to set up the 3N Medi-Cal program, one must be 

created manually. 

3 Save and accept EDBC when reviews indicate correct results. 

4 Send appropriate Time on Aid (TOA) Notice of Action (NOA), a CW 2184, 

and a MC 349 NOA, if not generated by C-IV. 

5 Notify the Welfare-to-Work (WTW) program worker and Child Care worker, 

if applicable, the adult is no longer aided due to the 48-month time limit. 

6 Notify the Eligibility Worker (EW) of the discontinuance and the need to 

review for correct CalFresh work registration code. 

7 Complete Journal entry using the Program Integrity Division (PID) Time 

Limit Review Journal template, and Short Description of “Time Limit 

Review Completed”. 

8 Complete Quality Review Record and copy and paste Journal entry into 

Quality Review record. 

9 Hold time limit information for two days if changes were made to the C-IV 

Time Limit page and/or Welfare Data Tracking Implementation Project 

(WDTIP) to ensure that C-IV and WDTIP interfaced and matched. 

10 Call in a trouble ticket if C-IV and WDTIP did not interface and do not 

match. 

Journal the trouble ticket call and reason 

Journal response received from the C-IV Service/Help desk 

Make manual corrections in WDTIP, if necessary, after response from 

C-IV Service/Help desk is received. 

11 Image time limit information into C-IV. 



CalWORKs: Action On Timing Out, Continued 

CalFresh action If the timed-out adult is included in a CalFresh household, QRU will review 

the CalFresh EDBC and take necessary action regarding the following: 

• Case considered as a non-CE household (Refer to the CalFresh Policy 

Handbook for specific instructions) 

• Benefits re-budgeted with correct cash aid amount 

A Task will be set for the EW for any necessary work registration action for 

the timed-out adult (see CalFresh Policy Handbook). 

Medi-Cal action Timed-out adults are eligible to receive Medi-Cal benefits on an aid code 3N 

program. These cases will have the RE set for the same month and year as 

the cash aid program, and will be carried by the CalWORKs EW. 

Action is taken by the QRU as follows: 

Step Action 

1 Discontinue the timed-out adult from the cash aid program in the 

C-IV system. This creates an auto transfer to the aid code 3N 


Note: If the C-IV system fails to set up the 3N Medi-Cal program, 

one must be manually created. 

2 Send a MC 349 NOA, automated in C-IV. 

Child Care A timed out adult with Child Care benefits is no longer eligible to Stage 1 

benefits, but is eligible to Stage 2. QRU will send an e-mail to the Child Care 

worker to advise of the discontinuance action, when one is taken, so the 

Child Care program can be adjusted appropriately. 



CalWORKs: Action On Timing Out, Continued 

Needs and 

income of 

timed-out 

adults 

Needy 

caretaker 

relative times 

out 

The income and needs of adults who have been discontinued from the 

Assistance Unit (AU) due to reaching the CalWORKs time limit are 

considered as shown in the following table. 

Who Needs Income 

Parents 

• Living in the home 

• Required to be in the 

AU (if had not 

timed-out) 

Non-parent Caretaker 

Relative 

Not included in AU or 

Family Maximum Aid 

Payment (MAP) 

• Not included in AU 

or Family MAP 

• No longer eligible to 

be optional AU 

member 

Stepparent • Included in the 

Family MAP 

• No longer eligible to 

be optional AU 

member 

• All income is used in 

the grant 

computation 

• Appropriate 

disregards are 

allowed 

• Not considered in 

grant computation 

• All income is used in 

the grant 

computation 

• Appropriate 

disregards are 

allowed 

When a needy caretaker relative reaches his/her CalWORKs time limit, and 

does not meet an extender, he or she is no longer eligible to be an optional 

AU member. The case is transferred to the appropriate aid code (See 

CalWORKs Safety Net Program section of this Handbook Chapter), and the 

aided children are eligible to Exempt MAP. 


Complete Time On Aid Reviews 

Introduction Complete Time on Aid (TOA) reviews are completed by the Quality Review 

Unit (QRU) at the following times: 

Requesting 

closed files 

Customer’s 

request 

State Appeals 

Hearing 

request 

Time on Aid 

Notice of 

Action 

Customer’s request 

Filing of a State Appeals Hearing Request 

The complete TOA review requires a review of all physical case files, as well 

as data base reviews, for cash aid received from 12/96 to current. 

When a complete case review is required, all case files from 12/96 forward 

will be requested from central and district closed files. The QRU will indicate 

“Priority Time Limits” on these requests for closed files. 

A customer may request a TOA review at any time. When a customer asks to 

have his/her TOA reviewed, the QRU will be notified within three days of the 

request, and a complete case review is completed. 

When the complete TOA review results from a State Appeals Hearing 

request, all Welfare-to-Work (WTW) program files must be requested and 

reviewed in addition to the physical cash aid case files and data base 

reviews. 

A TOA Notice of Action (NOA) is sent whenever an adult’s time on aid is 

reviewed: 

When aid is authorized – Intake and additional adult(s) 

RE – Timed-out adults 

CalWORKs 42 nd month and 48 th month (after July 1, 2011) 

At customer’s request 

At State Administrative Hearing (Appeals) request 

A TOA NOA is sent regardless of the number of months of aid it is 

determined the customer has received (see the Time on Aid (TOA) notices 

section of this handbook chapter for a list of TOA NOAs). A CW 2184 must 

be included with any TOA NOA sent. The CW 2184 must be sent manually 

when NOAs are generated and sent in batch by the C-IV system, as it is not 

currently included in the C-IV forms inventory. 

Exception: TOA NOAs are not sent for adults not currently receiving cash 

aid, as no review is completed beyond the determination that aid is not 

currently received and WDTIP TRAC updated. 




CHAPTER 19 

Charts, Tables and Lists 

Overview ......................................................................................................................19-1 

Regionalized Grants.....................................................................................................19-2 

San Bernardino and Region 2 MAP, MBSAC and IIK Charts ......................................19-3 

Region 1 MAP, MBSAC and IIK Charts .......................................................................19-4 

CalWORKs Income Reporting Threshold (IRT) Charts................................................19-5 

Aid Codes.....................................................................................................................19-6 


Overview 

Charts, Tables and Lists 

Introduction This Chapter contains the following the Region 1 and Region 2 CalWORKs 

Charts: 

• Maximum Aid Payment (MAP), Minimum Basic Standard of Adequate 

Care (MBSAC), and Income In-Kind (IIK), 

• Income Reporting Threshold (IRT), and 

• Aid Codes. 

Reference The following references are applicable to the information in this chapter: 

• 44-115.3, 44-315.321, and 44-316.324 

• ACLs 04-39, 05-18 and 06-51 



Regionalized Grants 19-2 

San Bernardino and Region 2 MAP, MBSAC, and IIK Charts 19-3 

Region 1 MAP, MBSAC, and IIK Charts 19-4 

CalWORKs Income Reporting Threshold (IRT) Charts 19-5 

Aid Codes 19-6 

CWPHB #4605 (04/11) CHARTS, TABLES AND LISTS 19-1

Regionalized Grants 

Regionalized 

Grants 

Region 1 

counties 

Region 2 

counties 

California counties are divided into two Regions based on the lowest quartile 

rents as reported on the 1990 Census. Counties in Region 2 have Maximum 

Aid Payment (MAP) and Minimum Basic Standard of Adequate Care 

(MBSAC) amounts that are 4.9% lower than those in Region 1 counties. 

Refer to the appropriate chart in this Chapter for the MAP, MBSAC, and 

CalWORKs Income Reporting Threshold (IRT) amounts. 

The Region 1 counties are listed below. 

• Alameda • Orange • Santa Clara 

• Contra Costa • San Diego • Santa Cruz 

• Los Angeles • San Francisco • Solano 

• Marin • San Luis Obispo • Sonoma 

• Monterey • San Mateo • Ventura 

• Napa • Santa Barbara 

The Region 2 counties are listed below: 

• Alpine • Lassen • San Joaquin 

• Amador • Madera • Shasta 

• Butte • Mariposa • Sierra 

• Calaveras • Mendocino • Siskiyou 

• Colusa • Merced • Stanislaus 

• Del Norte • Modoc • Sutter 

• Fresno • Mono • Tehama 

• Glenn • Nevada • Trinity 

• Humbolt • Placer • Tulare 

• Imperial • Plumas • Tuolumne 

• Inyo • Riverside • Yolo 

• Kern • Sacramento • Yuba 

• Kings • San Benito 

• Lake • San Bernardino 


San Bernardino and Region 2 MAP, MBSAC, and IIK Charts 

Charts – 

Region 2 

Below are the San Bernardino and other Region 2 Counties CalWORKs 

Maximum Aid Payment (MAP), Minimum Basic Standard of Adequate Care 

(MBSAC), and Income In-Kind (IIK) Charts. This page has the: 

07/2011 and ongoing MAP, and 

07/2012 through 06/2013 MBSAC and IIK amounts. 

NON EXEMPT- 

07/2011 and 

ongoing 

07/2012 

and ongoing 

EXEMPT- 

07/2011 and 

ongoing 

SIZE MAP MBSAC MAP 

1 $300 $546 $334 

2 490 896 550 

3 608 1,110 681 

4 725 1,320 809 

5 825 1,507 923 

6 926 1,694 1,035 

7 1,016 1,858 1,137 

8 1,109 2,028 1,239 

9 1,198 2,191 1,340 

10 1,286 2,386 1,439 

More 

than 10 

1,286 

Add $22 for each 

extra person 

1,439 

INCOME IN-KIND – 07/2012 and ongoing 

SIZE HOUSING UTILITIES FOOD CLOTHING TOTAL 

1 $249 $56 $143 $44 $492 

2 330 62 305 85 782 

3 361 65 390 127 943 

4 380 68 483 168 1,099 

5 380 68 585 212 1,245 

6 380 68 677 254 1,379 

7 380 68 755 298 1,501 

8 380 68 825 333 1,606 

9 380 68 907 383 1,738 

10 

More 

380 68 979 420 1,847 

than 

10 

380 68 979 420 1,847 


Region 1 MAP, MBSAC, and IIK Charts 

Charts – 

Region 1 

Below are the Region 1 Counties MAP, MBSAC, and IIK Charts. Use these 

charts for the Inter-county Transfer (ICT) information This page has the 

07/2011 and ongoing MAP, and 

07/2012 through 06/2013 MBSAC and IIK amounts. 

NON EXEMPT- 

07/2011 and 

ongoing 

07/2012 

and ongoing 

EXEMPT- 

07/2011 and 

ongoing 

SIZE MAP MBSAC MAP 

1 $317 $576 $351 

2 516 943 577 

3 638 1,169 714 

4 762 1,387 849 

5 866 1,584 966 

6 972 1,781 1,086 

7 1,069 1,957 1,192 

8 1,164 2,131 1,301 

9 1,258 2,311 1,405 

10 1,351 2,509 1,510 

More 

than 10 

1,351 

Add $22 for each 

extra person 

1,510 

INCOME IN-KIND – 07/2012 and ongoing 

SIZE HOUSING UTILITIES FOOD CLOTHING TOTAL 

1 $260 $56 $143 $44 $503 

2 347 62 305 85 799 

3 380 65 390 127 962 

4 398 68 483 168 1,117 

5 398 68 585 212 1,263 

6 398 68 677 254 1,397 

7 398 68 755 298 1,519 

8 398 68 825 333 1,624 

9 398 68 907 383 1,756 

0 398 68 979 420 1,865 

More 

than 10 

398 68 979 420 1,865 


CalWORKs Income Reporting Threshold (IRT) Charts 

San 

Bernardino 

and Region 2 

IRT chart 

Region 1 IRT 

chart 

Reporting size 

of zero 

The following chart has the San Bernardino County and other Region 2 

counties Income Reporting Threshold (IRT) amounts for Quarterly Reporting 

(QR) Assistance Units (AUs) for the period 10/01/2012 through 09/30/2013. 

Reporting Size Income Reporting Threshold 

0 $ 114 

1 $1,211 

2 $1,640 

3 $2,069 

4 $2,498 

5 $2,927 

6 $3,356 

7 $3,785 

8 $4,214 

9 $4,643 

10 or more $5,072 

The following chart has the Region 1 IRT amounts for QR AUs for the period 

10/01/2012 through 09/30/2013. 

Reporting Size Income Reporting Threshold 

0 $ 114 

1 $1,211 

2 $1,640 

3 $2,069 

4 $2,498 

5 $2,927 

6 $3,356 

7 $3,785 

8 $4,214 

9 $4,643 

10 or more $5,072 

The line for a Reporting Size of zero (0) is used when the only eligible AU 

member is a Maximum Family Grant (MFG) child, and the Reporting Size 

would be zero. 

Example: Mom is receiving Supplemental Security Income (SSI) and the 

only eligible child is MFG. The CalWORKs program remains open because 

the MFG child is eligible for cash-based Medi-Cal and special needs. 


Aid Codes 

Introduction This section defines the aid codes used by CalWORKs Assistance Units 

(AUs). Included in this section are: 

Two-Parent 

family 

Zero-Parent 

Family 

• Descriptions and examples of the family types, 

• The aid codes, including Diversion and TANF 60-month and CalWORKs 

60-month time out codes, and 

• Charts to assist in determining the correct aid code to use. 

A Two-Parent family is an AU that includes two, aided non-disabled, 

biological or adoptive parents of the same aided or SSI/SSP minor child 

living in the home unless both parents are aided minors and neither is the 

head-of-household. For purposes of this definition: 

• The disability determination for a parent is based on the definition of 

incapacity related to Incapacity Deprivation. 

• A minor parent is not considered a head-of-household when aided as a 

child. 

A Zero-Parent family is an AU in which the parent(s) or caretaker(s) is 

excluded from or ineligible to CalWORKs. These are AUs containing no 

aided adults, for example, the parent(s) in the home is an ineligible 

noncitizen, SSI/SSP recipient, or drug/fleeing felon. 

All-Family The All-Family family is an AU that cannot be identified as either a Two- 

Parent or Zero-Parent family. 

Examples – 

Two-Parent 

Families 

The following are examples of Two-Parent Families. This list is not allinclusive. 

• Aided non-disabled-parents are married or unmarried to each other and 

have a child in common. Child is aided (includes penalized child) or 

receiving SSI/SSP. 

• Each aided non-disabled parent has his/her own aided child and a child 

in common that is aided. 

• Two aided non-disabled parents with an aided child in common. One 

parent is over 18 and the other parent is a minor. 

• Two aided non-disabled mothers with their separate aided children who 

are half-siblings to each other. The non-disabled father of all the children 

is in the home and receiving aid. 

• Two aided non-disabled parents with an aided child in common. One or 

both parents are WtW sanctioned. 



Aid Codes, Continued 

Examples – 

Zero-Parent 

Families 

Examples – All- 

Families 

Welfare-to- 

Work sanctions 


aid codes 

The following are examples of Zero-Parent Families. This list is not allinclusive. 

• Non-needy caretaker relative. 

• Two-parent families and both parents are receiving SSI/SSP, ineligible 

noncitizens, or drug/fleeing felons. 

• One-parent family and that parent is receiving SSI/SSP, an ineligible 

noncitizen, or is a drug/fleeing felon. 

• Minor parent(s) (aided or unaided and not aided as a child) with his/her 

baby, is living on his/her own or with an unaided senior parent. 

The following are examples of All-Families. This list is not all-inclusive. 

• One aided parent/needy caretaker relative with an aided child or an 

SSI/SSP child. 

• Two aided parents with an aided child and at least one parent is 

incapacitated/disabled. 

• Two parent family with one parent aided and the other parent unaided 

(SSI/SSP recipient, ineligible noncitizen, drug/fleeing felon). 

• One aided parent with an aided child and aided stepparent. 

If the parent(s) is Welfare-to-Work (WtW) sanctioned, the AU will remain on 

the existing aid code. 

Example: A parent receiving aid in a Two Parent aid code 35 is WtW 

sanctioned. The AU will remain on aid code 35. 

Separate aid codes are necessary to identify AUs that have adults who have 

reached their TANF 60-month time limit. These aid codes are as follows: 

• Aid code 32 All-Family AU, from Aid code 30 All-Family AU - TANF 

timed-out and the head of household or spouse of the head of household 

has: 

− Received TANF assistance for a total of 60 cumulative months, and 

− Continues to be eligible for CalWORKs assistance. 

• Aid code 3W All-Family Case, from Aid code 3E All-Family AU - TANF 

timed-out mixed case and the head of household or spouse of the head 

of household has: 

− Received TANF assistance for a total of 60 cumulative months, 

− Continues to be eligible for CalWORKs assistance, and 

− The family includes at least one non-federally eligible individual (other 

than the TANF timed-out individual) who does not meet the qualified 

noncitizen status and entered the U. S. after 08/22/1996. 





codes 

Aid codes - 


Aid Codes – 

Diversion 

Aid Codes – 3E, 

3L, 3M, and 3U 

Two Safety Net aid codes have been established for cases in which all 

adults have reached the CalWORKs 60-month time limit without meeting a 

time extender and the children remain eligible. These aid codes are: 

• Aid code 3A All-Family Child-Only AU, from Aid code 30, 32, 3E, 3L, 

and 3W All-Family AUs. 

• Aid code 3C Two-Parent Child-Only AU, from Aid code 35, 3M and 3U 

Two-Parent AUs. 

The chart below lists the type of family involved and the CalWORKs aid 

codes. 

CalWORKs family type Aid code 

Two-Parent 35, 3M, 3U, 3C 

Zero-Parent 33, 3G, 3H 

All-Family 30, 3L, 3E, 32, 3W, 3A 

The chart below lists the type of family involved and the Diversion aid codes. 

Diversion family type Aid code 

Two-Parent Diversion 3K, 3Y 

Zero-Parent Diversion 3J 

All-Family Diversion 3J, 3X 

Aid codes 3E, 3L, 3M, and 3U are assigned to AUs based on an individual’s 

citizenship and family type. See the CalWORKs family type, claiming, and 

aid code chart in this section for more information. 





family type, 

claiming, and 

aid code chart 

The chart below explains the family type, situation, claiming (State, Federal, 

or Mixed), and aid code for CalWORKs. Diversion situation, claiming and aid 

codes explanations are in the next block. 

Family Type Situation Claiming Aid code 

Two-Parent All AU members are U.S. citizens, or meet qualified State/ 35 

noncitizen status. Adults have or have not TANF timed Federal as 

An AU that out. 

of 10/2006 

includes two All AU members do not meet qualified noncitizen status, State 

aided non- 

and entered the U.S. after 08/22/1996. Adults have or 

disabled 

have not TANF timed out 

parents of the 

same aided, or Some AU members are: 

State 

SSI/SSP, minor • U.S. citizens or meet qualified noncitizen status, and 

3M 

3U 

child(ren) • Not U.S. citizens or do not meet qualified noncitizen 

status, and 

• Adults have or have not TANF timed out. 

All parents have TANF and CalWORKs timed out. State 3C 

Zero-Parent All AU members are U.S. citizens or meet qualified 


Federal 33 

An AU in which All AU members do not meet qualified noncitizen status State 3G 

the parent(s) or and entered the U.S. after 08/22/1996. 

caretaker All least one AU member is: 

relative is 

• A U.S. citizen or meets qualified non-citizen status, 

excluded from 

and 

or ineligible to 

CalWORKs • Not a U.S. citizen or does not meet qualified noncitizen 

status and enter the U.S. after 08/22/1996. 

Mixed 3H 

All-Family All AU members are U.S. citizens or meet qualified 

noncitizen status and no adult has TANF timed out 

Federal 30 

An AU that 

cannot be 

identified as 

either a Two- 

Parent or Zero- 

Parent family 

All AU members are U.S. citizens or meet qualified 

noncitizen status and at least one adult has TANF timed 

out 

All AU members do not meet qualified noncitizen status 

and entered the U.S. after 08/22/1996. 

At least one AU members is: 

• A U.S. citizen or meets qualified noncitizen status, and 

State / 

Federal as 

of 01-2004 

State 

Mixed 

32 

3L 

3E 

• Not a U.S. citizen or does not meet qualified noncitizen 

status and enter the U.S. after 08/22/1996, and 

• No adult has TANF timed out. 

At least one AU members is: 

State / 3W 

• A U.S. citizen or meets qualified non-citizen status, 

and 

Federal as 

of 01-2004 

• Not a U.S. citizen or does not meet qualified noncitizen 

status and enter the U.S. after 08/22/1996, and 

• At least one adult has TANF timed out. 

All parents in the home have TANF and CalWORKs 

timed out 

State 3A 




Diversion 

claiming and 

aid code 

Aid code 

comparison 

chart – time 

limits 

This chart below explains the situation, claiming (State or Federal), and aid 

code for Diversion. The previous chart has this same information for 


Situation Claiming Aid code 

CalWORKs apparently eligible applicant 

customers meeting the definition of All-Family 

or Zero-Parent Family. 

Federal 3J 


customers meeting the definition of Two- 

Parent Family. 

Federal 3K 


customers meeting qualified noncitizen status 

and meeting the definition of Two-Parent 

Family 

State 3Y 


customers meeting qualified noncitizen status 

and meeting the definition of All-Family 

State 3X 

The following chart lists different family types of CalWORKs programs and 

the aid codes that apply to them before and after reaching the TANF time 

limit, and after meeting the CalWORKs 60-month time limit without meeting 

time limit extender criteria. For more information regarding the TANF and 

CalWORKs 60-month time limits, please see Chapter 18 of this handbook. 




Aid code 

comparison 

chart – time 

limits 

The following chart lists different family types of CalWORKs programs and 

the aid codes that apply to them before and after reaching the TANF time 

limit, and after meeting the CalWORKs 60-month time limit without meeting 

time limit extender criteria. For more information regarding the TANF and 

CalWORKs 60-month time limits, please see Chapter 18 of this handbook. 

Description – family type Aid Code 

Before 

Time 

Limits 

TANF Timed-Out 

Aid Code 

TWO-PARENT (UNEMPLOYMENT DEPRIVATION) 

Both parents citizens 35 N/A - 35 

Adult never received 



eligible 

Legal non-citizen - Mixed 

• One fed child/one nonfed 

adult 

All children federally 

eligible 

No child is federally 

eligible 

• At least one child 

federally eligible, and 

• At least one child not 

federally eligible 

3M 

60 TANF months 

N/A - 3M 


TANF 

3C 

3U N/A - 3U 


TANF 

ZERO-PARENT 

33 33 

No eligible adult to 

time out 

N/A 

3G 3G 


time out 

N/A 

3H 3H 


time out 

N/A 

Safety Net Aid 

Code (CalWORKs 

Timed-Out) 

ALL-FAMILY 

One parent 30 32 3A 

No TANF or 

One needy caretaker 

relative 

Two parent, deprivation is 

absence, incapacity or 

death 



eligible 

Legal non-citizen - 

mixed 

• One fed person/one 

non-fed adult 

• One fed person/ no 

fed adult 


30 32 3A 

No TANF or 


30 32 3A 

No TANF or 

3L N/A - 3L 

Adult never 

received TANF 

3W 

Federal adult 

TANF times out 

3E 

N/A - 3E 


TANF 


3A 

No CalWORKs 

time left 

3A 

No TANF or 

CalWORKs time 

left 


"What's New" 

For your reference, you will find here a list of all 

published Handbook Letters, IIN's, and 103's. 

The Handbook Letter Covers, IIN's and 103's 

are organized by publishing date from the 

newest to the oldest.

Handbook Cover Letters: 

We are publishing Cover Letters that 

accompany every HB Letter that has 

become part of the handbook. 

They are organized by publishing date 

from the newest to the oldest.

SAN BERNARDINO COUNTY HUMAN SERVICES 

APRIL 30, 2013 

CALWORKS POLICY HANDBOOK LETTER #4656 

CHAPTER 1 – Applications 

CHAPTER 2 – Deprivation 

CHAPTER 4 – Children and Eligibility 

CHAPTER 7 – Work Requirements 

CHAPTER 9 – Income 

CHAPTER 14 – Discontinuance 

CHAPTER 16 – Court Orders 

CHAPTER 17 – Fraud/QR/Appeals 

CHAPTER 18 – Time Limits 

Overview Several Chapters of the CalWORKs Policy Handbook (CWPHB) have been 

updated with the: 

Action time 

frame 

Change 

summary 

Filing 

instructions 

Distribution CalWORKs 

DM:PC:deg 

Program name change from Employment Services Program (ESP) to 

Welfare-to-Work (WTW), and 

Job classification name change from Employment Specialist (ES) to 


Low Level – At next staff meeting. 

Effective immediately the Employment Services Program (ESP) will be 

known as the Welfare-to-Work (WTW) program and Employment 

Specialists (ESs) will be known as Employment Services Specialists (ESSs). 

Remove and Replace: 

Pages: 1-6, 1-48, 1-71 through 1-74, 1-77, 1-83, 1-84, 2-8, 4-29, 4-35, 4-38, 

4-66, 4-79, 4-90, 7-2, 7-3, 7-4, 7-8, 7-9, 7-13, 7-14, 7-15, 7-19, 7-20, 7-23, 

7-25, 7-29, 9-10, 14-2, 14-7, 14-8, 14-10, 14-12, 14-17, 16-5, 17-5, 17-9, 

17-10, 17-15, 17-16, 17-34, 17-35, 17-36, 18-27, 18-30, 18-31, 18-53, 18-54, 

18-56, 18-67, 18-72, 18-76, 18-82, and 18-85. 

CWPHB #4656 (04/13) CVR LTR PAGE 1 OF 1


APRIL 24, 2013 



Overview Chapter 1 – Applications, page 1-40, of the CalWORKs Policy Handbook 

(CWPHB) has been revised to clarify who may complete a phone interview 

for a CalWORKs Re-evaluation (RE) appointment. Page 1-40 has been 

revised to match statements made on page 1-41. 

Action time 

frame 

Affected 

cases 

Filing 

instructions 


DM:PC:deg 

Low Level – At next staff meeting. 

CalWORKs cases requiring an RE interview may be affected by this change. 


Page 1-40 



APRIL 23, 2013 


Overview This handbook letter is being issued to obsolete the following Interim 

Instruction Notices (IINs) in the CalWORKs Policy Handbook (CWPHB) as 

the information/instructions in the IINs are obsolete and will not be added to 

the handbook: 

Filing 

instructions 

#12-012 – 2012 Social Security Cost-of-Living Adjustment (COLA) and 

Medicare Part B Premium. 

#12-022 – Social Security administration (SSA) and Medicare Premium 

Implementation Case Exception Lists. 

#12-026 – Final Social Security Administration (SSA) Cost-of-Living 

Adjustment (COLA) Case Exception Lists. 

#12-042 – Holiday Distribution Project/Santa Claus, Inc. 

#12-050 ERRATA – Using a Negative income Amount in the 

CalWORKs/CalFresh Budget. 

#13-004 ERRATA – 2013 Social Security Cost-of-Living 

Adjustment (COLA) and Medicare Part B Premium. 

Remove: 


DM:PC:deg 

IIN #12-012 

IIN #12-022 

IIN #12-026 

IIN #12-042 





MAY 6, 2013 


CHAPTER 10 – Reporting 

CHAPTER 12 – Budgeting 

Overview Chapter 10 – Reporting and Chapter 12 – Budgeting of the CalWORKs 

Policy handbook (CWPHB) has been updated to: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Remove information regarding CalFresh Deduction Change, and 

Incorporate information from Interim Instruction Notice (IIN) #12-074 

regarding Annual Reporting/Child Only (AR/CO) cases. 

Low Level – Review with staff at next unit meeting. 

CalWORKs cases meeting the AR/CO criteria are affected. 

The change is summarized in the table below. 

Old Policy New Policy 

CalWORKs AR/CO case policy was 

previously implemented via 

IIN #12-074. 

The AR/CO policy is being 

incorporated into the CWPHB. 

Obsolete IIN #12-074 is obsolete with the release of this handbook letter. 

Filing 

instructions 


AO:KA:ts 


Chapter 10: Table of Contents, Page 3 of 3 

Pages: 10-57 and 10-58 

Chapter 12: Table of Contents, Page 3 of 3 

Add: 

Chapter 10: Pages: 10-59 through 10-64 

Chapter 12: Pages: 12-86.1 through 12-86.9 



MAY 2, 2013 



Overview Chapter 18 – Time Limits of the CalWORKs Policy Handbook (CWPHB) has 

been revised to update information regarding: 

Action time 

frame 

Affected 

cases 

Time On Aid (TOA) received in Oregon, 

Annual Reporting (AR), 

Young Child Exemption (YCE), and 

Expiration of the Good Cause Lack of Supportive Services Exemption. 


The following CalWORKs cases may be affected by the changes: 

Customers receiving aid in Oregon, 

Safety Net cases, and 

Customers receiving the YCE or Good Cause Lack of Supportive 

Services Exemption. 



Chapter 18 – Time Limits, Continued 

Change 

summary 

Filing 

instructions 

The changes are summarized in the table below. 


All Temporary Assistance for Needy 

Families (TANF) time on aid 

received in Oregon was counted 

towards the TANF 60-month and 

CalWORKs 48-month time limits. 

Safety Net cases were subject to 

Quarterly Reporting (QR). 

Months in which the customer 

received exemption code 407 for 

Good Cause - Lack of Supportive 

Services did not tick the CalWORKs 

48-month time limit clock. 

Time on aid received in Oregon 

prior to 7/1/03 does not count 

towards the TANF or CalWORKs 

time limit. 

Effective 10/1/12, Safety Net cases 

are subject to Annual Reporting 

(AR). 

Effective 3/1/13, the Good Cause - 

Lack of Supportive Services 

exemption is no longer a valid 

exemption; therefore, customers 

previously receiving the exemption 

will have their CalWORKs 

48-month time limit clock tick 

effective 3/1/13. 

No previous policy. Exemption code 318 for care of a 

child 0-23 months of age does not 

tick the CalWORKs 48-month time 

limit clock. This exemption is 



Pages: 18-8, 18-15, 18-53, 18-76 and 18-81 

Add: 

Page: 18-81.1 


MC:KA:sg:ts 



APRIL 22, 2013 



Overview Chapter 1 – Applications of the CalWORKs Policy Handbook has been 

revised to include information regarding: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:deg 

Effective dates of Extended CalWORKs eligibility, and 

Inter-County Transfers (ICTs) for Young Adult cases. 

High Level – Review with staff immediately. 

CalWORKs cases with Foster Care children receiving CalWORKs may be 

affected by these changes. 

The changes are summarized below: 


The maximum age for eligibility to 

extended CalWORKs benefits will be 

phased in as follows: 

January 1, 2012 – Up to age 19, 


and 

January 1, 2014 – Up to age 21 

(contingent upon availability of 

state funding). 


Pages: 1-38.4 and 1-38.8 

The maximum age for eligibility to 

extended CalWORKs benefits is 

effective as follows: 


and 

January 1, 2013 – Up to age 21. 



MARCH 26, 2013 



Overview The CalWORKs Policy Handbook (CWPHB) Chapter 1 – Applications has 

been updated to: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:EK:deg 

Clarify that CalWORKs Re-Evaluations (REs) complete the Application 

For Cash Aid, Food Stamps, and/or Medi-Cal (SAWS 1) if the customer 

also has CalFresh benefits. The Application for Food Stamp Benefits 

(DFA 285 A1) is no longer given out for CalFresh Recertifications (RCs). 

Add the term “RC” to several areas. 


All CalWORKs cases requiring a Re-Evaluation (RE) that also have CalFresh 

may be affected by this information. 

The following has been updated: 


The DFA 285 A1 is used for 

customers with CalFresh when 

conducting an RE interview. 


Pages: 1-40 through 1-42 

The SAWS 1 is used for customers 

with CalFresh when conducting an 

RE interview. 



MARCH 18, 2013 


CHAPTER 17 – Fraud/QC/Appeals 

Overview The CalWORKs Policy Handbook (CWPHB) Chapter 17 – Fraud/QC/Appeals 

has been updated with clarification regarding the following: 

Action time 

frame 

Affected 

cases 

Filing 

instructions 


DM:EK:deg 

Income Eligibility Verification System (IEVS) section was updated 

regarding the following reports, now accessed in the C-IV system: 

IEVS Applicant abstract 

Payment Verification System (PVS) Report 

New Hire Report (NHR) 

Note: The PVS 40 and New Hire Run sections were removed, and 

information was added to the IEVS section. 

The Correcting QC Errors section was removed, as CalWORKs cases 

are not read for Quality Control (QC) errors. 

Low Level – Distribute on a flow basis. 

All CalWORKs cases may be affected by this information. 


Table of Contents: Page 1 of 2 




FEBRUARY 25, 2013 



Overview CalWORKs Policy Handbook (CWPHB) Chapter 12 – Budgeting has been 

updated to specify who may send an e-mail to the Program Integrity 

Division (PID) Quality Review Unit (QRU) Recovery Account inbox when 

requesting an account be voided. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:EK:deg 

Medium Level – At next staff meeting. 

CalWORKs cases requiring assistance with voiding a Recovery Account may 

be affected by these changes. 

There is no change to policy. The only person(s) who can send a void 

request e-mail to the PID QRU Recovery Account inbox is an Eligibility 

Worker Supervisor I (EWS I). Eligibility Worker IIIs (EW IIIs) may not request 

Recovery Account voids. 


Page: 12-92.1 





CHAPTER 19 – Charts, Tables and Lists 

Overview The CalWORKs Policy Handbook (CWPHB) Chapter 19 - Charts, Tables and 

Lists has been revised to include new Income Reporting Threshold (IRT) 

amounts for Quarterly Reporting (QR) Assistance Units (AUs) effective 

10/1/2012. 

Action time 

frame 

Affected 

cases 

Change 

summary 


All active CalWORKs cases except Annual Reporting/Child Only (AR/CO) 

cases are affected by the change. 

The IRT amounts used for QR AUs increased effective 10/1/2012. 

SCR 43671 SCR 43671 has been created to update the IRT amounts in C-IV. The new 

IRT amounts will be effective in C-IV for the 3/2013 benefit month. C-IV will 

provide a list of CalWORKs and Refugee Cash Assistance (RCA) cases 

discontinued with a program status of “Over IRT” for the benefit months of 

10/2012, 11/2012, 12/2012, 1/2013 and 2/2013. 

Filing 

instructions 


DM:KA:deg 

Staff will be notified when the list is available and provided with instructions 

for required action on the cases. 


Page: 19-5 

CWPHB #4647 (01/13) CVR LTR 1 OF 1




CHAPTER 11 – Special Needs 

Overview Chapter 11 – Special Needs of the CalWORKs Policy Handbook has been 

revised to include procedures for: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:cds 

Issuing temporary Homeless Assistance (HA) payments via Electronic 

Benefit Transfer (EBT), and 

Obtaining Form W-9 from landlords when permanent Homeless 

Assistance (HA) payments are issued. 

Entering taxpayer identification information and imaging the Form W-9 

and Internal Revenue Service (IRS) authorization letter, if applicable, for 

the provider in the Resource Databank (RDB). 

High Level – Please review with unit immediately. 

CalWORKs cases in which temporary HA and/or permanent HA payments 

are issued are affected by this change. 



Temporary HA payments were 

issued via voucher to the landlord. 

The landlord was not required to 

complete the W-9 when permanent 

HA payments were issued. 

Temporary HA payments will be 

issued directly to the customer via 

EBT. 


Pages: 11-32 through 11-34, 11-38 and 11-39 

Add: 

Page 11-39.1 

The landlord must complete the W-9 

as appropriate before permanent 

HA payments will be issued. 





CHAPTER 8 – Resources 

Overview CalWORKs Policy Handbook (CWPHB) Chapter 8 – Resources has been 

updated to include the following: 

Some sections were reorganized. 

CalFresh regulations MPP 63-501.1 – 63.501.6 have been added. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:deg 


All CalWORKs cases are affected by the change. 

The following changes were made to this chapter: 

Motor Vehicles: 

– Adds instructions for accessing and using the Kelly Blue Book 

website to determine a vehicle’s fair market value (FMV). 

Real Estate: 

– Describes the customer’s net market value (NMV) interest in real 

property and the use of allowable encumbrances. 

– Clarifies real estate value determination and excludes real property 

for three (3) months when a former home is owned by both spouses 

during a marital split. 

Liens: 

– Adds the definition for lien. 

– Explains lien procedures and the use of the CW 81 and CW 82 forms. 

Restricted Accounts: 

– Adds to the Qualifying Withdrawals block specifics on securing 

permanent rental housing and lists the allowable expenditures. 


Entire Chapter 



NOVEMBER 27, 2012 



Overview CalWORKs Policy Handbook (CWPHB) Chapter 9 – Income has been 

revised with updates to contact information for San Bernardino County 

Department of Veterans Affairs (VA) locations. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:EK.deg 

Low Level – Distribute on a flow basis. 

CalWORKs, CalFresh, and Medi-Cal cases may be affected by these 

changes. 

The County Department of Veterans Affairs offices have been updated with 

the following changes: 

The Victorville location has moved to Hesperia and the Chino location 

has moved to Rancho Cucamonga. 

The Loma Linda location has been removed. 

Office hours and phone numbers have changed for some locations. 


Page 9-23 



AUGUST 24, 2012 

CALWORKS HANDBOOK LETTER #4642 


Overview CalWORKs Policy Handbook (CWPHB) Chapter 1 – Applications has been 

updated to include information issued in All County Letter (ACL) #12-35 

regarding the restoration of eligibility and benefits in the month following case 

discontinuance due to an incomplete or non-submission of the QR 7. 

Action time 

frame 

Affected 

cases 

Change 

summary 

ACL #12-35 instructs counties to restore CalWORKs/ CalFresh eligibility and 

benefits without completing a new application or intake interview when a 

complete QR 7 is received in the month following the month of the QR 7 

discontinuance, provided all other eligibility criteria are met. 

High Level – Review immediately. 

All CalWORKs and CalWORKs/CalFresh cases may be affected by this 

change. 

The change is summarized in the table below: 

Old Policy New Policy Effective 7/1/2012 

No previous policy. Customers submitting a completed QR 7 within the 

month following discontinuance for an incomplete 

QR 7 or non-submission of a QR 7 will have their 

CalWORKs/CalFresh benefits restored without 

completing a new application or intake interview, 

provided all other eligibility criteria are met; benefits 

will be pro-rated from the date the completed QR 7 

is received. 



CalWORKs Policy Handbook Letter #4642, Continued 

Specific 

instructions 

Filing 

instructions 


DM:KA:deg 

SCR 45252 has been created to implement the CalWORKs Restoration of 

Aid functionality and is scheduled for Release 12.11 on 11/26/12. Until the 

SCR is deployed, the Eligibility Worker (EW) will take the following action to 

restore the CalWORKs program, when applicable: 

Step Action 

1 Rescind discontinuance using Rescind Reason of Erroneous 

Disc/Deny. 

2 Complete a manual budget to determine the CalWORKs benefit 

amount for the month of restoration. 

3 Run a regular CalWORKs Eligibility Determination and Benefit 

Calculation (EDBC) for the month of restoration. 

4 Click on the Override Payment button on the CalWORKs EDBC 

Summary page. 

Note: EWs may not have the security rights to complete this action. 

If the Override Payment button is not showing, an EW III or 

Supervisor must assist with this action. 

5 Send a NA 40-125A to inform customer of the restoration approval. 

6 Flag the case using Case Flag titled, “CalWORKs Restoration”. 

7 Journal all action(s) taken. 

Note: See the C-IV User Guide instructions, “Rescind, Restoration of 

Eligibility and Benefits for CalFresh” when restoring the CalFresh program. 



Page: 1-2 

Add: 

Pages: 1-34.1 through 1-34.9 



AUGUST 3, 2012 


CHAPTER 13 – BENEFIT ISSUANCE 

Overview Chapter 13 – Benefit Issuance has been revised to remove information 

regarding issuing Vendor Payments for the Assistance Unit’s (AU’s) rent 

when the parent/aided caretaker is: 

Filing 

instructions 


DM:KA:deg 

Welfare-to-Work (WtW) sanctioned for the second and subsequent time, 

and/or 

Convicted of a felony for the use or distribution of a controlled substance. 

This was a temporary policy and is no longer in use. 



Pages: 13-1 and 13-56 through 13-58 



AUGUST 14, 2012 



Overview Chapter 18 – Time Limits has been updated to include the: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Use of the Time Limit Review Inbox for requesting Time On Aid (TOA) 

reviews for customers meeting TOA extender criteria, and 

California Tribal Reservations and Rancherias that have provided 

information regarding unemployment rates of 50% or higher for the year 

2011 in order to determine Temporary Assistance for Needy Families 

(TANF) and CalWORKs time limit exemptions for those customers living 

in Indian Country. 


CalWORKs cases with customers potentially eligible to a time limit extender 

or living on Tribal Reservations and Rancherias may be affected by the 

changes. 



Eligibility Workers (EWs) notified the 

Quality Review Unit (QRU) when a 

TOA review for a time limit extender 

was required. 


DM:KA:deg 

Tribal Reservations and Rancherias 

meeting the 50% or higher 

unemployment rate through 2010 

were listed in policy. 


Pages: 18-32 and 18-47 through 18-51 

EWs will utilize the Time Limit 

Review Inbox to request a TOA 

review for a time limit extender. 

Policy now includes Tribal 

Reservations and Rancherias 

meeting the 50% or higher 

unemployment rate through 2011. 



AUGUST 23, 2012 



Overview CalWORKs Policy Handbook (CWPHB) Chapter 1 – Applications has been 

updated with the following changes regarding Re-Evaluation (RE) interviews: 

Action time 

frame 

Affected 

cases 

Change 

summary 

For all CalWORKs cases with a CalFresh case, the RE packet must 

include the CalFresh Notice of Expiration of Certification - QR 377.2 

instead of the NA 990 NEC. 

If the customer misses the RE interview or is found to be ineligible, 

CalWORKs must be discontinued prior to the 10-day Notice of 

Action (NOA) deadline in the RE month. This is to prevent the release of 

benefits in the event the benefits are held due to non-receipt of the QR 7. 

If the customer then turns in the QR 7 prior to the 10-day NOA deadline, 

benefits are issued erroneously. 

Information has been added regarding REs that are rescheduled for 

dates after 10-day NOA. 

High – Upon receipt of this handbook letter. 

The information in this Handbook Letter will affect all CalWORKs and 

CalWORKs/CalFresh cases. 

The following changes are effective upon receipt of this handbook letter. 


If the household receives CalFresh 

benefits, include the NOA 990 NEC 

letter in the RE packet. 

If the customer misses the RE 

interview, either in the office or via 

telephone, the Eligibility 

Worker (EW) will send a NOA for 

discontinuance effective the end of 

the RE month. 

If the customer completes the RE 

and is found to be ineligible, 

discontinue the case at the end of 

the RE month. 

If the household receives CalFresh 

benefits, the QR 377.2 must be sent 


If the customer misses the RE 

interview, either in the office or via 

telephone, the Eligibility 

Worker (EW) will send a NOA for 

discontinuance prior to the 10-day 

NOA deadline in the RE month. 

If the customer completes the RE 

and is found to be ineligible, 

discontinue the case prior to the 

10-day NOA deadline in the RE 

month. 




Filing 

instructions 


DM:EK:dg 





AUGUST 24, 2012 



Overview Chapter 12 – Budgeting of the CalWORKs Policy Handbook has been 

updated to include: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Development of a Recovery Account inbox in Outlook and examples of 

when to contact Program Integrity Division’s (PID) Quality Review Unit 

(QRU) via the Recovery Account Inbox, 

Information about termination of overpayment recoupment from minors 

who become a member of a new AU when the overpayment occurred 

while the minor was a member of the previous AU. 

Removal of unresolved Income Eligibility Verification System (IEVS) 

discrepancy information (obsolete policy). 

High Level – Review with unit immediately. 

CalWORKs cases requiring assistance with recovery accounts may be 

affected by these changes. 

The following changes are effective immediately: 


Transitional Assistance 

Department (TAD) and QRU had 

district liaisons to assist eligibility 

staff with resolving complex issues 

dealing with recovery accounts. 

Eligibility Workers (EWs) notified 

QRU when a CalWORKs applicant 

with an unresolved IEVS 

discrepancy was referred to the 

QRU when approved for benefits. 

Overpayments are not recouped 

from an adult or emancipated 

minor who was a minor in the AU 

for which the overpayment was 

computed. 

Eligibility Worker Supervisors (EWS Is) 

now have one location to send 

Recovery Account void requests. 

Provides a forum for the EWS Is and/or 

Eligibility Worker IIIs (EW IIIs) to submit 

questions regarding Recovery Accounts 

and/or get assistance with budgeting 

recovery accounts. 

The “Unresolved IEVS Discrepancy” policy 

is obsolete; therefore, the applicant will no 

longer be referred to QRU upon approval. 

Additionally, overpayments will not be 

recouped from minors who become a 

member of a new AU when the 

overpayment occurred while the minor was 

a member of the previous AU. 

CWPHB #4636 (08/12) 


CVR LTR PAGE 1 OF 2


Filing 

instructions 



Pages: 12-87, 12-92, 12-93, 12-94, 12-95, 12-96, 12-97, 12-99, 12-100, 

12-101, 12-102 and 12-103 

Add: 

Page: 12-92.1 

Remove: 

Page: 12-103.1 


DM:KA:kc 



AUGUST 13, 2012 



Overview CalWORKs Policy Handbook (CWPHB) Chapter 19 – Charts, Tables and 

Lists has been revised to include the new Minimum Basic Standard of 

Adequate Care (MBSAC) and Income In-Kind (IIK) amounts effective 

07/1/2012. 

Action time 

frame 

Affected 

cases 

Change 

summary 

High Level – Staff must begin using the new MBSAC and IIK amounts 

with new or pending CalWORKs applications effective 07/01/2012 or 

later. For continuing CalWORKs cases, the new IIK amount is effective 

with the 07/01/2012 aid payment. 

CalWORKs cases with new or pending applications effective 07/01/2012 or 

later and all cases with IIK are affected by the MBSAC/IIK increase. 

The changes are summarized in the table below: 


Previous MBSAC and IIK amounts 

are effective through 06/30/2012. 

MBSAC and IIK amounts increased 

by 2.98% effective 07/01/2012. 




Specific 

Instructions 

Filing 

instructions 


DM:KA:deg 

The MBSAC and IIK changes are effective 07/01/2012. SCR 43675 has been 

deployed to implement the changes in C-IV. The following case lists have 

been posted to the C-IV Resource Center: 

CalWORKs MBSAC: CalWORKs or RCA cases with saved Eligibility 

Determination and Benefit Calculations (EDBCs) that have been 

denied for failing the financial eligibility test for 07/2012, 08/2012 or 

09/2012, and 

CalWORKs IIK: CalWORKs or RCA cases with an active program person 

receiving IIK for any months of 07/2012, 08/2012 or 09/2012. 

Note: This list includes cases that have an actual IIK amount entered; 

however, the standard IIK amount is used in the EDBC because the actual 

IIK amount is more than the standard IIK amount. 

Eligibility Workers (EWs) must take the following action on the lists: 

List Action 

CalWORKs MBSAC Review cases by 8/31/12. 

Run EDBC for the appropriate month, and 

If the EDBC … Then… 

Passes the financial 

eligibility test, 

Does not pass the 

financial eligibility 

test, 

Rescind the denial, 

Approve the application, 

and 

Journal the action 

taken. 

The denial remains in 

effect. 

Journal that the case 

was reviewed for 

increased MBSAC 

amounts. 

CalWORKs IIK Review cases when processing the next QR 7. 

Run EDBC for the applicable months of 07/2012 

through the come up month to utilize the new IIK 

amounts. 

Journal the action taken. 


Pages: 19-3 and 19-4 






Overview CalWORKs Policy Handbook (CWPHB) Chapter 7 – Work Requirements has 

been updated to change the Eligibility Worker’s (EW) responsibility regarding 

automated Tasks to Review WEX/Community Service hours. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:EK:dg 

High –Upon receipt of this letter. 

CalWORKs cases with Employment Services Program (ESP) participants in 

Work Experience (WEX) or Community Service activities may be affected by 

these changes. 

The change is summarized below. 


When the EW receives an 

automated Task to Review 

WEX/Community Service hours, 

the EW reassigns the Task to an 

ESP Position ID. 


Page: 7-18.1 

When the EW receives an 

automated Task to Review 

WEX/Community Service hours, 

the EW clears the Task. 






Overview Chapter 2 – Deprivation of the CalWORKs Policy Handbook (CWPHB) has 

been updated to include information regarding: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Good Cause claims for not cooperating with the Department of Child 

Support Services (DCSS), 

Support Questionnaire completion when the customer claims Good 

Cause for not cooperating with DCSS, and 

Tasks generated for Child Support non-cooperation. 


CalWORKs cases in which the customer has claimed Good Cause for not 

cooperating with the DCSS may be affected by these changes. 

The following changes were added: 

Customer may claim Good Cause for not cooperating with the DCSS for 

any other reason that would be contrary to the best interest of the child. 

Tasks with Task Type of “Child Support Non Co-op” may be generated 

when the customer claims Good Cause with the DCSS. 


No previous policy existed. When the customer claims Good Cause and 

refuses to provide required information to 

complete the Support Questionnaire in C-IV, 

the EW will add “Refused to state” as the 

parent name on the Support Questionnaire. 



CalWORKs Policy Handbook Letter #4635 

Filing 

instructions 


DM:KA:deg 


Pages: 2-20, 2-21, and 2-22. 

Add: 

Page: 2-22.1 



MAY 23, 2012 

CalWORKs POLICY HANDBOOK LETTER #4634 



the information/instructions in the IINs are obsolete and: 

Filing 

instructions 

Added to the handbook: 

#11-031 – Upcoming CalWORKs Program Changes. 

#11-034 – CalWORKs 48-Month Time Limit. 

Will not be added to the handbook: 

#12-024 – C-IV System Down-Time. 

Remove: 

IIN #11-031 

IIN #11-034 

IIN #12-024 


DM:KA:deg 



MAY 24, 2012 



Overview Chapter 10 – Reporting of the CalWORKs Policy Handbook (CWPHB) has 

been updated to clarify what action is taken when the signature date on the 

QR 7 is an obvious error. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:wsb 


All CalWORKs cases are affected by the change. 



When the signature date on the 

QR 7 is in the Data Month and the 

QR 7 is stamp dated as received in 

the Submit Month, the QR 7 

certification block is incomplete. 


Pages: 10-24 and 10-28 

The QR 7 certification block is 

considered complete when the: 

QR 7 is signed in the Data 

Month, and 

Signature date is prior to the 

date the QR 7 was mailed to the 

customer, and 

QR 7 is stamp dated as received 

in the Submit Month. 



MAY 18, 2012 


CHAPTER 1 – Application 

Overview Chapter 1 – Application of the CalWORKs Policy Handbook (CWPHB) has 

been updated with: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Required action when the SOC 161 is not received timely for a Young 

Adult, 

Beginning Date of Aid (BDA) information for a Newborn and Dad 

resulting in a benefit decrease, and 

Revised process for adding persons to CalWORKs. 


CalWORKs cases with Young Adults and add persons actions may be 

affected by the changes in this Handbook letter. 

Information regarding the SOC 161 is summarized in the chart below. 


When the SOC 161 for the Young Adult 

is not received by the end of the first 

month of the next six month period, the 

Eligibility Worker (EW) will: 

Discontinue CalWORKs benefits for 

the Young Adult, and 

Send a NA 1270 to notify the Young 

Adult of CalWORKs 



Pages: 1-38.7, 1-55, 1-56 

Add: 

Page: 1-55.1 


DM:KA:deg 

When the SOC 161 is not received by 

the end of the first month of the next six 

month period, the EW will: 

Suspend CalWORKs benefits until 

the SOC 161 is received, and 

Send a NA 100 C-IV to notify the 

Young Adult of the CalWORKs 

suspension. 



MARCH 21, 2012 



Overview Chapter 1 – Applications of the CalWORKs Policy Handbook has been 

updated to: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


Include information regarding identifying children who are 

dependents/wards of the court and placed with relatives who are 

receiving CalWORKs on their behalf. 

Clarify when the SOC 161, Six Month Certification of Extended Foster 

Care Participation form is received by the Eligibility Worker (EW). 


CalWORKs cases with wards/dependents of the court placed with relatives 

who are receiving CalWORKs benefits are affected by the change. 


Old Policy through 

New Policy Effective 03/01/2012 

02/29/2012 

No policy. Children who are dependents/wards of the court, not 

eligible to Foster Care payments, and placed with 

relatives who are receiving CalWORKs on the 

dependent’s behalf are eligible to either fee-for-service 

Medi-Cal or Medi-Cal managed care health care 

coverage. These children must be identified in C-IV by 

using the case flag titled “4H FC dependent – 

CalWORKs” until the newly established aid code 4H is 

available in C-IV. 




Add: 

Pages: 1-38.7 and 1-38.8 






Overview Chapter 12 – Budgeting of the CalWORKs Policy Handbook (CWPHB) has 

been revised due to changes in State regulations regarding collection of 

overpayments from adults and emancipated minors who were minors in the 

Assistance Unit (AU) at the time the overpayment occurred. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


CalWORKs cases affected by this change are those in which an 

overpayment is being recouped from an adult or emancipated minor who was 

a minor in the AU for which the overpayment was computed. 


Old Policy through 01/06/2012 New Policy Effective 01/09/2012 

Overpayments were recouped from 

other members of the original AU 

after all efforts to recoup from the 

caretaker relative were exhausted. 


Pages: 12-89, 12-102 and 12-103 

Add: 

Page: 12-103.1 


DM:KA:sg 

Overpayments are not recouped 

from an adult or emancipated minor 

who was a minor in the AU for 

which the overpayment was 

computed. 







the information/instructions in the IINs are obsolete and will not be added to 

the handbook: 

Filing 

instructions 


DM:DMP:deg 

#11-003 – Social Security COLA. 

#11-051 – Holiday Distribution Project/Santa Claus, Inc. 

#11-071 ERRATA – Random Assignment of Social Security Numbers 

(SSNs) Beginning with the Number Eight (8). 

Remove: 

IIN #11-003 

IIN #11-051 







Overview The California Department of Social Services (CDSS) published All County 

Letter (ACL) #11-78 to implement eligibility to extended CalWORKs benefits 

for young adults. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:wsb 

High Level – review with staff immediately. 

CalWORKs cases with dependents/wards of the court placed with relatives 

who are receiving CalWORKs benefits may be affected by the change. 

To aid in identifying, tracking and transitioning of CalWORKs cases with 

dependents/wards of the court placed with relatives and who are receiving 

CalWORKs benefits, these cases will be assigned to a specialized worker. 

The policy change is summarized below. 


Dependents/wards of the court placed with 

relatives who are not eligible to receive 

federal or state foster care payments but 

are still eligible to foster care services may 

qualify for CalWORKs benefits until: 

Age 18, or 

The child graduates from high school 

or a vocational or technical training 

program if enrolled full time and will 

graduate before reaching age 19. 



Add: 


Dependents/wards of the court 

may be eligible to extended 

CalWORKs benefits after age 18 

as a young adult when living with 

an approved caretaker relative 

who is not eligible to federal or 

state foster care payments. 






Overview CalWORKs Policy Handbook (CWPHB) Chapter 7 - Work Requirements has 

been revised to include the new policy for referring aided customers with a 

child under one to Welfare-to-Work (WTW). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:ker 


CalWORKs cases with mandatory WTW program participants are affected by 

the change. 



The Eligibility (EW) determined if a 

customer was eligible for the Care 

of First Child - FE exemption. 


Page: 7-13 

Remove: 

Page: 7-13.1 

When a customer is aided and has a child 

under the age of one, the EW will: 

Set a Task for the Employment 

Services Specialist (ESS) to review the 

case for a Care of First Child - FE 

exemption. 

Refer customer to employment 

Services Program (ESP) Orientation if 

there is no ESS assigned to the case. 

Note: The ESS will determine the 

customer’s Care of First Child - FE 

exemption. 




CALWORKS POLICY HANDBOOK LETTER #4626 ERRATA 


Overview The CWPHB Chapter 15 Charts, Tables and Lists has been revised to 

include new Income Reporting Threshold (IRT) amounts. 

Action time 

frame 

Affected 

cases 

Change 

summary 


All active CalWORKs cases. 



The Eligibility Worker (EW) 

determined the IRT by using the 

IRT chart. 

The EW will determine IRT utilizing the 

revised chart. 

SCR 43670 SCR 43670 has been created to update the IRT amounts in C-IV. The new 

IRT amounts will be effective in C-IV for the 3/2012 benefit month. The 

following two lists will be provided: 

Filing 

instructions 


DM:KA:ts 

CalWORKs and Refugee Cash Assistance (RCA) cases discontinued with 

a program status of “Over IRT” for the benefit months of 10/2011, 11/2011, 

12/2011, 1/2012 and 2/2012, and 

CalWORKs and Refugee Cash Assistance (RCA) cases with a household 

size of zero for the benefit months of 12/2011, 11/2011, 12/2011, 1/2012 

and 2/2012. 

Staff will be notified when the lists are available and provided with instructions 

for required action on the cases. 


Page: 19-5 

CWPHB #4626 ERRATA (01/12) CVR LTR 1 OF 1





Overview The CWPHB Chapter 15 Charts, Tables and Lists has been revised to 

include new Income Reporting Threshold (IRT) amounts. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


MC:BB:deg 


All active CalWORKs cases. 



The Eligibility Worker (EW) 

determined the IRT by using the 

IRT chart. 


Page: 19-5 

The EW will determine IRT utilizing the 

revised chart. 

CWPHB #4626 (01/12) CVR LTR 1 OF 1





Overview This Handbook letter is being issued to update instructions in Chapter 2 – 

Deprivation regarding completion of the Support Questionnaire (NA 2.1Q) 

and the removal of the 970 restriction code from the Medi-Cal Eligibility Data 

System (MEDS). 

Action time 

frame 

Affected 

cases 

Filing 

instructions 


DM:SMB:deg 


Any case with a Support Questionnaire (CW 2.1 Q), or a 970 restriction code 

on MEDS may be affected by this information/change. 


Pages: 2-24 through 2-25, and 2-29 through 2-30 

CWPHB #4624 (12/11) CVR LTR 1 OF 1




CHAPTER 6 – Citizens, Noncitizens and Refugees 

Overview Chapter 6 – Citizens, Noncitizens and Refugees of the CalWORKs Policy 

Handbook has been revised to clarify what action to take when the customer 

cannot provide citizenship verification. 

Filing 

instructions 


DM:KA:dg 








Overview Chapter 7 – Work Requirements of the CalWORKs Policy Handbook 

(CWPHB) has been revised to include information regarding the 

reassignment of Tasks to the Employment Services Specialist (ESS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


CalWORKs cases with Welfare-to-Work (WTW) program participants may be 

affected by the change. 


Old Policy 

through 

10/31/2011 

No previous policy 

existed. 


Page 7-18 

Add: 

Page 7-18.1 


DM:KA:dg 


When the Eligibility Worker (EW) receives an 

automated Task to Review WEX/Community Service 

hours, he/she will: 

Reassign the Task (for customers who are on 

CalWORKs) to the Employment Services Program 

(ESP) Position ID as follows: 

36ES18960B - For offices in Victorville, 

Adelanto, Hesperia, Barstow and Needles, and 

36ES01SD0D - All other offices. 

Delete the Task if the customer is not included in a 

CalWORKs program. 

CWPHB #4622 ERRATA (11/11) CVR LTR PAGE 1 OF 1





Overview Chapter 7 – Work Requirements of the CalWORKs Policy Handbook 

(CWPHB) has been revised to include information regarding the 

reassignment of Tasks to the Employment Services Specialist (ESS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


CalWORKs cases with Welfare-to-Work (WTW) program participants may be 




No previous policy existed. When the Eligibility Worker (EW) 

receives an automated Task to Review 

WEX/Community Service hours, he/she 

will reassign the Task to the Employment 

Services Program (ESP) Position ID as 

follows: 

36ES18960B - For offices in 

Victorville, Adelanto, Hesperia, 

Barstow and Needles, and 

36ES01SD0D - All other offices. 


Page 7-18 

Add: 

Page 7-18.1 


DM:KA:sg 

CWHB #4622 (11/11) TABLE OF CONTENTS PAGE 1 OF 1




Overview This handbook letter is being issued to obsolete Interim Instruction Notices 

(IINs) in the CalWORKs Policy Handbook (CWPHB), as follows: 

Filing 

instructions 

IIN #09-062 – Non-Compliance Records and Negative Action in C-IV. 

SCR #27954 made all non-compliances records program specific 

(released 9/26/11). The information/instructions in this IIN are obsolete 

and will not be added to the handbook. 

IIN #10-051 – C-IV Program Application Enhancement – Phase 1 SCR 

35048. The information in this IIN was added to the Operation and 

Reference Handbook (ORHB) in Letter #3341. 

Remove: 

IIN #09-062 

IIN #10-051 


DM:DMP:cds 






Overview Information in CalWORKs Policy Handbook (CWPHB) Chapter 18 Time 

Limits, regarding Transitional Assistance for Needy Families (TANF) time 

limit months has been corrected with the release of this handbook letter. 

Filing 

instructions 


Page 18-42 


DM:KA:dg 






CHAPTER 13 – Benefit Issuance 

Overview Various chapters in the CalWORKs Policy handbook have been updated to 

include the following information: 

Filing 

instructions 

Chapter 7: 

Clarification regarding identifying and applying the Care of First Child 

exemption, commonly referred to as the Full Exemption (FE) for 

Welfare-to-Work (WTW) participants. 

Example showing how to apply the FE to subsequent children. 

Chapter 13 – Incorporated information regarding Electronic Benefit 

Transfer (EBT) cash access at Automated Teller Machines (ATMs) and 

Point-of-Sale (POS) devices from IIN #11-013. 

Additionally, the following IINs have been obsoleted, but information was not 

incorporated into the handbook: 

IIN 10-046 information was updated in IIN #11-040. 

IIN 10-048 information obsolete as of 12/31/2010. 


Pages: 7-11, 7-12, 7-13, and 13-16 

Add: 

Page: 7-13.1 

Obsolete: 


DM:KA:kc 

IINs: 10-046, 10-048 and 11-013 



CalWORKs POLICY HANDBOOK #4618 

CHAPTER 17 – FRAUD/QC/APPEALS 


Overview The CalWORKs Policy Handbook, Chapter 17 – Fraud/QC/Appeals has been 

updated to add the Income Eligibility Verification System (IEVS) 

reconciliation information for Eligibility Workers (EW) to locate when they 

receive PVS 40 reports. 

Filing 

instructions 


Page 17-18 


DM:DC:dg 




CHAPTER 13 – BENEFIT ISSUANCE 

JULY 20, 2011 

Overview The CalWORKs Policy Handbook, Chapter 13, Benefit Issuance has been 

updated to add information regarding Electronic Benefit Transfer (EBT) 

accounts that have reached an aged status. 

Filing 

instructions 


DM:DC:deg 


Pages: 13-6, 13-7, 13-8 

CWPHB #4615 (07/11) CVR LTR 1 OF 1


JULY 21, 2011 



Overview Chapter 17 – Fraud/QC/Appeals of the CalWORKs Policy handbook has 

been updated to remove the “Automated procedures” information from the 

Fleeing Felons and Probation/Parole Violators section. The procedures are 

no longer applicable to the Quality Review Unit (QRU). 

Filing 

instructions 


DM:KA:ts 


Pages 17-41 and 17-42 



JULY 14, 2011 


Overview This handbook letter is being issued to obsolete Interim Instruction Notices 

(IINs) in the CalWORKs Policy Handbook (CWPHB), as follows: 

Filing 

instructions 

• Information not added to the handbook from the following IINs: 

− #09-039 – Full-Scope Medi-Cal Benefits During the Reasonable 

Opportunity Period (ROP). ROP is obsolete. Regulation regarding the 

ROP was released prior to the implementation of the federal Deficit 

Reduction Act (DRA) Social Security Number (SSN) Validation 

process which is currently used to verify citizenship/identity of 

Medi-Cal applicants/beneficiaries. 

− #09-044 – MC/NAFS Combo Workers – Updated Process and 

Procedures. This IIN was created as a training tool for the 

Medi-Cal/Non-Assistance CalFresh (MC/NACalFresh) Combo 

Workers in 2009. Information is not required in the CWPHB. 

− #09-047 – Immunization Requirements. On 7/1/2011, the California 

Department of Public Health provided notice that the nationwide 

shortage of the Haemophilus influenzae type b (Hib) vaccine was 

resolved. Information in this IIN is no longer valid. Customers must 

meet all immunization requirements effective 7/1/2011. 

− #10-049 – Holiday Distribution Project/Santa Claus, Inc. IIN was 

created to inform staff of the process for referring customers to Santa 

Claus, Inc for the 2010 Holiday Distribution Project. 

• Information from IIN #09-073 – Work Experience/Community Service and 

Job Readiness was added to the CWPHB in Letter #4607. 

Remove: 

• IIN 09-039 

• IIN 09-044 

• IIN 09-047 

• IIN 09-073 

• IIN 10-049 


DM:KA:kc 



JULY 20, 2011 




CHAPTER 15 – Medi-Cal 


Overview Various chapters of the CalWORKs Policy Handbook have been updated as 

follows: 

Action time 

frame 

Affected 

cases 

• Chapter 6 : 

− Included information regarding the Social Security Number (SSN) 

validation process to verify citizenship/identity for Medi-Cal customers 

to meet the federal Deficit Reduction Act (DRA) citizenship/identity 

requirements. 

− Updated the telephone number for the Cash Assistance Program for 

immigrants (CAPI) Eligibility Worker (EW). 

− Corrected formatting errors. 

• Chapter 12 – Removed information regarding the Incremental Grant 

Reductions (IGRs). 

• Chapter 15 – Revised information regarding California Children Services 

(CCS) Deemed Eligible (DE) infants. 

• Chapter 18: 

− Removed information regarding the IGRs. 

− Removed 317 exemption code for care of child ages 24 months to 35 

months. 


CalWORKs cases with companion Medi-Cal cases may be affected by the 

SSN validation process, and cases with CCS DE infants being added to 

CalWORKs are affected by the change in the process for adding these 

infants to CalWORKs. 




Change 

summary 

Filing 

instructions 

The changed policy is indicated below. 


Customers were required to provide 

original documents to verify 

citizenship/identity. 


DM:KA:kc 

The CCS EW sent a request to the 

CalWORKs EW to add a Deemed 

Eligible (DE) infant to the case. 

The IGR policy was scheduled for 

implementation effective 9/1/2011. 

The use of time limit exemption code 

317 for the care of a child from age 

24 months through 35 months was 



Chapter 6: Pages 6-8, 6-8.1, 6-9, 6-68 

Chapter 12: Pages 12-47, 12-48, 12-50 

Chapter 15: Page 15-26 

Staff will use the SSN validation 

process to verify citizenship/identity 

of Medi-Cal customers 

The CCS EW will take action to add 

the DE infant to the existing case. 

The IGR policy will not be 

implemented because the legislation 

enacting the policy was repealed. 

Legislation enacting the exemption of 

a parent or caretaker caring for a 

child ages 24 months through 35 

months was repealed. The 317 

exemption code is no longer valid. 

Chapter 18: Table of Contents 1 of 2, Pages 18-2, 18-3, 18-4, 18-17, 18-18, 

18-19, 18-53, 18-76, 18-80, 18-81, 18-82 



JUNE 20, 2011 



Overview This Handbook letter is being issued to correct information regarding child 

support cooperation and refusal to assign support rights. 

Action time 

frame 

Affected 

cases 

Filing 

instructions 


DM:SMB:deg 


Affected cases consist of any case where the parent has failed to: 

• Cooperate by 

− Completing child support forms, 

− Establishing paternity, or 

− Completing the child support process. 

• Assign child support rights. 


Page: 2-23 

CWPHB #4612 (06/11) CVR LTR 1 OF 1


JUNE 13, 2011 



Overview CalWORKs Policy Handbook Chapter 18, Time Limits, has been updated 

with the following information: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:deg 

• Each year the California Department of Social Services (CDSS) advises 

counties via an All County Letter (ACL) of the California Tribal 

Reservations and Rancherias that have provided information on 

unemployment rates of 50% or higher for the Transitional Assistance for 

Needy Families (TANF) 60-month time limit exemption for those 

individuals living in Indian country. 

• The reference to the 54/60-month Time On Aid (TOA) review procedures 

on page 18-72 of the handbook has been corrected to 42/48-month 

review procedures. 


CalWORKs cases with families living on the listed Tribal Reservations and 

Rancherias are affected by this change. 

The list of Tribal Reservations and Rancherias has been updated to include 

those listed in ACL 11-41 for the year 2010. 


Pages: 18-47 through 18-51 and 18-72 

CWPHB #4611 (06/11) CVR LTR PAGE 1OF 1


MAY 26, 2011 


CHAPTER 1 - Application 

CHAPTER 3 - Assistance Unit/Responsible Persons 

CHAPTER 4 - Children and Eligibility 

CHAPTER 11 - Special Needs 

CHAPTER 12 - Budgeting 

CHAPTER 14 - Discontinuance 

CHAPTER 15 - Medi-Cal 

CHAPTER 18 - Time Limits 

Overview Various chapters in the CalWORKs handbook have been revised to include 

the following policy changes as directed by SB 72: 

Action time 

frame 

Affected 

cases 

• Adult customers will receive CalWORKs for a total of 48 countable 

months. 

• Child-only cases will receive Incremental Grant Reductions (IGRs) when 

a child(ren) has received CalWORKs for more than 60 months. 

High Level – Review with Staff immediately. 

All CalWORKs cases are affected by the changes. 




Change 

summary 

Recipient 

noticing 

requirements 

The handbook has been revised as follow: 

• References to the CalWORKs 60-month time limit have been changed to 

reflect the new CalWORKs 48-month time limit in the following chapters: 

− Chapter 1: Applications 

− Chapter 3: Assistance Unit/Responsible Persons 

− Chapter 4: Children and Eligibility 

− Chapter 11: Special Needs 

− Chapter 12: Budgeting 

− Chapter 14: Discontinuance 

− Chapter 15: Medi-Cal 

− Chapter 18: Time Limits 

• Added information regarding IGRs and child time clocks. 


The maximum amount of time an 

adult customer can receive 

CalWORKs aid is 60 cumulative 

months. 

The maximum amount of time a 

customer can receive CalWORKs aid 

is 48 cumulative months. 

Old Policy New Policy Effective 07/01/2011, 

To Be Implemented 09/01/2011 

No previous policy. Child-only cases will be subject to the 

following IGRs: 

• 5% at 61 CalWORKs months. 



Because of the significant impact the 48-month time limit and IGR policies 

will have on CalWORKs recipients, customers must be provided a 30-day 

Notice of Action (NOA) when the CalWORKs grant is reduced or aid 

discontinued due to the 48-month time limit or IGR policies. This 30-day 

NOA requirement will temporarily replace the existing 10-day NOA 

requirement through 12/2011. 

The form TEMP 2186A CalWORKs Time Limit and Welfare-To-Work 

Participation Exemption Request Form must be included with the 30-day 

NOA for those customers reaching the CalWORKs 48-month time limit. 

Effective 1/1/ 2012, the 10-day NOA requirement for grant reduction or 

discontinuance of aid will be reinstated. 




C-IV noticing 

for 48-month 

time limit 

The 30-day NOAs for 7/1/2011 grant reductions or discontinuances of aid 

due to the customer reaching the 48-month time limit will be sent by C-IV to 

affected customers. 

IGR policy Although the IGR policy is legislated by SB 72 to be effective 7/1/2011, 

counties will not implement this policy until 9/1/2011. 

Filing 

instructions 


DM:KA:kc 

The 30-day NOAs will be batched by C-IV in 7/2011 for the 9/1/2011 

implementation. Information will be released at a later date regarding any 

required action for the 7/2011 and 8/2011 CalWORKs benefit months. 


Pages: 1-71, 1-72, 1-73, 1-80, 1-90, 1-93, 1-94, 1-95, 1-96, 3-21, 3-28, 4-58, 

4-63, 11-11, 12-38, 12-47, 12-48, 12-50, 14-8, and 15-3 

Chapter 18: Entire Chapter 



MAY 25, 2011 


CHAPTER 3 – AU/Responsible Persons 


Overview Effective July 1, 2011, the CalWORKs Earned Income Disregard will change. 

The new income disregard will retain the $225 disregard for disability based 

income, but limits the Earned Income Disregard to any remainder of the $225 

or $112, whichever is less. 

Action time 

frame 

High Level – Eligibility Workers (EWs) must use the new income 

disregard effective July 1, 2011. 

Affected cases All CalWORKs cases with earned income are affected by the reduced 

income disregard. 

Change 

summary 

New and 

pending 

applications 

Continuing 

applications 



Net income was calculated by 

disregarding the first $225 of 

disability based unearned income 

and/or any earned income and 50 

percent of any remaining earned 

income. 

Net income is calculated by 

disregarding the first $225 of 

disability based unearned income. 

With earned income, apply the 

remainder of the $225 or $112 

(whichever is less), then 50 percent 

of the remaining earned income. 

Effective July 1, 2011, begin using the new Earned Income Disregard for all 

new and pending applications. 

Begin using the new Earned Income Disregard effective July 1, 2011, upon 

receipt of this handbook letter; however, this is not considered a countyinitiated 

change, so do not reduce grant amounts mid-quarter. Benefits 

should be recalculated in the respective upcoming quarter with appropriate 

notice. 




SCR 41713 SCR 41713 was created to update the Earned Income Disregard for 

CalWORKs processing and will be implemented with a batch process in 

06/2011. 

Filing 

instructions 


Pages: 12-24, 12-29, 12-35, 12-58 thru 12-61, 12-66, 12-68, 12-72, 12-83 

thru 12-86 

Add: 


DM:SMB:deg 

Pages: 3-23.1 and 3-23.2 



MAY 10, 2011 



Overview Effective July 1, 2011, the CalWORKs Maximum Aid Payment (MAP) levels 

will be reduced by 8%. This grant reduction affects all grant levels, including 

exempt and non-exempt MAP levels. 

Action time 

frame 

The CalWORKs Minimum Basic Standard of Adequate Care (MBSAC) Cost 

of Living Adjustment (COLA) and Income In-Kind (IIK) levels are increased 

effective July 1, 2011. This year’s COLA increases MBSAC and IIK by 

1.92%. The new MBSAC levels are to be used in determining applicant 

financial eligibility for customers applying for CalWORKs on or after July 1, 

2011. 

High Level – Eligibility Workers (EWs) must use the new MAP, MBSAC 

and IIK levels for processing effective July 1, 2011. 

Affected cases All CalWORKs cases are affected by the reduced MAP levels. 

Change 

summary 

New and 

pending 

applications 

Continuing 

applications 



Current MAP levels are effective The MAP levels are reduced by 8% 

through June 30, 2011. 

effective July 1, 2011. 

Current MBSAC and IIK levels are The MBSAC and IIK levels increased 

effective through June 30, 2011. by 1.92% effective July 1, 2011. 

Effective July 1, 2011, begin using the new MAP, MBSAC and IIK levels for 

all new and pending applications. 

Upon receipt of this handbook letter, begin using the new MAP and IIK levels 

effective with the July 1, 2011 aid payment. This is considered a 

county-initiated change; the MAP reduction and IIK increase can be 

budgeted mid-quarter. 



Chapter 19- Charts, Tables and Lists, Continued 

Chart updates The CalWORKs MAP, MBSAC and IIK charts for Region 1 and Region 2 

have been updated to reflect this year’s COLA. The charts are attached to 

this cover letter. The chart for Region 2 will be posted on the Transitional 

Assistance Department (TAD) website. 

SCR 41698 SCR 41698 was created to update the MAP, MBSAC and IIK levels for 

CalWORKs processing and will be implemented on June 9, 2011. A batch 

process will be performed in June 2011 for all active CalWORKs cases for 

the month of July 2011. An exception report will be generated for cases 

missed by batch. A C-IV announcement will be issued when the report is 

available. 

Filing 

instructions 


Pages 19-3, 19-4 


DM:SMB:deg 



MARCH 22, 2011 






CHAPTER 19 – Charts/Lists/Tables 

Overview Chapters 7, 8, 9, 15, 18 and 19 of the CalWORKs Policy Handbook have 

been updated to incorporate information from Interim Instruction Notices 

(IINs), and to clarify existing information as follows: 


− Corrected the reference to the location of Cal-Learn information. 

• Chapter 8 

− Clarified federal tax refunds and Earned income Tax Credit (EITC) 

payments are exempt as resources for 12 months. 


− Included: 

Cooperative Agencies Resources for Education (CARE) program 

educational grants as exempt from the income eligibility 


Temporary census income treated as earned income 

(IIN #10-028). 

American Recovery and Reinvestment Act increase in UIB treated 

as unearned income (IIN #09-012). 

− Added paid Work Experience (WEX) timeframes (IIN #09-073). 


− Added the address for sending Department of Disability Service 

Division (DDSD) disability packets. 


− Clarified the current Income Reporting Threshold (IRT) amounts will 

continue through 9/30/2011. 

Obsolete The following IINs are obsolete: 

• 09-012 

• 09-073 

• 10-028 




Filing 

instructions 


DM:KA:deg 

Remove: 

Pages: 19-3.1 and 19-4.1 


Pages: 7-4, 8-5, 8-6, 8-7, 9-7, 9-9, 9-14, 9-27.1, 15-12, 19-5 



APRIL 4, 2011 


CHAPTERS 1 - 19 

Overview The CalWORKs Policy Handbook has been updated changing Food Stamps 

(FS) references and all variations to CalFresh throughout the handbook. 

Action time 

frame 

Filing 

instructions 


DM:DC:deg 

Medium – At next staff meeting 


Entire CalWORKs Policy Handbook 



MARCH 24, 2011 



Overview Chapter 14 of the CalWORKs Policy Handbook has been updated to include 

the following information: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:deg 

• Inter-County Transfers (ICTs) are completed manually or electronically. 

• Partial ICTs are completed when some members of the Assistance Unit 

(AU) move to another county and cash assistance is requested. 


CalWORKs cases in which some members of the Assistance Unit (AU) move 

to another county and will be aided on a CalWORKs case in that county are 

affected by the update. 

The change is summarized below: 


No previous policy. When some members of an existing AU 

move to another county and apply for 

assistance as a new case or in an existing 

case in that county before the members are 

discontinued from San Bernardino County, 

Eligibility Workers (EWs) will complete a 

partial ICT. 


Pages: 14-14 and 14-14.1 






Overview The following information has been removed from Chapter 6 of the 

CalWORKs Policy Handbook: 

Action time 

frame 

Affected 

cases 

Change 

summary 

• Repatriation Program – currently located in the Repatriation Handbook. 

• USCIS Documentation Examples – currently located in the Operations 

and Reference Handbook (ORHB). 

Additionally, the definition of an unaccompanied minor refugee has been 

updated. 


Refugee Cash Assistance (RCA) cases with unaccompanied minors are 


The definition of an unaccompanied minor refugee has been updated to 

include persons granted Special Immigrant Juvenile (SIJ) status by the 

Department of Homeland Security. 


The current policy for RCA for 

unaccompanied minor refugees did 

not include persons granted SIJ. 

Persons granted SIJ may be eligible 

for RCA for unaccompanied minor 

refugees. 



CALWORKS POLICY HANDBOOK LETTER #4604, Continued 

Filing 

instructions 


DM:KA:deg 


Table of Contents: Page 1 of 2 and Page 2 of 2 

Pages: 6-1, 6-7 and 6-30 

Remove: 






CHAPTER 8 - Resources 

CHAPTER 17 - Fraud/QC/Appeals 

Overview Chapters 8 and 17 of the CalWORKs Policy Handbook have been revised to 

update the following: 

Action time 

frame 

Affected 

cases 

Filing 

instructions 


DM:KA:dg 

• Chapter 8 

− Example of excess real property and lien 

− Forwarding completed CW 81s 

• Chapter 17 

− Program Integrity Division (PID) address, 

− Appeals Unit Complaints telephone number, and 

− Fraud Investigation Unit (FIU) contact telephone number for imposing 

Intentional Program Violation (IPV) disqualification penalties. 


CalWORKs cases requiring the completion of the CW 81 Lien form and 

cases in which an IPV disqualification penalty has been imposed are affected 

by the update. 


Pages: 8-16, 17-28, 17-29 and 17-39 






Overview This handbook letter updates required actions to the Homeless Assistance 

(HA) program. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High – Review handbook letter with staff immediately upon receipt. 

Cases approved for Permanent HA for housing and/or utilities will be affected 

by these changes. 

HA Eligibility Workers (EWs) have been assigned responsibilities for the 

issuance of HA. 

No policy existed for the 

disbursement of HA. 

Add: 


DM:PC:dg 


Pages: 11-42.1 and 11-43.1 

HA EWs are now responsible for 

running Eligibility Determination 

Benefit Calculation (EDBC) upon 

completion of HA actions. 






Overview Effective July 1, 2009, CalWORKs cases with aid codes 32 and 3W will no 

longer be funded with federal funds. These cases will be state-only funded. 

As a result: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:dg 

• The TANF 60-month clock will not tick. 

• The CalWORKs 60-month clock will continue to tick. 


CalWORKs cases authorized under aid code 32 and 3W are affected by this 

change. 



Prior to July 1, 2009, CalWORKs 

aid code 32 and 3W cases were 

federally funded and resulted in the 

TANF 60-month clock ticking. 


Pages: 18-10, 18-26 and 18-29 

CalWORKs aid code 32 and 3W 

cases are state-funded and will not 

tick the TANF 60-month clock. 



December 3, 2010 



Overview This handbook letter updates Chapter 7 – Work Requirements with an 

additional example of a sanction cure and clarification of current sanction 

cure examples. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


DM:KA:dg 

Low Level – Review with staff. 



Previous policy did not 

include an example of 

sanctions involving the 

month-end batch job. 


Pages: 7-21 

New policy includes an added sanction cure 

example and additional clarification to 

existing sanction cure examples. 

CWPHB #4601 (12/10) CVR LTR Page 1 of 1





Overview Instructions regarding completion of the Support Questionnaire for a single 

parent adoption case have been added to Chapter 2 of the CalWORKs 

Policy Handbook. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


CalWORKs cases involving single parent adoptions are affected by the 

change. 



No policy existed for 

completion of the 

Support Questionnaire 

for single parent 

adoptions. 


Page: 2-27 

Remove: 

Page: 2-27.1 

Add: 

Pages: 2-28 and 2-29 


DM:KA:dg 

For single parent adoption cases, the Support 

Questionnaire will be completed with: 

• “Not Applicable” as the Parentage Status for 

child(ren), and 

• “Single Parent Adoption” as the absent 

parent name. 

CWPHB #4600 (12/10) CVR LTR 1 OF 1





Overview Chapter 13 – Benefit Issuance of the CalWORKs Policy Handbook (CWPHB) 

has been updated with a list of establishments whose Electronic Benefit 

Transfer (EBT) cash access to Automated Teller Machines (ATMs) and 

Point-of-Sale (POS) has been deactivated by the EBT vendor per the state’s 

request. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low – At next staff meeting 

CalWORKs/CalFresh cases are affected by this information. 

The change includes a list of establishments that can no longer accept EBT. 


Customers were able to utilize 

EBT cards to obtain cash or 

services at the list of 

establishments. 

Remove and replace: 

Table of Contents: Pages 1 of 3 

Add: 

Page 13-15.1 

Distribution CalWORKs/CalFresh 

DM:DC:dg 

The state has requested deactivation of 

ATMs and POS services at certain 

establishments to maintain the intent of 

the CalWORKs program. Customers are 

not able to obtain to cash or services at 

the listed establishments. 

CWPHB #4598 (11/10) CVR LTR 1 OF 1





Overview The CWPHB has been updated to: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:jv:dg 

• Add sponsored noncitizens codes 

• Add years 2005 – 2010 to the section “How the SSA Calculates 

Quarters.” 

High Level – Please review with unit staff immediately. 

Any case with a noncitizen 



Limited number of codes listed Added more sponsored noncitizen 

codes 


Pages: 6-21 and 6-39 






Overview Cash Assistance Program for Immigrants (CAPI) cases are located in the 

Transitional Assistance Department (TAD) District #75 office. The CWPHB 

has been updated with this information and the current CAPI telephone and 

fax numbers utilized for CAPI application requests. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – Review changes with unit at next staff meeting. 

CAPI cases and CAPI application requests are affected by this change. 

Requests for CAPI applications shall be forwarded to the TAD District #75 

office. 


CAPI cases were previously located 

in TAD District #25 office. 


Page 6-50 


DM:KA:dg 

CAPI cases are now located in TAD 

District #75 office. 

CWPHB #4596 (09/10) CVR LTR 1 OF 1



CalWORKs POLICY HANDBOOK LETTER #4595 ERRATA 


Overview The CalWORKs Policy Handbook Chapter 1 Applications has been updated 

to include changes in the Advance Eligibility Determination (AED) process. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MP:deg 

High Level – Staff immediately 

The following changes are effective September 27, 2010 


AED worker did not inform applicants 

of creating a C4Yourself.com account 

or Interactive Voice Response (IVR). 


Page: 1-6.3 

AED worker will inform all applicants 


• C4Yourself.com and creating an 

account, and 

• IVR. 







to include changes in the Advance Eligibility Determination (AED) process. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MP:ker 


The following changes are effective September 27, 2010 


AED worker did not inform applicants 

of creating a C4Yourself.com account 

or Interactive Voice Response (IVR). 


Page: 1-6.3 

AED worker will inform all applicants 


• C4Yourself.com and creating an 

account, and 

• IVR. 





CHAPTER 1 - Applications 


to include changes in the Advanced Eligibility Determination (AED) process. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MP:deg 


The following changes are effective immediately: 

Old Policy Revised Policy 

• Return appointments were not 

scheduled for ‘obvious ineligible 

applicant”. 

• Homeless applicants were not given 

a same day appointment. 

• Reception did not annotate 

information in the County Use 

section for Expedited Service (ES). 

• AED interviewer did not document 

the County Use section on the 

SAWS 1, and 

• Intake Eligibility Worker (EW) did 

not image the TAD 127, TAD 278 ID 

or Medi-Cal Eligibility Data System 

(MEDS). 



• Return appointment will be 

scheduled for “obvious ineligible 

applicant” upon his/her request, 

• Applicants with questionable 

employment hours or income will 

receive a return appointment, 

• Homeless applicants will receive a 

same day appointment, 

• Reception will review the Food 

Stamp ES Script (FS 31) with the 

applicant and write “ES Explained” 

and initial in the County Use section 

under the Primary language area of 

the SAWS 1, 

• AED interviewer will complete the 

County Use section on the SAWS 1, 

and 

• Intake EW will image the TAD 127, 

TAD 278 ID, SAWS 1, MEDS, and 

other supporting documents. 

CWPHB #4594 (09/10) CVR LTR 1 OF 1





Overview This handbook letter updates Chapter 7 – Work Requirements, as follows: 

Action time 

frame 

Affected 

cases 

Change 

summary 

• Provides information regarding what action to take when the Employment 

Services Specialist (ESS) notifies the customer of a Welfare-to-Work 

(WTW) sanction and the CalWORKs case is discontinued prior to the 

sanction being applied, and 

• Incorporates Knowledge Database (KD) questions. 


Intake applications in which an Assistance Unit (AU) member was previously 

notified of a WTW sanction but the sanction was not applied prior to the case 

being discontinued are affected by the change. 



No previous policy. When the AU was discontinued from CalWORKs 

before a WTW sanction was effective for an AU 

member, and the AU subsequently reapplies and 

is eligible for CalWORKs, the Eligibility Worker 

(EW) will apply the WTW sanction to the AU 

member when the application is approved. 




Filing 

instructions 


Pages: 7-20, 7-22, 7-23, 7-25, and 7-26 

Add: 

Page: 7-26.1 

Delete KD FAQs: 

• 3418 

• 3429 

• 3434 


DM:KA:dg 






Overview The CWPHB has been updated to clarify Eligibility Worker (EW) Time Limit 

Review Actions including the EW requirement of emailing all TOA requests 

using the Time Limit In Box. 

Action time 

frame 

Change 

Summary 

Filing 

instructions 


MC:SS:wsb 




The Eligibility Worker 

previously emailed all Time 

On Aid review requests to 

the QRU. 

The Eligibility Worker is now required to 

email all Time On Aid requests using the 

Time Limit In Box. Any time limit reviews or 

corrective action requests resulting from an 

Appeals review must be sent as a high 

priority with “Appeals TOA action” 

in the subject line of the email. 


Table of Contents, Pages 1 of 3 and 2 of 3 

Pages: 18-4, 18-30 through 18-34, 18-40 through 18-46 



AUGUST 18, 2010 



Overview The CWPHB has been updated to include information regarding the issuance 

of cash aid payments less than $10. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:dg 


CalWORKs cases eligible to a monthly aid payment of less than $10 are 

affected by this update. 

There is no change in policy. The information is being restored to the 

handbook. 


Page 12-35 



AUGUST 17, 2010 


CHAPTER 6 – Citizens, Non-citizens and Refugees 

Overview The CWPHB has been updated to: 

• Clarify the following information: 

− Identification of Cuban/Haitian immigrants. 

− Eligibility periods for Afghan Special Immigrants. 

− Identification of sponsored noncitizens. 

− Payment of cash aid under the Trafficking and Crime Victims 

Assistance Program (TCVAP). 

• Add information regarding noncitizen child victims of human trafficking. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:dg 


The updated information may affect CalWORKs cases with Cuban/Haitian 

and Afghan Special Immigrants, sponsored noncitizens and noncitizen 

victims of human trafficking. 



No previous policy. Noncitizen child victims of human 

trafficking may be eligible to 

federally funded cash assistance to 

the same extent as refugees. 



Pages: 6-22, 6-25.1, 6-28, 6-32, 6-39, 6-47.1 through 6-47.5 

Add: 

Pages: 6-22.1, 6-47.6 and 6-47.7 





CHAPTER 1 – Application 

Overview This handbook letter provides information on the following items for 

e-Applications: 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MP:dg 

• Generic date of birth, and 

• Homeless address. 

Low Level – Review at next staff meeting 



No policy existed. • When an e-Application is received without a date 

of birth (DOB) for the applicant, the Office 

Assistant (OA) will contact the customer and 

complete research in Medi-Cal Eligibility Data 

System (MEDS). If a DOB cannot be identified a 

generic date of 01/01/1970 will be used. The 

Eligibility Worker (EW) may need to: 

− Correct MEDS alert, 

− Correct Client Index Number (CIN), and 

− Request Income Eligibility Verification 

System (IEVS). 

• When an e-Applicant is homeless the OA will 

enter the Transitional Assistance Department 

(TAD) office address. 


Pages: 1-6.8 and 1-6.9 

Add: 

Page 1-6.10 

CWPHB #4590 (08/10) CVR LTR 1 OF 1


July 21, 2010 



Overview This handbook update provides updates and formatting changes to the minor 

parent section of the CalWORKs Policy Handbook. 

Action time 

frame 

Filing 

instructions 

Low Level 


Table of Contents: Page 1 of 3 and 2 of 3 

Pages: 4-34 thru 4-42 

Add 


DM:SB:dg 


Pages: 4-36.1, 4-37.1, 4-38.1, 4-39.1 and 4-41.1 



July 20, 2010 


CHAPTER 4 – CHILDREN AND ELIGIBILITY 

CHAPTER 7 – WORK REQUIREMENTS 

Overview This handbook letter provides updated information regarding the Cal-Learn 

program. 

Action time 

frame 

Affected 

cases 

Change 

summary 

The Cal-Learn program in C-IV has been automated to: 

• Create a Cal-Learn case for eligible pregnant and parenting teens. 

• Discontinue pregnant and parenting teens no longer eligible or required 

to participate in the Cal-Learn program. 

The Cal-Learn Referral and Registration procedures have not changed. The 

Eligibility Worker (EW) still has the ability to manually create a Cal-Learn 

program. 

Medium Level – Review with staff at next unit meeting. 

All Cal-learn cases are affected. 



The Cal-Learn program was 

always created and discontinued 

manually. 

• Cal-Learn cases may be created or 

discontinued manually by the EW or 

automatically by C-IV. 

• An automatic Journal entry will be created 

when the Cal-Learn program is automatically 

created by C-IV. 

• When teen parents volunteer to participate 

in the Cal-Learn program, the EW must 

update the program status and manually 

discontinue Cal-Learn when the teen is no 

longer eligible to voluntarily participate. 

• The CalWORKs discontinuance Notice of 

Action (NOA) will include information 

regarding the removal of the teen from the 

Cal-Learn program, when appropriate. 




Job Aids The following job aids are available: 

• The Job Aid – Cal-Learn Program Processing and Payment 

Issuances in C-IV Help has been updated. 

• Cal-Learn, Program Processing has been added to the C-IV User 

Guide 

Filing 

instructions 


DM:KA:dg 

The Cal-Learn section has been removed from Chapter 7 – Work 

Requirements and added to Chapter 4 – Children and Eligibility. 




Remove: 

Chapter 4: Table of Contents: Pages 1 of 2 and 2 of 2 

Chapter 7: Table of Contents: Pages 1 of 2 and 2 of 2 

Pages 7-31 through 7-57 

Add: 

Chapter 4: Table of Contents: Pages 1 of 3, 2 of 3 and 3 of 3 

Pages 4-1.1, 4-51 through 4-77 

Chapter 7: Table of Contents: Page 1 of 1 



JUNE 28, 2010 



Overview The CalWORKs Minimum Basic Standard of Adequate Care (MBSAC) Cost 




financial eligibility for customers applying for CalWORKs on or after 

July 1, 2010. 

Action time 

frame 

High Level – Eligibility Workers (EWs) must use the new MBSAC and 

IIK levels for processing cases effective July 1, 2010. 

Affected cases CalWORKs cases with new and pending applications for July 1, 2010, and all 

cases with IIK are affected by the MBSAC/IIK increases. 

Change 

summary 

New and 

pending 

applications 

Continuing 

cases 



Current MBSAC and IIK levels are 

effective through June 30, 2010. 

The MBSAC and IIK levels increased 

by 1.57% effective July 1, 2010. 

Upon receipt of this handbook letter, begin using the new MBSAC and IIK 

levels on all new and pending applications for July 1, 2010. 

Upon receipt of this handbook letter, begin using the new IIK levels effective 

with the July 1, 2010 aid payment. This is considered a County-initiated 

change; the IIK increase can be budgeted mid-quarter. 



Chapter 19 – Charts, Tables and Lists, Continued 

Chart updates The CalWORKs MBSAC and IIK charts for Region 1 and Region 2 have 

been updated to reflect this year’s COLA. The charts are attached to this 

cover letter. The chart for Region 2 will be posted on the Transitional 


SCR 36573 SCR 36573 has been created to update the MBSAC and IIK levels for 

CalWORKs processing. SCR 36573 is due to be released the week of June 

28, 2010. After implementation of the SCR, C-IV will provide the following 

lists: 

Filing 

instructions 

• Cases processed July 1, 2010 and later with saved EDBCs that were 

denied due to failing the financial eligibility test for the month of July 

2010. 

• Cases that should have EDBC run for the months of July 2010 and 

August 2010 to utilize the new IIK levels (there will not be batch 

processing of these cases due to the low number of cases impacted). 


Pages 19-3, 19-4 


DM:KA:dg 



JUNE 11, 2010 



Overview This handbook letter contains updated information to the following: 

• Tribal Reservations and Rancherias qualifying for time limit exemption 

due to the unemployment rate. 

• Beginning date of aid for CalWORKs timed-out person eligible to 

additional time due to: 

− Meeting time limit extender criteria, or 

− Child support reimbursement. 

Action time 

frame 

Affected 

cases 

Change 

summary 


CalWORKs cases with aided adults may be affected by the time limit 

exemption/extender changes. 



CWPHB letter #4558 contained 

Tribal Reservation and Rancheria 

information up to and including ACL 

09-29 dated 06/18/2009. 

CalWORKs timed-out adults 

meeting time limit extender criteria 

or with child support reimbursement 

were added to cash aid effective 

future month. 

This handbook letter contains Tribal 

Reservation and Rancheria 

information found in the previous 

handbook letter and in ACL 10-24 

dated 04/29/2010. 

CalWORKs timed-out adults 

meeting time limit extender criteria 

or with child support reimbursement 

are added to cash aid effective the 

first of the month following the 

month the determination of meeting 

extender criteria or child support 

reimbursement was made. 




Filing 

instructions 


DM:KA:dg 


Pages: 18-48 through 18-51, and 18-81 

Add: 

Page: 18-51.1 



JUNE 22, 2010 


CHAPTER 5 – Residency 

Overview The chapter has been revised to update information regarding customers: 

Action time 

frame 

Affected 

cases 

Change 

summary 

• Whose whereabouts are unknown, 

• Temporarily absent from the county/state, and 

• Who are homeless. 

Low Level – Review with Eligibility Workers at next staff meeting. 

CalWORKs cases with customers whose whereabouts are unknown, 

temporarily absent from the county or state, or who are homeless are 

affected by this information. 

Changes to this chapter include: 

• Grammar and format revisions. 

• Deletion of reference to using the ML 4521 to obtain customer’s 

statement of intent to return to California. 

• How to contact out-of-county/state Social Services agencies 

• Homeless customers failing to provide a completed HA 45 without good 

cause will not be discontinued. 


No previous policy. When customer’s mail is returned as 

“undeliverable” or ”addressee 

unknown”, EWs must attempt to contact 

the customer before taking 

ML 4521 used to document customer’s 

intent to return to California. 

Customers were discontinued from 

CalWORKs when a completed HA 45 

was not provided. 

EW’s scheduled customers to meet with 

the Fraud Investigation Unit (FIU) or 

Homecall staff to discuss reasons for 

continued homelessness. 

discontinuance action. 

ML 4521 has been obsoleted. EWs 

may send the ADM 107 in C-IV to the 

customer to verify intent to return to 

California. 

The EW will take no action against the 

customer when the HA 45 is not 

provided. 

Customers are not required to meet 

with FIU or Homecall staff to discuss 

continued homelessness. 




Filing 

instructions 


Entire Chapter 5 


JV:KA:dg 



JUNE 4, 2010 



Overview This handbook letter provides information on the following: 

Action time 

frame 

Affected 

cases 

Change 

summary 

• Receipt of Inter-County Transfers (ICTs) for victims of domestic abuse. 

• Statewide Finger Imaging System (SFIS): 

− San Bernardino County SFIS Coordinator 

− Victims of Domestic Abuse 

− Excessive length of the index fingernail. 

Low Level – Review at next staff meeting. 

CalWORKs cases where an individual is a victim of domestic abuse, or the 

length of an individual’s index fingernail prevents the SFIS process are 

affected. 



No policy existed. • When an ICT case involving a victim of 

domestic abuse is received, information 

regarding the victim will only be released when 

a WTW 37 form - Permission to Release 

Domestic Abuse Information When Moving to 

Another County is completed and signed by the 

victim. 

• When a customer is a victim of domestic abuse 

and has changed his/her name, staff will contact 

the SFIS Coordinator to inactivate the 

customer’s prior SFIS record before completing 

the SFIS process. 

• When excessive length of the index fingernail 

prevents SFIS process the Office Assistant 

(OA) will request the customer to shorten the 

length of the nail. 

(Continued on next page) 



Filing 

instructions 


Pages: 1-60, 1-81 through 1-85.1, and 1-87 

Add: 

Page: 1-60.1 


JV:MP:dg 



MAY 27, 2010 



Overview This handbook letter contains updates to the Child Support good cause 

procedures. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:MM:dg 

Low Level – Eligibility Workers (EWs) must implement the changes in this 

handbook letter immediately. 

This handbook letter impacts all cases where customers claim good cause 

for failure to comply with Child Support requirements. 

EWs must image the CW 51 into C-IV when a customer has claimed good 

cause for not cooperating with Child Support Requirements. Instructions 

about how to complete the good cause pages in C-IV have been added. 


• EWs would fax the CW 51 to 

PID when evaluating a 

customer for good cause. 

• No instructions existed on how 

to enter good cause into C-IV. 


Page 2-17.1 

Add: 

Page 2-17.2 

• EWs must now image the CW 51 

into C-IV when a customer claims 

good cause. 

• Instructions now exist on how to 

enter good cause into C-IV. 



MAY 19, 2010 



Overview This chapter has been updates the use of Electronic Benefit Transfer (EBT) 

transaction information to track customer residence. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:KA:wsb 

Low Level – Review with Eligibility Workers (EWs) at next staff meeting. 

CalWORKs cases with benefits issued by EBT. 



No policy. The EW will attempt to verify 

customer residence when EBT 

transaction reports indicate 

customer made purchases out-ofcounty 

or state. 


Page 13-36 



MAY 27, 2010 



Overview This handbook letter contains new policy regarding the Homeless 

Management Information System (HMIS), which is used to: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


DM:MM:dg 

• Track the use of homeless programs, 

• Understand patterns of use, 

• Measure the effectiveness of homeless program, and 

• Produce an unduplicated count of the people using those programs. 

High Level – Effective 06/01/2010, EWs working with the temporary 

Homeless Assistance (HA) program must follow the instructions provided in 

this handbook letter. 

The instructions in this handbook letter affect all new applications for 

temporary HA. 

The Transitional Assistance Department (TAD) has agreed to provide 

Community Action Partnership of San Bernardino County (CAPSBC) with 

temporary HA customer information to be used by HMIS. 


No policy existed for sharing 

temporary HA customer 

information with CAPSBC. 



Page 11-19 

Add: 

Pages 11-34.1 through 11-34.3 

New policy has been developed to 

facilitate the sharing of temporary HA 

customer information with CAPSBC. 



MAY 11, 2010 


CHAPTER 9 - Income 

Overview The Income chapter has been updated to add a section for Veteran’s Affairs 

(VA) benefits and when to obtain the CW 5 from the customer. The CW 5 is a 

required form for eligibility determination at intake and add person 

application. It is now obtained at Re-Evaluation (RE). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Medium – At next staff meeting 

CalWORKs cases with military veterans, their spouse and/or dependents. 

The CW 5 is now requested at RE. 


The CW 5 is requested at intake 

and add person application, for 

veterans, their spouse and/or 

dependents. 

Remove and replace: 

Table of Contents and pg 9-1 

Add: 


JV:DC:dg 

Pages 9-21.1 and 9-21.2 

Begin requesting the CW 5 at 

RE for veterans, their spouse, 

and/or dependents. 



APRIL 12, 2010 



Overview This letter has been issued to clarify incorrect information in CWPHB Letter 

#4569 regarding restoring cash aid to a Welfare-to-Work (WTW) sanctioned 

customer when he/she cures the sanction. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level – Please review with staff immediately. 

CalWORKs cases with WTW sanctioned customers who subsequently 

cooperate to end sanction. 

Cash aid is restored the first day of the month following the date the 

customer contacted the Employment Services Specialist (ESS) to indicate 

his/her desire to cure the WTW sanction. 


Pages: 7-27, 7-27.1 


JV:KA:dg 



APRIL 1, 2010 



Overview This letter updates the handbook with the following information: 

• Example of the current I-551 Permanent Resident Card issued by United 

States Citizenship and Immigrations Services (USCIS). 

• Coding the noncitizens Date of Entry and Section Code in C-IV. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

High Level – Please staff immediately. 

CalWORKs cases with customers having Legal Permanent Resident (LPR) 

status. 


• Example of the current I-551 Permanent Resident card issued by USCIS 

has been added to the handbook. 

• Explanation of using the I-551’s “Resident Since” and “Category” entries 

as the C-IV “Date of Entry” and “Section Code” entries, respectively, is 

included. 





APRIL 6, 2010 



Overview The purpose of this letter is to incorporate information from Interim Instruction 

Notice (IIN) #08-037 regarding restricted accounts, and retirement and 

educational accounts. 

Filing 

instructions 


JV:KA:lc 



Pages: 8-7, 8-19, 8-21 and 8-22 

Add: 

Page: 8-23 

Obsolete: 

IIN #08-037 



APRIL 12, 2010 

CalWORKS POLICY HANDBOOK LETTER #4567 


Overview The CalWORKs Policy handbook has been revised to add information 

regarding victims of Domestic Abuse who move from one county to another, 

and includes: 

Action time 

frame 

• Permission to Release Domestic Abuse Information When Moving to 

Another County form (WTW 37). 

• County responsibilities, for customers who are victims of Domestic 

Abuse, and their case is transferred to another county. 

Low Level – Review at next staff meeting. 

Affected cases Cases when an individual is a victim of domestic abuse are affected by this 

change. 

Change 

summary 

Filing 

instructions 


MC:SS:wsb 


No Policy existed. The transmission of information 

regarding victims of Domestic Abuse 

will only be released when the WTW 

37 form is completed and signed, by 

the domestic abuse victim. 


Page: 14-14 

Add: 

Page: 14-14.1 



APRIL 1, 2010 



Overview This handbook letter provides an additional page reserved for information 

currently in development. 

Action time 

frame 

Affected 

cases 

Filing 

instructions 

Low Level 

No CalWORKs cases are affected. 

Add: 

Page 1-60.1 


JV:KA:dg 



MARCH 16, 2010 


CHAPTER 1 - Applications 

Overview On 2/23/10, the Department of Health Care Services (DHCS) issued 

Medi-Cal Eligibility Division Information Letter (MEDIL) I 10-03 regarding 

changes to the Medi-Cal Eligibility Data System (MEDS) Social Security 

Number (SSN) Verification (VER) codes that allow staff to verify a customer’s 

SSN when a Social Security card is not available. This handbook letter 

provides information regarding those changes. 

Action time 

frame 

High Level – Eligibility Workers (EWs) will refer to the information 

contained in this handbook letter when verifying a customer’s SSN. 

Affected cases All CalWORKs cases are affected. 

Change 

summary 

Filing 

instructions 

The MEDS SSN-VER code values have been redefined by DHCS as of 

9/25/09. 

Old Policy New Policy effective 9/25/09 

Prior to 9/25/09, only MEDS 

SSN-VER code of “J” was the 

acceptable verification. 


Pages: 1-13 and 1-16 


DM:AC:dg 

MEDS SSN-VER code of “J” is no longer 

acceptable verification. The following 

codes have replaced “J” verification: 

• W, and 

• A. 



APRIL 1, 2010 



Overview This handbook letter provides information regarding: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

• Deemed eligible infants, and 

• California Children Services (CCS) and actions required by Transitional 

Assistance Department (TAD) Eligibility Workers (EWs) in the CCS 

application process. 

Low Level – EWs should refer to this information when adding deemed 

eligible infants to Medi-Cal, and when receiving requests from CCS. 

CalWORKs cases with newborns and excluded/unaided children potentially 

eligible to CCS. 



No previous policy. Eligibility for the deemed eligible 

infant must be established within 10 

days following the date the birth is 

reported. 

No previous policy. EWs must take action on requests 

from CCS immediately. 



Pages: 15-1 and 15-18 

Add: 


Pages: 15-21.1 through 15-21.3 



MARCH 18, 2010 



. 

Overview Adding information to the Benefits Issuance Chapter on Cross-County 

printing of EBT cards. Cross-County printing of EBT cards allows a county, 

other than the county of issuance to print an EBT card. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – At next staff meeting 

All CalWORKs cases with benefits placed on the EBT card. 

The new policy is as follows: 


None When a customer moves to another county and has 

EBT benefits remaining in his/her account, and the 

EBT card has been lost or stolen, a new card can be 

printed from the new county of residence. 


Table of Contents, Page 1 of 3 

Page 13-3 

Add: 

Page 13-21.1 


JV:DC:wsb 



MARCH 2, 2010 



Overview The CWPHB has been revised to include the following information: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

When a Welfare–to–Work (WTW) sanctioned customer cures his/her 

sanction, the Eligibility Worker (EW) must take action to restore aid to the 

customer within three (3) business days of the date notification is received 

from the Employment Services Specialist (ESS). 

High Level – The new policy should be staffed and implemented 

immediately upon receipt. 

CalWORKs cases with WTW sanctioned customers who subsequently 

cooperate to end sanction. 


Old Policy 03/14/2010 New Policy Effective 03/15/2010 

EWs were not required to take action 

to restore cash aid to former WTW 

sanctioned customers within a 

specified time frame. 


Page: 7-27 

Add: 

Page: 7-27.1 


JV:KA:dg 

EWs are required to take action to 

restore cash aid to former WTW 

sanctioned customers within three 

(3) working days of being informed 

of the cure by the ESS. 



MARCH 17, 2010 



Overview The purpose of this handbook letter is to provide the Unemployment 

Insurance Benefits (UIB) website and telephone numbers to assist customers 

with the application process and to notify staff information regarding EDD 

Real-Time Match is located in the MEDS My Easy Desk Source. 

Action time 

frame 

Filing 

instructions 

Low Level 


JV:MP:dg 


9-43 

CWPHB # 4566 ERRATA (03/10) CVR LTR PAGE 1 OF 1


APRIL 1, 2010 



Overview This handbook letter contains information regarding the Safe At Home 

Program. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

Low Level – Staff should refer to these handbook pages when a customer 

in the Safe At Home Program is identified. 

CalWORKs cases with customers enrolled in the Safe At Home Program. 



No Previous Policy Cases identified as a Safe At Home 

case must be kept confidential. 



Page: 1-56 

Add: 

Pages: 1-60.2, 1-60.3 



APRIL 1, 2010 



Overview This handbook letter contains updated information CalWORKs denials and 

referrals to Medi-Cal. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

Low Level – EWs will refer to the information contained in this 

handbook letter when referring denied CalWORKs cases to the 

Medi-Cal unit. 

All denied CalWORKs applications are affected. 

Requests for CalWORKs verification may count as the first contact for the 

Medi-Cal application when the CalWORKs application is denied and referred 

to Medi-Cal. 

Old Policy Effective 04/04/2010 New Policy Effective 04/05/2010 

CalWORKs application denials must 

be referred to the Medi-Cal unit 

immediately. 


Pages: 1-9 and 1-10 

CalWORKs application denials must 

be referred to the Medi-Cal Unit 

within three (3) working days. 






Overview The handbook has been revised to clarify the following information: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

If CalWORKs is discontinued for the receipt of income in excess of the 

Income Reporting Threshold (IRT), the Food Stamp Household (HH) must be 

transferred to Transitional Food Stamps (TFS). 

High Level – When CalWORKs is discontinued Eligibility Workers must 

confirm the Food Stamp household is transferred to TFS. 

Cases with both active CalWORKs and Food Stamp programs are affected. 

If CalWORKs is discontinued for the receipt of income in excess of the 

Income Reporting Threshold (IRT), the Food Stamp Household (HH) must be 

transferred to Transitional Food Stamps (TFS). 


Page: 10-45 


JV:KA:dg 






Overview This handbook letter provides information regarding the Filipino Veterans 

Equity Compensation Fund created by the America Recovery and 

Reinvestment Act (ARRA). 

Retroactive 

payments 

Action time 

frame 

Affected 

cases 

Filing 

instructions 

This law provide for certain veterans who served in the military of the 

Government of the Commonwealth of the Philippines during World War II 

and the spouses of those veterans to receive a one-time payment of up to 

$15,000. These benefits must not be used to determine eligibility for or the 

amount of benefits in any federal program. 

Effective date of this provision is April 1, 2009. Eligibility Workers (EWs) are 

only required to review cases for retroactive payments at recertification, or 

when it is discovered that a Filipino veteran received a payment from the 

Filipino Veterans Equity Compensation Fund. 

If a Filipino Veterans Equity Compensation Fund payment is discovered, 

EWs must determine if the payment was excluded from income and 

resources and take corrective action to restore benefits, if necessary. 

Level – Mid 

CalWORKs cases that report receiving a Filipino Veterans Equity 

Compensation Fund payment. 


9-6 


JV:MC:dg 






Overview The purpose of this handbook letter is to provide the Unemployment 

Insurance Benefits (UIB) website and telephone numbers to assist customers 

with the application process. 

Action time 

frame 

Filing 

instructions 

Low Level 


JV:MP:dg 


9-43 

CWPHB # 4566 (02/10) CVR LTR PAGE 1 OF 1





Overview The Department of Child Support Services’ (DCSS) Rancho Cucamonga 

office has moved to Ontario. The CalWORKs Policy Handbook is being 

updated with this information. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – 


JV:KA:dg 

CalWORKs cases are affected. 

The following updates have been made: 

• Added the DCSS Ontario office address. 

• Updated customer inquiry/public contact telephone number. 

• Updated DCSS contact list. 


Page 2-21 





CHAPTER 3 – Assistance Unit/Responsible Persons 

Overview The CalWORKs Policy handbook has been updated to clarify which persons 

are mandatorily included in the Assistance Unit (AU). 

Action time 

frame 

Affected 

cases 

Change 

summary 

High Level – Eligibility Workers (EWs) will refer to this information when 

processing CalWORKs cases. 

CalWORKs cases containing mutual children/unmarried fathers (UMFs). 

Examples have been added to clarify mandatory inclusion regulations and 

who must be included in or excluded from the AU. 

Training A CalWORKs Mandatory Inclusion PowerPoint Training is available on both 

the TAD and PDD Websites. 

Filing 

instructions 


JV:KA:dg 


Pages: 3-15, 3-16 

Add: 

Page: 3-16.1 






Overview This handbook letter was issued to: 

Action time 

frame 

Affected 

cases 

• Correct the list of locations where people are born that qualify them for 

U.S. citizenship. 

• Include the use of the MEDS INQE screen print to verify citizenship. 

• Clarify eight-month eligibility period for Afghan Special Immigrants. 

• Clarify eligibility to cash assistance for non-citizens applying as victims of 

human trafficking, or domestic violence and other serious crimes. 

Low Level – Eligibility Workers (EWs) must refer to updates when 

processing case actions. 

CalWORKs cases with customers: 

• Aided as a citizen, but were born in The Trust Islands, Palau District, Yap 

District, Truk District, Ponape, Kograe, or The Marshall Islands. 

• Who are non-citizen victims of human trafficking, or domestic violence 

and other serious crimes. 



CalWORKs Policy Handbook #4554, Continued 

Change 

summary 

Additional 

information 

Filing 

instructions 


JV:KA:dg 

The following information has been added and/or clarified: 

• The Trafficking and Crime Victims Assistance Program provides statefunded 

cash assistance to non-citizen victims while they are awaiting 

approval of their application for a T Visa or U Visa from the United States 

Citizenship and Immigration Services (USCIS), or to customers who have 

received a U Visa. 

• Customers obtaining a U Visa are not eligible to federally-funded cash 

assistance; however, they may be eligible to state-only CalWORKs. 


Persons born in the following locations 

were identified as U.S citizens: 

• The Trust Islands 

• Palau District 

• Yap District 

• Truk District 

• Ponape 

• Kograe 

• The Marshall Islands 

Persons born in the following locations are 

not U.S citizens and must present 

required non-citizen documentation for 

eligibility to CalWORKs: 





• Ponape 

• Kograe 


No previous policy. The MEDS INQE screen print indicating 

acceptable citizenship verification has 

been provided will be used to verify 

customer’s citizenship. 

An IIN will not be issued as previously stated because there are no cases 

affected by the following changes: 

• Afghan Special Immigrant customers who may be eligible to additional 

months of cash assistance. 

• Customers born in The Trust Islands, Palau District, Yap District, Truk 

District, Ponape, Kograe, or The Marshall Islands. 


Pages: 6-2, 6-3, 6-5, 6-25.1, 6-25.2, 6-25.3, 6-47.1 and 6-47.4 

Add: 

Page: 6-25.4 






Overview Effective January 4, 2009, customers will no longer receive the 

CalWORKs/Food Stamps Initial Interview Questions (TAD 99) when 

submitting a CalWORKs application in the district office. 

The Advance Eligibility Determination (AED) Interviewer will complete the 

CalWORKs/Food Stamps AED Worksheet (AED 100) during the customer’s 

initial interview. 

Action time 

frame 

Change 

summary 

High Level – Eligibility Workers (EWs) will refer to this information when 

completing the AED process. 

The change is summarized in the table below 


• The customer completed the 

TAD 99 when applying for 

CalWORKs and or Food 

Stamps. 

• The AED Interviewer reviewed 

the TAD 99 to determine 

potential eligibility. 

Obsolete Effective 12/31/2009 the TAD 99 is obsolete. 

Filing 

instructions 


JV:MP:lc 


1-6.2 through 1-6.7 

The AED Interviewer will complete 

the AED 100 during the customer’s 

initial interview to determine 

potential eligibility for CalWORKs 

and Immediate Need. 




CalWORKS POLICY HANDBOOK LETTER #4558 ERRATA 


Overview Each year the California Department of Social Services (CDSS) advises the 

counties, via an All County Letter (ACL), of the California Tribal Reservations 

and Rancherias that have provided information on unemployment rates of 

50% or higher for the 60 month time limit exemption for those individuals 

living in Indian country. This handbook letter updates the list of Tribal 

Reservations and Rancherias with those identified in ACL 09-29 dated 

06/18/2009. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

In addition to the updated list, information regarding deletion of the 60 th TANF 

month and 54 th CalWORKs month tasks has been included. 

Low Level 


JV:KA:dg 

Intake and Continuing CalWORKs cases with families living on the listed 

Tribal Reservations and Rancherias are affected by this change. 


Old Policy through 09/30/2009 New Policy effective 10/1/2009 

No previous policy. Eligibility Workers are responsible for 

deleting the 60 th TANF month and 




08-28, dated 06/10/2008. 


Pages 18-41, 18-42, 18-48 through 18-51, and 18-62 

54 th CalWORKs month tasks. 




Handbook letter and the information 

in ACL 09-29 dated 06/18/2009. 






Overview Effective November 23, 2009, customers will be able to apply for CalWORKs 

online via C4Yourself e-Application. The purpose of this letter is to add to 

the handbook information regarding the C4Yourself e-Application process. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

High Level – Eligibility Workers (EWs) will refer to this information as well as 

information in the Operations and Reference Handbook and C-IV User Guide 

when processing C4Yourself e-Applications. 

Intake applications may be received through C4Yourself. 



Customers are required to apply for 

CalWORKs by submitting an 

application in the district office. 

Customers will be able to apply for 

CalWORKs online through 

C4Yourself as well as submitting an 

application in the district office. 



Pages: 1-1 through 1-6.1, 1-7, 1-8, 1-16, 1-18, 1-20, 1-22, 1-29, 1-30 and 

1-31 

Add: 

Pages: 1-6.8, 1-6.9 and 1-31.1 






Overview The purpose of this handbook letter is to correct information contained in 

Chapter 10. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

CalWORKs cases with earned income are affected. 

Corrections have been made to: 

• Page 10-7: Revised the Result information in Example 4. 

• Page 10-37: Corrected information in the Action sections of Example 1 

and Example 2. 


Pages: 10-7 and 10-37 






CHAPTER 3 – AU/Responsible Persons 

Overview The enactment of Assembly Bill (AB) 205 gives California registered 

domestic partners and same-sex spouses the same rights, protections, 

benefits , responsibilities, obligations, and duties as stepparents. The 

purpose of this letter is to amend CalWORKs regulations to give California 

registered domestic partners and same-sex spouses these rights and 

obligations within the CalWORKs program. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Low Level – Eligibility Workers (EWs) will refer to this update when 


CalWORKs cases with California registered domestic partners or same-sex 

spouses. 

California registered domestic partners and same-sex spouses now have the 

same rights and obligations with respect to a partner’s child as would apply 

to a stepparent or former stepparent of a child. 


California registered domestic 

partners were treated as an adult 

male/female having no relationship 

to their partner or the child of their 

partner. 

California registered domestic 

partners now have the same rights 

and obligations as a spouse to their 

partner or a stepparent to the child of 

their partner. 

No previous policy. Same-sex spouses married between 

June 16, 2008 and November 4, 

2008 have the same rights and 

obligations as a spouse to their 

partner or a stepparent to the child of 

their partner. 


CWPHB #4557 (10/09) CVR LTR PAGE 1 of 2


Filing 

instructions 


JV:KA:dg 



Pages: 3-1, 3-3, 3-5, 3-16, 3-18, 3-24 

Add: 

Pages: 3-18.1, 3-23.1, 3-23.2 

CWPHB #4557 (10/09) CVR LTR PAGE 2 of 2









living in Indian country. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 



This CWPHB letter updates the list of Tribal Reservations and Rancherias 

with those identified in ACL 09-29 dated 06/18/2009. 

Old Policy through 09/30/2009 2009 

No previous policy. Eligibility Workers are responsible for 

deleting the 60 th TANF month and 



information up to and including 

ACL 08-28, dated 06/10/2008. 



Pages 18-41, 18-42, 18-48 through 18-51, and 18-62 

54 th CalWORKs month tasks. 




Handbook letter and the information 

in ACL 09-29 dated 06/18/2009. 






Overview The purpose of this letter is to inform Eligibility Workers (EWs) of the new 

Income Reporting Threshold (IRT) levels for Region 1 and Region 2 for the 

period October 1, 2009 through September 30, 2010 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 


JV:KA:dg 

All CalWORKs cases are affected by the increase in IRT levels. 

The IRT amounts have increased for the period October 1, 2009 through 

September 30, 2010. 


IRT levels for the period 10/1/2008 

through 9/30/2009 were used. 


Page 19-5 


through 9/30/2010 are used. 





CHAPTER 7 – WORK REQUIREMENTS 

Overview The purpose of this handbook letter is to inform staff of the increase in the 

OmniTrans bus pass rates effective 10/1/09. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

Cal-Learn cases eligible to transportation supportive services. 

The following table summarizes the changes. 


The OmniTrans bus rates through 

9/30/09 are: 

• Daily pass $3.00 

• Monthly pass $44.50 

• Student pass $32.50 


Page 7-44 


JV:KA:dg 

The new OmniTrans bus rates are: 

• Daily pass $3.60 

• Monthly pass $47.00 

• Student pass $35.00 






Overview This handbook letter was issued to: 

• Correct the list of locations where people are born that qualify them for 

U.S. citizenship. 

• Include the use of the MEDS INQE screen print to verify citizenship. 

• Clarify eight-month eligibility period for Afghan Special Immigrants. 

• Clarify eligibility to cash assistance for non-citizens applying as victims of 

human trafficking, or domestic violence and other serious crimes. 

Action time 

frame 

Affected 

cases 

Low Level – Eligibility Workers (EWs) must refer to updates when 


CalWORKs cases with customers: 

• Aided as a citizen, but were born in The Trust Islands, Palau District, Yap 

District, Truk District, Ponape, Kograe, or The Marshall Islands. 

• Who are non-citizen victims of human trafficking, or domestic violence 

and other serious crimes. 




Change 

summary 

Additional 

information 

Filing 

instructions 

The following information has been added and/or clarified: 

• The Trafficking and Crime Victims Assistance Program provides statefunded 

cash assistance to non-citizen victims while they are awaiting 

approval of their application for a T Visa or U Visa from the United States 

Citizenship and Immigration Services (USCIS), or to customers who have 

received a U Visa. 

• Customers obtaining a U Visa are not eligible to federally-funded cash 

assistance; however, they may be eligible to state-only CalWORKs. 


Persons born in the following locations 

were identified as U.S citizens: 





• Ponape 

• Kograe 


Persons born in the following locations are 

not U.S citizens and must present 

required non-citizen documentation for 

eligibility to CalWORKs: 





• Ponape 

• Kograe 


No previous policy. The MEDS INQE screen print indicating 

acceptable citizenship verification has 

been provided will be used to verify 

customer’s citizenship. 

A list of affected cases and instructions will be issued under a separate 

Interim Instruction Notice (IIN) for the following: 

• Afghan Special Immigrant customers who may be eligible to additional 

months of cash assistance. 

• Customers born in The Trust Islands, Palau District, Yap District, Truk 

District, Ponape, Kograe, or The Marshall Islands. 


Pages: 6-2, 6-3, 6-5, 6-25.1, 6-25.2, 6-25.3, 6-47.1 and 6-47.4 

Add: 

Page: 6-25.4 


JV:KA:dg 






Overview The purpose of this handbook letter is to update the information in this 

chapter to correspond to information requested on the revised QR 7 – 

Eligibility/Status Report. 

Action time 

frame 

Affected 

cases 

Change 

summary 

High Level – The QR 7 (12/08) revision will be mailed to CalWORKs 

customers in October 2009 for the September 2009 Data Month. Eligibility 

Workers will need to refer to this chapter when processing the revised QR 7. 

All CalWORKs cases are affected. 

Changes to this chapter include: 

• Corrections to grammar and formatting where necessary. 

• Examples of when the Intake EW must generate a QR 7. 

• Updates to QR 7 Completeness sections to correspond to revised QR 7. 

• Clarification of adding newborn to CalWORKs immediately pending 

receipt of the CW 8A and birth certificate. 

Special Note In order to provide consistent information regarding QR 7 completion and 

customer reporting requirements, this chapter contains information for both 

the CalWORKs and Food Stamp programs. 

Filing 

instructions 




JV:KA:dg 


SAN BERNARDINO COUNTY HUMAN SERVICESS 




Overview This handbook letter was issued to include information on intercounty 

transfer (ICT) applications for customers who are nonneedy caretaker 

relatives receiving CalWORKs benefits on behalf of a child who is a 

dependent of the court and not eligible to federal Foster Care. The customer 

is exempt from the face-to-face interview requirement. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

See the “Inter-County Transfer (ICT)” section of the Operations and 

Reference Handbook (ORHB) for information on processing ICT applications. 

Low Level – Intake Eligibility Workers (EWs) should refer to this information 

and the information in the ORHB when processing ICT applications. 

ICT applications. 



All ICT applications required a faceto-face 

interview with the customer. 


Page: 1-6 


JV:KA:dg 

ICT applications for customers who 

are nonneedy caretaker relatives 

receiving CalWORKs benefits on 

behalf of a child who is a dependent 

of the court and not eligible to 

federal Foster Care are exempt 

from the face-to-face interview 

requirement. 






Overview The CalWORKs Policy Handbook (CWPHB) Chapter 13 Benefit Issuance, 

has been updated to include new EBT Vendor information and processes. 

Effective September 21, 2009, San Bernardino County will change EBT 

vendors from JP Morgan Electronic Financial Services (EFS) to Affiliated 

Computer Services, Inc. (ACS). The conversion will be a seamless process 

with little impact to customers and staff. 

Prior 

notification 

To ensure customers are aware of the new EBT vendor and impact, the 

following will be done: 

• Posters will be displayed in the lobbies. 

• The EWs will: 

− Post Flyer #09-125 at his/her workstation, and 

− Distribute Flyer #09-125 to each customer at new application. 

• Office Assistants (OAs) will add Flyer #09-125 to CalWORKs and Food 

Stamp Intake application packets through September 18, 2009. 

Conversion All records will be transferred from JP Morgan to ACS on Saturday, 

September 19, 2009 at 11 PM through Sunday, September 20, 2009 at 11 

PM. During this time, the EBT system will be unavailable. Staff must remind 

customers of the following: 

After the 

conversion 

period 

• During conversion customers will not be able to purchase food or make 

cash withdrawals, and 

• The need to plan ahead for withdrawing cash and shopping needs. 

After conversion customers will have: 

• Access to benefits as usual, using his/her current card and Personal 

Identification Number (PIN). 

• Lower transaction fees at the Automated Teller Machine (ATM) 

− Transaction fees have been lowered from 85 cents to 80 cents per 

use, after the first four free cash only withdrawals per month. 

• Access to a new EBT website at www.ebt.ca.gov. This website allows 

the customer to: 

− Check food and cash benefit balances, 

− See his/her EBT card use history, and 

− Find places to use his/her EBT card. 



CHAPTER 13 – Benefit Issuance, Continued 

Filing 

instructions 


Pages 13-1 through 13-2, 13-4 through 13-6, 13-8, 13-10, 13-12 through 

13-21, 13-24, 13-26, 13-31 through 13-35 

Obsolete: 

IIN #09-034 

Distribution CWPHB 

CM:MF:dg 






Overview This handbook is issued to correct information located on page 7-21. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – 

CalWORKs cases with welfare-to-work (WTW) non-compliant customers. 

The dates in Example 2 on page 7-21 have been corrected. 


Page: 7-21 


JV:KA:dg 



AUGUST 24, 2009 



Overview This handbook letter clarifies some Department of Child Support Services 

(DCSS) policies and procedures. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MM:dg 

Low Level – Eligibility Workers (EWs) must review this information as they 

process cases or take actions which require the use of DCSS forms. 

Clarification was included for minor parent referrals, DCSS applicants and 

how they cannot be the absent parent also, what to do if the absent parent 

has been excluded as the father, and what to do when an Support 

Questionnaire was completed in error. 


• No policy existed on referring 

the absent parents of a minor 

parent on his/her own case to 

DCSS. 

• Parents were selected as the 

applicant and absent parent on 

a Support Questionnaire 

• No process existed for absent 

fathers who had been excluded 

from paternity. 

• No policy existed for cases 

where parents where not 

cooperating and good cause 

was denied. 


Pages 2-16, 2-17.1, and 2-27 

Add: 

Page 2-16.1 

• A paper procedure now exists 

for referring the absent parents 

of a minor parent in his/her own 

case. 

• The applicant on the Support 

Questionnaire cannot be the 

absent parent. 

• The Support Questionnaire must 

be updated for absent fathers 

excluded from paternity. 

• When good cause is denied, the 

parent must be given a chance 

to cooperate and if not, continue 

the non-cooperation penalty. 



AUGUST 20, 2009 



Overview This handbook update provides an update to the days and times an Eligibility 

Worker (EW) can schedule appointments for the minor to see a Child 

Protective Services (CPS) worker. 

Action time 

frame 

Change 

summary 

Filing 

instructions 

Low Level – EWs are to take action on this change when referring minors to 

CPS. 

EWs are not able to schedule minors living independently, due to an unsafe 

home, to CPS any work day during office hours. 


EWs could only schedule CPS 

appointments for Tuesdays and 

Thursdays at 9 a.m. 


Page 4-39 


JV:MM:dg 

EWs can now schedule CPS 

appointments for minors any day of 

the week during office hours. 



AUGUST 17, 2009 



Overview This handbook letter is issued to inform staff of the following revisions: 

• Removal of the reference to MEDS Specialist, and 

• Change in policy to applying the child support non-cooperation penalty 

when a penalized customer’s case is subsequently discontinued, and the 

customer reapplies for cash assistance. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Low Level – CalWORKs Eligibility Workers (EWs) must refer to the changes 

as necessary when processing cases. 

CalWORKs cases discontinued while the customer was penalized for not 

cooperating with the Department of Child Support Services (DCSS) and the 

customer reapplies for cash assistance. 



The Eligibility Worker will contact the 

MEDS Specialist or MEDS Office 

Assistant (OA) to have Medi-Cal 

restriction removed when the DCSS 

penalized parent/caretaker relative 

becomes pregnant. 

If an applicant customer is denied or 

a recipient customer is penalized 

25% due to non-cooperation with the 

DCSS and the entire case is 

subsequently discontinued, the 

penalty was continued if the 

customer reapplied within 60 days 

after the discontinuance. 

The Eligibility Worker will contact the 

MEDS Office Assistant (OA) to have 

Medi-Cal restriction removed when 

the DCSS penalized parent/caretaker 

relative becomes pregnant. 

If an applicant customer is denied or 

a recipient customer is penalized 

25% due to non-cooperation with the 

DCSS and the entire case is 

subsequently discontinued, the 

penalty is end dated and the 

customer given a new opportunity to 

cooperate with DCSS. 




Other 

information 

Filing 

instructions 


JV:KA:dg 

KD question #2464 will be archived with the release of this handbook letter. 


Page: 2-19 




AUGUST 18, 2009 



Overview The purpose of this Handbook Letter is to inform staff of the following 

CWPHB change: 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

• Reference to care of a child in the AU, for a child under 12 months of 

age, changed to care of a child in the home. 

• Added clarification that the care of a child under six (6) months of age; 

commonly referred to as the limited exemption is a six (6) month 

exemption. 

Low Level 


MC:BB:dg 

CalWORKs customers required to participate in welfare to work (WTW) 

activities may be affected by the change. 



Care of a child under 12-months of 

age exemption is based on care for 

the youngest child in the AU. 

Care of a child under 12-months of 

age exemption is based on care for 

the youngest child in the home. 

No previous policy. Added clarification that the care of a 

child under six (6) months of age; 

commonly referred to as the limited 

exemption is a six (6) month 

exemption. 


Pages: 

7-12 

7-13 



AUGUST 25, 2009 



Overview Per ACIN I-05-09, SB 1160 exempts nonneedy caretaker relatives who are 

receiving CalWORKs on behalf of a child who is a dependent of the court (and 

not eligible for federal Foster Care) from the face-to-face interview 

requirement when moving from one county to another. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Refer to the Operations and Reference Handbook for detailed information on 

Intercounty Transfer (ICT) procedures. 

High Level – Beginning September 1, 2009, when completing the CW 215 

for an ICT, Eligibility Workers (EWs) must notify other counties if the 

customer is a nonneedy caretaker relative receiving CalWORKs on behalf of 

a child who is a dependent of the court and not eligible for federal Foster 

Care. 

When a CW 215 with this information included is received from another 

county, EWs will not schedule a face to face interview for the customer. 

ICT cases with nonneedy caretaker relatives receiving cash assistance on 

behalf of a child(ren) who is a dependent of the court are affected by the 

change. 



All ICT cases were required to 

attend a face-to-face interview to 

redetermine CalWORKs 

eligibility. 


Page: 14-14 


ICT cases with nonneedy caretaker 

relatives receiving cash assistance on 

behalf of a child(ren) who is a 

dependent of the court are exempt from 

attending face-to-face interviews. 



JULY 8, 2009 



Overview This letter is to notify Eligibility Workers (EWs) information on Companion 

Medi-Cal Cases has been added to the handbook. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:dg 

Low Level – EWs will refer to this information when processing CalWORKs 

cases that have companion Medi-Cal cases. 

CalWORKs cases with companion Medi-Cal cases. 

In addition to the Companion Medi-Cal Cases information, the following 

updates/clarifications have been made: 

• Clarified that although the only eligible child placed in Foster Care is not 

eligible to Aid Code 38 Medi-Cal, the aided parent/caretaker relative is 

transferred to Aid Code 38 Medi-Cal. 

• Added Accelerated Enrollment (AE) eligibility must be determined prior to 

the end of the second month of AE eligibility on MEDS. 

• Updated procedures involving MEDS Specialists. 

• Corrected grammar and formatting as necessary. 

Old Policy effective 07/31/09 New Policy effective 08/01/09 

No previous policy. EWs must determine AE eligibility prior to 

the end of the second month of AE eligibility 

on MEDS. 


Table of Contents Page 1 of 1 

Pages: 15-1, 15-4, 15-9, 15-10, 15-12, 15-14, 15-15, 15-18, 15-19 and 

15-21 

Add: 

Page 15-12.1, 15-12.2 



JULY 10, 2009 



Overview The purpose of this handbook letter is to notify Eligibility Workers (EWs) of 

the change in the duration of cash aid eligibility of Afghan Special 

Immigrants. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Effective March11, 2009, Afghan Special Immigrants are eligible to receive 

cash aid for eight months from the date of entry to the United States or the 

date of adjustment of status if applying within the U.S. for special immigrant 

status. 

Low Level – EWs will refer to this handbook material when processing 

cases with Afghan Special Immigrants. 

CalWORKs cases with Afghan Special Immigrants are affected. 



Afghan Special Immigrants may 

receive federally funded benefits 

and other services for up to six 

months. 



Pages: 6-25.1 and 6-25.2 

Afghan Special Immigrants may 

receive federally funded benefits 

and other services for up to eight 

months. 



JUNE 26, 2009 



Overview The purpose of this handbook letter is to notify staff of revisions and 

additions to Chapter 12 which is being reissued in its entirety. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Low Level – Refer to updates as needed when taking case action. 

All CalWORKs cases are affected. 


• Corrected grammar and formatting where necessary. 

• Added Exempt MAP eligibility determination example for the receipt of 

IHSS services on page 12-7. 

• Added additional examples of stable and fluctuating income on page 

12-19. 

• Added example on averaging income on page 12-22. 

• Clarified how to average fluctuating income. 

• Updated MBSAC and MAP charts for AU members. 

• Updated MAP amounts used in examples. 

• Clarified intake mid-quarter reports. 

• Added section on when to discontinue persons when SSI is received. 

• Added definition for “uncollectible overpayments”. 

• Updated EW overpayment responsibilities. 

• Added information and example on non-collection of nonfraudulent 

overpayments under $35. 


No policy on the non-collection of 

nonfraudulent overpayments under 

$35. 

Overpayments which are 

nonfraudulent (administrative error) 

and totaling less than $35 are noncollectible. 




Filing 

instructions 


JV:KA:dg 





JUNE 15, 2009 



Overview The purpose of this handbook letter is to provide clarification regarding what 

convictions make a customer a drug felon. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Level – Low 


JV:LF:wsb 

All cases where a customer has a drug felon conviction. 

There is no change in policy. The handbook letter is for information only. 

Examples have been added regarding convictions for drug felons. 


Pages 17-42 & 17-43 

Add: 

Page 17-42.1 



MAY 15, 2009 



Overview The information regarding continuing eligibility for 18 year-olds not expected 

to graduate before his/her 19 th birthday because of a disability as outlined in 

IIN #05-007 has been added to the handbook. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

CalWORKs cases with 18 year-olds not expected to graduate before his/her 

19 th birthday because of a disability. 

There is no change to the existing policy. IIN #05-007 is obsolete with the 

addition of this information to the handbook. 


Table of Contents Page 1 of 2 

Pages 4-6, 4-7 

Add: 

Page 4-7.1 through 4-7.4 

Obsolete: 

IIN #05-007 


CWPHB #4541 (05/09) CVR LTR 1 OF 1


MAY 15, 2009 


CHAPTER 19– Charts, Tables and Lists 

Overview Effective July 1, 2009, the CalWORKs Maximum Aid Payment (MAP) levels 

will be reduced by 4%. This grant reduction affects all grant levels, including 

exempt and non-exempt MAP levels. 

Action time 

frame 

The CalWORKs Minimum Basic Standard of Adequate Care (MBSAC) Cost 




financial eligibility for customers applying for CalWORKs on or after July 1, 

2009. 

High Level – Eligibility Workers (EWs) must use the new MAP, MBSAC 

and IIK levels for processing effective July 1, 2009. 

Affected cases All CalWORKs cases are affected by the reduced MAP levels. CalWORKs 

cases with new and pending applications for July 1, 2009, and cases with IIK 

are affected by the MBSAC/IIK increases. 

Change 

summary 

New and 

pending 

applications 

Continuing 

applications 



Current MAP levels are effective The MAP levels are reduced by 4% 

through June 30, 2009. 


Current MBSAC and IIK levels are The MBSAC and IIK levels increased 

effective through June 30, 2009. by 1.53% effective July 1, 2009. 

Upon receipt of this handbook letter, begin using the new July 1, 2009 MAP, 

MBSAC and IIK levels for all new and pending applications. 

Upon receipt of this handbook letter, begin using the new MAP and IIK levels 

effective with the July 1, 2009 aid payment. This is considered a 

county-initiated change; the MAP reduction and IIK increase can be 

budgeted mid-quarter. 



Chapter 19- Charts, Tables and Lists, continued 

Chart updates The CalWORKs MAP, MBSAC and IIK charts for Region 1 and Region 2 

have been updated to reflect this year’s COLA. The charts are attached to 

this cover letter. The chart for Region 2 will be posted on the Transitional 


SCR 35561 SCR 35561 was created to update the MAP, MBSAC and IIK levels for 

CalWORKs processing and will be implemented with release 9.05 on 

May 18, 2009. A batch process will be performed in 06/2009 for all active 

CalWORKs cases for the month 07/2009. An exception report will be 

generated for cases missed by batch. A C-IV announcement will be issued 

when the report is available. 

Filing 

instructions 


Pages 19-3, 19-4 


JV:KA:wsb 



MAY 21, 2009 



Overview The CalWORKs Policy Handbook has been updated to add information 

regarding IIN #09-018 Advance Eligibility Determination (AED) Process. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

No action necessary 

All CalWORKs applications 



IIN #09-018 Advance Eligibility 

Determination Process 


Table of Contents Page 1 

Pages 1-2 

Add: 


Obsolete: 

IIN #09-018 


JV:MF:dg 

The AED process includes reviewing the 

customer’s SAWS 1 application, C-IV root 

questions, and the TAD 278 ID to 

determine: 

• The need for an expedited 

appointment for applicants with 

Immediate Need (IN) or Expedited 

Services (ES) eligibility, and 

• Potential eligibility for programs. 



MAY 6, 2009 



Overview Chapter 7 has been revised to state that the Eligibility Worker (EW) must 

initiate discontinuance for WTW non-compliance within seven (7) calendar 

days of being notified by the Employment Services Specialist (ESS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


MC:BB:wsb 

Low Level – Eligibility Workers should refer to Chapter 7 as required when 

processing changes. 

CalWORKs cases with customers required to participate in Welfare-to-Work 

program may be affected by the revision. 

The chapter has been revised as follows: 

• The Eligibility Worker (EW) must initiate discontinuance for WTW noncompliance 

within seven (7) calendar days of being notified by the 

Employment Services Specialist (ESS) via Task and e-mail. 

• The ESS will notify the EW of the sanction effective date. 


No Previous Policy. Eligibility Workers (EWs) do not need 

to send a WTW non-compliance 

Notice of Action (NOA) negative 

action notice when the NA 840, 845, 

816, or 817 has been sent by the 

EWs were required to initiate 

discontinuance for WTW noncompliance 

once notified by the ESS, 

but no time frame was established for 

taking the action. 


7-15 

7-19 

7-20 

7-22 

ESS. 

EWs must initiate discontinuance for 

WTW non-compliance within seven 

(7) calendar days of being notified by 

the ESS. 



APRIL 22, 2009 



Overview Chapter 7 has been revised to include current information on the Employment 

Services Program (ESP) and the Work Participation Rate (WPR). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Low Level – Eligibility Workers should refer to Chapter 7 as required when 

processing changes. 

CalWORKs cases with customers required to participate in Welfare-to-Work 

program may be affected by the revision. 

The chapter has been revised as follows: 

• Grammar and formatting corrected as required. 

• ESP objective to help customers become self-sufficient through 

employment added. 

• Marketing Tools used to inform participants of the WTW program and 

services added. 

• Definition of Work Eligible Individual added. 

• Communication between staff added. 

• WPR penalties and sanction added. 

• Section on introduction to the Word Participation Rate added. 

• Initiating participation process revised. 

• Acting on changes during participation section revised to include sending 

an e-mail as well as setting a task for the Employment Services 

Specialist (ESS). 


No Previous Policy. Eligibility Workers (EWs) do not need 

to send a WTW non-compliance 

Notice of Action (NOA) negative 

action notice when the NA 840, 845, 

816, or 817 has been sent by the 

EWs were required to initiate 

discontinuance for WTW noncompliance 

once notified by the ESS, 

but no time frame was established for 

taking the action. 

ESS. 

EWs must initiate discontinuance for 

WTW non-compliance within seven 

days of being notified by the ESS. 



CalWORKs Policy HTADandbook Letter #4537, Continued 

Filing 

instructions 


Chapter 7 

Obsolete: 

IIN 07-027 

IIN 07-042 Errata 




MC:BB:wsb 



APRIL 22, 2009 



Overview The purpose of this Handbook Letter is to inform Eligibility Workers (EWs) of 

the following change. 

Action time 

frame 

Affected 

cases 

Change 

Summary 

Filing 

instructions 

• Added EW and Employment Services Specialist (ESS) responsibilities for 

Re-Evaluation (RE) appointments from IIN #07-042 Errata. 

High level – EWs must notify ESSs when a customer who is not 

participating in WTW services is scheduled for a RE appointment. This 

will give the ESS the opportunity to meet with the customer and engage 

him/her in Welfare-to-Work (WTW) activities. 

All CalWORKs cases with a WTW work eligible person not participating in 

WTW are affected by the change. 



No previous policy. EWs will notify the ESS by setting a 

Task and sending an e-mail when 

scheduling a sanctioned WTW 

customer for a Re-Evaluation (RE) 

appointment. 

File in Chapter 1 of the CalWORKs Policy Handbook. 


1-31 


MC:BB:wsb 



APRIL 7, 2009 



Overview The purpose of this handbook letter is to notify staff the information on 

semimonthly warrants has been removed from the CalWORKs Policy 

handbook as San Bernardino County does not issue semimonthly warrants 

for CalWORKs payments. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Level – Low 

All CalWORKs cases 


JV:AK:dg 

Reference to issuing semimonthly warrants for CalWORKs payments has 

been removed. 


Page: 13-60 



MARCH 16, 2009 



Overview The purpose of this letter is to update Department of Child Support Services 

(DCSS) processes and inform staff of the changes. 

Action time 

frame 

Change 

summary 

Filing 

instructions 


JV:MM:dg 

Low Level – As Eligibility Workers (EWs) are applying or removing Child 

Support penalties, they must take the new information into consideration. 

See chart below for updates. 


• No specific information existed 

when forwarding the CW 51 to 

Program Integrity Division (PID). 

• Non-cooperation penalty 

continued after customer claimed 

good cause. 

• DCSS non-cooperation penalties 

were removed effective the first of 

the following month in which 

cooperation occurs. 

• The non-cooperation process 

included mailing of the ML 4621 

requesting the customer 

cooperate with DCSS prior to 

applying penalty. 


Pages 2-17.1, 2-19 and 2-20 

• Specific information is included 

when forwarding the CW 51 to 

PID. 

• Non-cooperation penalty must 

be ended when customer 

claims good cause. 

• DCSS non-cooperation 

penalties are now removed 

effective the first of the month 

in which cooperation occurs. 

• The non-cooperation process 

is now a chart and does not 

require the ML 4621 be sent to 

customers before applying 

penalty. 






Overview The purpose of this handbook letter is to notify staff of the changes in the 

time frames for customers to request a State Hearing or a rehearing of 

decisions due to the existence of good cause for filing the request late. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 


JV:AK:dg 

All CalWORKs cases are affected as customers may request a State Hearing 

beyond the 90-day time frame if good cause exists for filing late or request a 

rehearing of a decision beyond the 30-day time frame if good cause exists for 

the late filing. 



Customers could request a State 

Hearing within 90 days of any case 

action or inaction. 

Customers could request a rehearing 

of a decision within 30 days from the 

date the decision was received. 


Page 17-28 

Add: 

Page 17-28.1 

The 90 day time frame for requesting 

a State Hearing has been extended 

to 180 days if good cause exists for 

filing the request late. 

The 30 day time frame for requesting 

a rehearing of a decision has been 

extended to 180 days if good cause 

exists for filing the request late. 



January 22, 2009 

CalWORKS Policy Handbook LETTER #4531 

CHAPTER 6 – Citizens, Non-Citizens and Refugees 

Overview This handbook letter adds the aid code for Refugee Cash Assistance (RCA), 

in Chapter 6. 

Action time 

frame 

Filing 

instructions 


JV:dg 

None, information only. 


Page 6-31 




CalWORKs Policy Handbook #4530 Errata 


Overview The Errata is issued to update the mandatory journal entry wording to make it 

consistent with the Food Stamp Policy and Operation and Reference 

Handbooks. 

Filing 

instructions 

Distribution TAD staff 

JV:DC:dg 


Page 1-5 

CWPHB #4530 Errata (01/09) CVR LTR PAGE 1 OF 1


CalWORKS Policy Handbook #4530 



Overview The Applications chapter has been updated with the following information 

regarding the SAWS 2: 

• The SAWS 2 will be printed and reviewed with the customer. 

• The SAWS 2 will be given to the customer. 

• The certification/signature page, once signed, is the only page imaged 

into C-IV. 

• Wording for mandatory journal entries to used when the SAWS 2 is 

complete. 

Action time 

frame 

High Level: Beginning February 2, 2009, 

• Only the certification/signature page of the SAWS 2 will be imaged into 

C-IV. 

• SAWS 2 journal entries for application and re-evaluation will be required. 

Affected cases CalWORKs applications and re-evaluations. 

Change 

summary 

Filing 

instructions 


Old Policy Through 1/31/09 New Policy Effective 2/2/09 

The SAWS 2 was printed, reviewed 

with the customer, and imaged into 

C-IV. 


Page 1-5 

Add: 

Page 1-5.1 


The SAWS 2 will be printed, 

reviewed with the customer, and 

given to the customer. Only the 

certification page will be imaged into 

C-IV. 






Overview As an efficiency measure, the policy to refer customers with a disability 

lasting more than 12 months is being eliminated. 

Action time 

frame 

Change 

summary 

Filing 

instructions 

This Handbook Letter deletes the policy of referring customers to a 

Supplemental Security Income (SSI) Advocate. 

High Level – Immediately upon receipt of this handbook letter, Eligibility 

Workers (EWs) must stop referring customers to a SSI Advocate. 

See chart below for change. 


EWs were referring customers to a 

SSI Advocate when they had an 

incapacity expected to last 12 

months or more. 


Page 7-10, 7-12.1 

Distribution All CalWORKs 

JV:MM:dg 

EWs must no longer make any 

referrals to a SSI Advocate. 






Overview As an efficiency measure, the policy to refer customers with a disability 

lasting more than 12 months is being eliminated. 

Action time 

frame 

Change 

summary 

Filing 

instructions 

This Handbook Letter deletes the policy of referring customers to a 

Supplemental Security Income (SSI) Advocate. 

High Level – Immediately upon receipt of this handbook letter, eligibility 

Workers (EWs) must stop referring customers to a SSI Advocate. 



EWs were referring customers to a 

SSI Advocate when they had an 

incapacity expected to last 12 

months or more. 


Page 2-7 


JV:MM:dg 

EWs must no longer make any 

referrals to a SSI Advocate. 






Overview This Handbook Letter clarifies an EW must update the Expense Detail page 

in C-IV whenever permanent housing or utilities have been approved for 

Homeless Assistance (HA). 

Action time 

frame 

Change 

summary 

Filing 

instructions 

Mid Level – As Eligibility Workers (EWs) are processing HA, they must take 

the new information into consideration. 



EWs were not advised to update 

the Expense Detail page in C-IV 

whenever permanent housing or 

utilities were approved for HA. 


Pages 11-42 and 11-43 


JV:MM:dg 

EWs must update the Expense 

Detail page in C-IV whenever 

permanent housing or utilities have 

been approved for HA. 






Overview The purpose of this letter is to inform Eligibility Workers (EWs) of the new 

Income Reporting Threshold (IRT) levels for Region 1 and Region 2 for the 

period October 1, 2008 through September 30, 2009. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Other 

information 

Filing 

instructions 

High Level 


JV:KA:pcl 

All CalWORKs cases are affected by the increase in IRT levels. 







through 9/30/2009 will be used. 

SCR 32498 has been created to update the IRT levels in C-IV. C-IV will 

provide a list of cases denied or discontinued for being over IRT in 10/08, 

11/08, 12/08. When the list is made available, staff will be notified and 

instructions given for any required action. 


Page 19-5 

Note: The new IRT levels will also be placed on the Transitional Assistance 

Department (TAD) website under Resources. 



December 3, 2008 

CALWORKs POLICY HANDBOOK LETTER #4525 

CHAPTER 6 – CITIZENS/NONCITIZENS/REFUGEES 

Overview The purpose of this letter is to update the handbook with the Federal Deficit 

Reduction Act (DRA) requirements for documentation of citizenship status 

and identification for Medi-Cal applicants/recipients who claim to be United 

States (U.S.) citizens or nationals. The CalWORKs citizenship and identity 

documentation requirements fulfill the DRA requirements for current and 

former CalWORKs recipients. 

Also included is an update to information continuing eligibility for Afghan/Iraqi 

special immigrants and the I-151 Alien registration receipt card. 

Action High Level – The citizenship and identity verification must be 

completed on the Vital Statistics Detail page in C-IV for each program 

person claiming to a be U.S. citizen or national. For more information 

on documenting citizenship and identity verification, Eligibility Workers 

(EWs) may refer to the following IINs: 07-077, 07-086 Errata, and 08- 

065, or contact a Medi-Cal EW III for assistance. 

Affected 

cases 

At QR 7 and Re-Evaluation (RE) processing, EWs will need to review 

cases for noncitizens’ immigration status documentation. If the I-151 is 

the document provided for verification of immigration status, current 

documentation must be obtained. 

The following cases are affected by the changes: 

• All CalWORKs cases are affected by the DRA requirements. 

• CalWORKs cases with Afghan/Iraqi special immigrants. 

• CalWORKs cases with noncitizens who provided an I-151 as verification 

of immigration status. 




Change 

summary 

Filing 

instructions 


JV:KA:dg 



No policy. Citizenship and identity verification 

entries must be completed on the 

Vital Statistics Detail page for all 

U.S. citizens and nationals. 

No policy Afghan/Iraqi special immigrants may 

be eligible for state-funded benefits 

after the federal eligibility period 

ends, if they continue to meet all 

I-151 was acceptable as evidence of 

permanent residence indefinitely. 



Pages: 6-25.1, 6-25.2, 6-25.3, 6-60 

Add: 


other eligibility criteria. 

As of March 20, 1996, the I-151 was 

no longer acceptable as evidence of 

permanent residence. 



AUGUST 25, 2008 



Overview This Handbook Letter clarifies the TAD 371 is no longer needed. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 

Low Level – Information only. 

Only cases that require a referral to Child Support are affected by the 

updates of this Handbook Letter. 

See the table below for a summary of changes incorporated in this Handbook 

Letter. 


A TAD 371 was required when a 

discontinuance action was taken. 


Page 14-17 

A TAD 371 is no longer required to 

be sent Child Support when a 

discontinuance action is taken. 



AUGUST 25, 2008 



Overview This Handbook Letter clarifies the TAD 371 is no longer needed. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 





Letter. 


A TAD 371 was required to notify 

the support collection division when 

support was received directly from 

the absent parent. 


Page 9-18 

A TAD 371 is no longer required to 

notify the support collection division 

when support was received directly 

from the absent parent. 



AUGUST 25, 2008 



Overview This Handbook Letter clarifies the CW 2.1Q refers to the Support 

Questionnaire in C-IV. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 




CW 2.1Q is clarified as being the Support Questionnaire in the C-IV system. 


Page 4-37 



AUGUST 25, 2008 



Overview This Handbook Letter updates information regarding what information is 

exchanged via the Child Support interface with C-IV, and clarifies already 

established policies. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 

Low Level – Cal-Learn EWs must implement these changes as they 

encounter cases which must be referred to Child support. 




Letter. 


• No information existed as to 

what data was exchanged 

with Child Support once a 

customer claimed Good 

Cause. 

• CW 2.1Q was completed for 

both parents in the home 

when unmarried. 

• Information can now be found in the 

handbook as to what data is 

exchanged with Child Support once 

a customer claims Good Cause. 

• Only complete the Support 

Questionnaire (CW 2.1Q) for mother 

when both parents are in the home 

and unmarried. 


Pages 2-12, 2-12.1, 2-15 through 2-17, and 2-24 through 2-26 

Add: 

Pages 2-17.1 and 2-26.1 



AUGUST 14, 2008 



Overview This Handbook Letter updates some policies in the treatment of income and 

further clarifies existing policies. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


Medium Level – Eligibility Workers (EWs) must implement this policy as they 

encounter it. Changes need to be staffed upon receipt. 

All cases that contain earnings or anticipated income are affected by the 



Letter. 


• Old definition of reasonably 

anticipated income 

• Policy indicated every single 

income stub was required for 

Data Month with QR 7 

• Handbook indicated children 

of SSI recipients needed to 

apply for potentially available 

income 

• Explanation of narratives 

was limited 


Pages 9-4, 9-5, 9-20, 9-22 

Add: 

Page 9-22.1 

• Updated definition for reasonably 

anticipated income 

• Reference indicating all income 

stubs are required for the Data 

Month with the QR 7 has been 

removed 

• Reference regarding children of SSI 

recipients needing to apply for 

potentially available income has 

been removed 

• Journaling has been expanded for 

better understanding 

JV:MM:dg 



AUGUST 14, 2008 



Overview This Handbook Letter clarifies the definition of an unmarried adult male 

(UAM) and the CW 71 form. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 

Low Level – Eligibility Workers (EWs) must implement this policy as they 

encounter cases with UAMs. 

All cases with UAMs in the home are affected by the updates of this 

Handbook Letter. 


Letter. 


• Definition indicated an UAM 

is not related to a member of 

the Assistance Unit (AU) 

• Handbook did not clarify how 

often a CW 71 was needed 


Pages 9-38 and 9-40 

• Definition now shows an UAM is not 

related to any AU member 

• Handbook now clarifies a CW 71 will 

only be required once, unless a 

change in arrangements is reported 



AUGUST 22, 2008 



Overview This Handbook Letter updates the definition to Reasonably Anticipated 

Income, adds a section regarding budgeting mid-quarter reports at intake, 

and gives some examples. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:wsb 

High Level – Eligibility Workers (EWs) must implement this policy 

immediately. Changes need to be staffed upon receipt. 

All intake cases which have mid-quarter reports are affected by the updates 

of this Handbook Letter. 


Letter. 


No policy existed regarding what 

to do at intake if a mid-quarter 

change is reported and the case 

has already been processed. 


Table of Contents, page 2 of 3 

Pages 12-16 and12-48 

Add: 

Pages 12-57.1 and 12-57.2 

New policy exists on what to do at 

intake if a mid-quarter change is 

reported and the case has already been 

processed. 



AUGUST 21, 2008 



Overview This Handbook Letter advises of changes to policies regarding quarterly 

reporting, specifically when a QR 7 is complete vs. not complete, as well as 

how much verification is required for items reported on the QR 7. This 

handbook letter also contains minor updates and wording revisions. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:wsb 

High Level – Eligibility Workers (EWs) must implement this policy 

immediately. Changes need to be staffed upon receipt. 

All cases which contain earnings reported on the QR 7 are affected by the 



Letter. 

Old Policy through 09/30/08 New Policy 10/01/08 

• All pay stubs for the Data 

Month were required to be 

submitted with the QR 7. 

• New income was not 

included in the benefit 

determination for the 

upcoming quarter if it was 

not known by the customer 

in the Data Month. 


Chapter 10 

• QR 7 is not considered incomplete if 

all pay stubs are not included if 

enough information is provided and 

verified to reasonably anticipate and 

average income for the upcoming 

quarter. 

• Quarterly reporting rules allow 

income to be averaged based on all 

information and verification provided 

on the QR 7. 



JULY 28, 2008 



Overview The purpose of this handbook letter is to inform staff of what action to take 

when a customer requests a withdrawal of application in writing. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level – When a customer requests in writing to have their application 

withdrawn, the Eligibility Worker (EW) must complete the CW 10 and give it 

to the customer. A Notice of Action (NOA) is not given to the customer when 

withdrawing application in writing. 

CalWORKs intake cases are affected by the change. 


Old Policy through 07-31-08 New Policy Effective 08-01-08 

No previous policy. The EW will complete and give the 

CW 10 to the customer when the 

customer requests in writing to have 

their application withdrawn. 


Page 1-8 

Add: 

Page 1-8.1 


JV:KA:lc 



JULY 09, 2008 



Overview This Handbook Letter clarifies the responsibility of the Eligibility Worker (EW) 

to pend a Welfare-To-Work (WTW) program once a teen has been 

discontinued from Cal-Learn. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 


encounter Cal-Learn teens ending their participation. 

Only Cal-Learn cases are affected by the updates of this Handbook Letter. 


Letter. 


• No policy existed as to who 

would pend the WTW program 

once teen was discontinued 

from Cal-Learn. 


Page 7-56 

• The Cal-Learn EW must pend the 

WTW program in C-IV once the 

teen has ended his/her 

participation in Cal-Learn. 



JULY 7, 2008 



Overview The purpose of this handbook is to add information on restoring full scope 

Medi-Cal benefits to parents/needy caretaker relatives who become pregnant 

while receiving the 25% penalty for not cooperating with the Department of 

Child Support Services (DCSS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – The Eligibility Worker (EW) will contact the MEDS Specialist or 

MEDS Office Assistant (OA) and request the Medi-Cal restriction be removed 

in MEDS when parents/needy caretaker relatives become pregnant while 

receiving the 25% penalty for not cooperating with the Department of Child 

Support Services (DCSS). 

CalWORKs cases with the 25% penalty applied for not cooperating with 

DCSS are affected. 

Instructions for restoring full scope Medi-Cal to pregnant parents/needy 

caretaker relatives penalized for not cooperating with DCSS have been 

added. The change is summarized in the following table. 


No previous policy. When parents/needy caretaker 

relatives become pregnant while 

receiving the 25% penalty for not 

cooperating with the Department of 

Child Support Services (DCSS), the 

EW must contact the MEDS 

Specialist or MEDS OA and request 

removal of the restriction on the 

Medi-Cal. 


Page 2-19 


JV:KA:dg 

CWPHB #4514 (07/08) CVL LTR PAGE 1 OF 1


JULY 2, 2008 








Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 


JV:KA:dg 



This CWPHB Letter updates the list of Tribal Reservations and Rancherias 

with those identified in ACL 08-28 dated 06/10/2008. 


CWPHB Letter # 4473 contained 



07-25, dated 06/27/2007. 



This Handbook letter contains Tribal 



Handbook Letter and the 

information in ACL 08-28, dated 

06/10/2008. 



MAY 02, 2008 



Overview This Handbook Letter clarifies the timeframe an Eligibility Worker (EW) has 

when referring a customer to Welfare-To-Work (WTW) once Cal-Learn 

participation has ended. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:dg 


encounter Cal-Learn teens ending their participation. 

Only Cal-Learn cases are affected by the updates of this Handbook Letter. 


Letter. 


• No timeframe existed as to how 

long a Cal-Learn EW had to 

refer the teen to WTW. 

• Handbook did not clarify WTW 

and Cal-Learn programs could 

not be open simultaneously. 


Page 7-56 

• The Cal-Learn EW must refer the 

teen ending his/her participation 

in Cal-Learn to the WTW 

program within 10 days. 

• Handbook clarifies WTW and 

Cal-Learn programs must not be 

open simultaneously. 



JUNE 9, 2008 


CHAPTER 19– Charts, Tables and Lists 

Overview The CalWORKs Minimum Basic Standard of Adequate Care (MBSAC) Cost 


effective July 1, 2008. This year’s Cost of Living Adjustment (COLA) 

increases MBSAC and IIK by 5.26%. The new MBSAC levels are to be used 

in determining applicant financial eligibility for customers applying for 

CalWORKs on or after July 1, 2008. 

Action time 

frame 

High Level – Eligibility Workers (EWs) must use the new MBSAC and 

IIK levels for processing effective July 1, 2008. 

Affected cases CalWORKs cases with new and pending applications for July 1, 2008, and 

cases with IIK are affected by the MBSAC/IIK increases. 

Change 

summary 

New and 

pending 

applications 

Continuing 

applications 



Current MBSAC and IIK levels are 

effective through June 30, 2008. 

The MBSAC and IIK levels 

increased by 5.26% effective 

July 1, 2008. 

Upon receipt of this handbook letter, begin using the new July 1, 2008 

MBSAC and IIK levels for all new and pending applications. 

Upon receipt of this handbook letter, begin using the new IIK levels effective 

with the July 1, 2008 aid payment. This is considered a county-initiated 

change; the IIK increase can be budgeted mid-quarter. 

Chart Updates The CalWORKs MBSAC and Income In-Kind (IIK) charts for Region 1 and 

Region 2 have been updated to reflect this year’s COLA. The Charts are 

attached to this cover letter and will be posted to the TAD website. 



CHAPTER 19– Charts, Tables and Lists, Continued 

SCR 32423 SCR 32423 was created to update the MBSAC and IIK values for 

CalWORKs processing. Changes will be implemented 06/12/08. There will 

not be a batch run. A list of cases with saved EDBCs that have been 

previously denied due to failing the financial eligibility test through MBSAC 

for 07/01/08, but appear to be eligible under the new MBSAC levels will be 

provided. A list of active CalWORKs cases with IIK for the month of 07/2008 

will also be provided. Staff will be notified when these lists are posted. 

Filing 

instructions 


Pages 19-3, 19-4 


JV:KA:wsb 



JUNE 3, 2008 



Overview The purpose of this handbook letter is to inform staff of revisions to 

Chapter 15. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Low Level – CalWORKs Eligibility Workers (EWs) will need to refer to 

changes as necessary when action is taken on a case. 

All cases with discontinued persons transferred to Medi-Cal only and 

CalWORKs cases with companion Medi-Cal cases are affected. 


• Corrected grammar and formatting necessary. 

• Added the following sections: 

– Transitional Medi-Cal (TMC) 

– Post Medi-Cal Aid Code 54 – Four Month Continuing 

– Continuing Medi-Cal Aid Code 6J 

– Accelerated Enrollment (AE) for Children 

– Deemed Eligible (DE) Infants 

– Exception Eligible Report (EER) – Deemed Eligible Infants 

• Updated procedure for QMB determination. 

• Updated procedure for issuing Letters of Authorization. 

• Incorporated information from IIN 04-036. 


No previous policy. When case is discontinued for only 

eligible child out of home and 

customer claims disability but has no 

verification for Medi-Cal (MC) 

purposes, the EW must enter the 

appropriate medical condition on the 

Medical Condition Detail page in C- 

IV to ensure customer is transferred 

to MC aid code 6J. 



Filing 

instructions 

Remove and Replace 



JV:KA:dg 



MAY 27, 2008 



Overview The purpose of this handbook letter is to provide new information about 

noncitizen victims of human trafficking, domestic violence and other serious 

crimes regulations. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

Instructions 

High Level 

CalWORKs cases with noncitizen victims of human trafficking, domestic 

violence and other serious crimes. 

The changes are summarized in the following table. 


U Visa Interim Relief applications 

were accepted. 



Obsolete: 

IIN #07-097 


JV:BB:dg 

U Visa Interim Relief applications 

filed after October 17, 2007 are no 

longer accepted. 



APRIL 17, 2008 



Overview The purpose of this handbook letter is to correct the Exemption table for the 

VISTA Volunteer. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – As Eligibility Workers (EWs) encounter the above exemption, 

they are to use the correct review period. 

Cases with Welfare-To-Work (WTW) exemptions must be evaluated to see if 

they are impacted by this correction. 

The changed information is summarized in the table below. 


VISTA Volunteer exemption 

indicated a review was to be done 

monthly with the QR 7. 


Page 7-12 


JV:MM:dg 

VISTA Volunteer exemption now 

correctly states a review must be 

done quarterly with the QR 7. 



APRIL 18, 2008 



Overview The purpose of this handbook letter is to update Child Support Good Cause 

procedures due to the automation of Good Cause in C-IV, and the interface 

with the Department of Child Support Services’ (DCSS) new computer 

system (CCSAS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:wsb 

High Level – Effective 05/05/08, all Eligibility Workers (EWs) must follow the 

new procedures if a customer claims Good Cause for Child Support. 

All CalWORKs cases needing referral to DCSS are affected. 



• Paper CW 2.1 Q required to be 

sent to QRU and then to DCSS. 

• EW sent an email to DCSS to 

advise of Good Cause Claim. 


Page 2-17 

• Paper CW 2.1 Qs are no longer 

needed. 

• C-IV now holds or sends 

Support Questionnaire 

information to DCSS depending 

on C-IV entries. 



APRIL 18, 2008 



Overview This Handbook Letter explains the paper Support Questionnaire (CW 2.1Q) 

is no longer required to be sent to the Department of Child Support Services 

(DCSS), what happens once the referral is received in DCSS, and Tasks 

generated via the child support interface with C-IV. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Medium Level – CalWORKs Eligibility Workers (EWs) must implement these 

changes effective immediately for all Child Support referrals. 

All CalWORKs cases which require the completion of the Support 

Questionnaire (CW 2.1Q) are affected. 

The Child Support Referral Procedures have been updated to indicate the 

paper form of the Support Questionnaire (CW 2.1Q) is no longer required to 

be sent to DCSS, and that DCSS will contact the customer, instead of the 

customer initiating contact. 


• Upon completion of the 

CW 2.1Q, TAD sent the paper 

form to DCSS. 

• Customer would contact DCSS 

within 10 days. 

• Tasks were not listed in the 

handbook. 


Page 2-27 

Add: 

Page 2-27.1 


JV:MM:wsb 

• C-IV interfaces with DCSS to 

exchange Support Questionnaire 

information. 

• DCSS will contact customer to 

set up required interview. 

• Tasks are listed in the 

handbook. 



MARCH 21, 2008 




the need to restore full Medi-Cal to parents/needy caretaker relatives who 

become pregnant while receiving the 25% penalty for not cooperating with 

the Department of Child Support Services (DCSS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – If the parent or needy caretaker relative becomes pregnant 

while receiving the 25% penalty for non-cooperation with DCSS, Medi-Cal 

must be restored to the parent or needy caretaker relative. The EW will 

contact the MEDS specialist or MEDS Office Assistant and request that the 

Medi-Cal restriction be removed in MEDS. 

All CalWORKs cases with 25% penalty applied for not cooperating with 

DCSS. 

The change is summarized in the following table. 


No previous policy. If the parent or needy caretaker 

relative becomes pregnant while 

receiving the 25% penalty for noncooperation 

with DCSS, Medi-Cal 

must be restored to the parent or 

needy caretaker relative. 


Pages 2-18, 2-19 




MARCH 19, 2008 




when to add a parent or needy caretaker relative to the case when the 

immunization requirement has been met after a penalty was imposed. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 


JV:KA:cds 

CalWORKs cases with immunization penalties imposed against the parent or 

needy caretaker relative will be impacted. 

The change is summarized in the following table: 


When the parent or needy caretaker 

relative complies with the 

immunization requirement, the 

beginning date of aid (BDA) for 

adding the parent or needy 

caretaker to the case is the month 

prior to the date in which the: 

• IMMUN 1 or statement of 

exemption is received, 


• Child enters public or private 

school. 


Page 4-22 

When the parent or needy caretaker 

relative complies with the 

immunization requirement, the 

beginning date of aid (BDA) for 

adding the parent or needy 

caretaker to the case is the first of 

the month following the month in 

which the: 

• IMMUN 1 or statement of 

exemption is received, 


• Child enters public or private 

school. 



MARCH 20, 2008 




how to treat tax rebates received from the Economic Stimulus Act of 2008. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:cds 

Low Level – The tax rebates will be mailed out in May 2008. EWs will need 

to journal receipt of tax rebate and action taken. 

All CalWORKs cases with customers who are eligible to receive the tax 

rebate. 



No previous policy. Tax rebates received as a result of 

the Economic Stimulus Act of 2008 

are excluded in the month received 

and the following two (2) months. 


Page 9-14 



MARCH 18, 2008 




how to treat tax rebates received from the Economic Stimulus Act of 2008. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KA:cds 

Low Level – Rebates are due to be mailed out in May 2008. EWs will need 

to Journal receipt of tax rebate and action taken. 

All CalWORKs cases with customers who are eligible to receive the tax 

rebate. 



No previous policy. Tax rebates received as a result of 

the Economic Stimulus Act of 2008 

are excluded in the month received 

and the following two (2) months. 


Page 8-7 






Overview The purpose of this handbook letter is to notify Eligibility Workers (EWs) that 

Welfare to Work (WTW) sanctions will be applied to adults regardless of the 

number of months remaining in their CalWORKs 60-month time limit. The 

previous policy to not impose the WTW sanction when the adult was within 

three (3) months of his/her CalWORKs 60-month time limit is no longer in 

effect; therefore, this information is being removed from the handbook. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 

All CalWORKs cases 


JV:KA:deg 



Adults who are within three (3) 

months of reaching the CalWORKs 

60-month time limit will not have a 

WTW sanction applied for 

non-compliance. 


Table of Contents – Page 1 

Page 7-22 

WTW sanctions will be applied to 

adults regardless of the number of 

months remaining in their 

CalWORKs 60-month time limit. 






Overview The purpose of this handbook letter is to inform Eligibility Workers (EWs) of 

what action to take when evaluating a customer’s eligibility to the full 

exemption (FE) for the care of a child under 12-months of age. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

CalWORKs cases with children under 12-months of age. 



Either the EW or the Employment 

Specialist (ES) determined eligibility 

to the FE for the customer. 

The EW or ES researched the 

Welfare Archive Database (WD) 

when C-IV did not indicate FE was 

given to the customer. 


Pages 7-11, 7-12, 7-12.1 

Add: 

Page 7-12.2 


The EW will determine the 

customer’s eligibility for FE. 

The EW will research the “Full 

Exemption (FE) – Child Under One” 

list if C-IV does not indicate that the 

FE was given to the customer. 






Overview The purpose of this handbook letter is to provide new information about 

Cuban refugees, introduce regulations for Afghan and Iraqi Special 

Immigrants, and to add domestic violence to the noncitizen victims of human 

trafficking and other serious crimes regulations. 

Action time 

frame 

Affected 

cases 

Change 

summary 

High Level 

CalWORKs cases with Cuban refugees, Afghan and Iraqi immigrants, and 

noncitizen victims of domestic violence. 



No previous policy. Cuban medical professionals 

arriving in the U.S. may be eligible 

to receive Office of Refugee 

Resettlement (ORR) benefits; 

however, their non-Cuban spouses 

and children may not be eligible. 

No previous policy. Some Afghan immigrants have 

been granted Special Immigrant 

status and may be eligible to 

receive ORR benefits for no more 

than six months. 

No previous policy. Some Iraqi immigrants have been 

granted Special Immigrant status 

and may be eligible to receive ORR 

benefits for no more than eight 

Domestic violence was not included 

in the noncitizen victim of human 

trafficking and other serious crimes 

regulations. 

months. 

Domestic violence has been added 

to the noncitizen victim of human 

trafficking and other serious crimes 

regulations. 



CHAPTER 6 – Citizens, Noncitizens and Refugees, Continued 

Case flags Case flags must be set on CalWORKs cases with the following customers: 

Filing 

Instructions 


JV:KA:deg 

Customer Flag Title 

Afghan immigrant customer Afghan Special Immigrant 

Iraqi immigrant customer Iraqi Special Immigrant 

Noncitizen victim of human 

trafficking, domestic violence or 

other serious crime customer 


Table of Contents, Pages 1 through 3 

Pages 6-22, 6-47.1 through 6-47.4 

Add: 


Victim of Human Trafficking or Other 

Serious Crime 






Overview This handbook letter clarifies the communication method from Child Support 

regarding cooperation and non-cooperation. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:wsb 

Low Level – Action on cooperation and non-cooperation information 

received from Child Support must be on a flow basis, as they occur. 

All cases with referrals to the Department of Child Support Services (DCSS) 

have the potential of being impacted. 

The Customer non-cooperation process section was updated to show how 

Child Support staff communication this information to Eligibility Workers 

(EWs). 


Old policy did not indicate how EWs 

would be notified of non-cooperation 

or cooperation with Child Support. 


Page 2-20 

New policy shows Child Support will 

set a Task to inform EWs of noncooperation 

and cooperation. 



NAME OF HANDBOOK LETTER #4491 


CHAPTER 6 – Citizens, Noncitizens, and Refugees 

Overview This Handbook Letter makes minor revisions due to the changes in agency 

name and other grammatical or wording changes. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – Action on obtaining an HS 623 (E/S) must be taken as needed, 

and on a flow basis. 

All cases where birth verification is needed have a potential of being 

impacted. 

The revisions to page 6-4, were made to: 

• Update old policy to use current language 

• Change the name of the form to HS 623 (E/S) from HSS 623. 

• Other non-substantive wording changes. 


Old policy had outdated 

information and 

language. 


Page 6-4 


JV:MM:deg 

New policy indicates: 

• Change in form name, 

• Birth verification will be obtained, instead of 

verifying circumstances in a birth, and 

• Use Journal instead of narrate. 

CW HB #4491 (02/08) CVR LTR PAGE 1 OF 1


CALWORKS POLICY HANDBOOK #4477 



Overview Chapter 18 has been revised to include recent changes and to remove 

obsoleted information. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 

All CalWORKs cases. 

Chapter 18 has been revised as follows: 

• Corrected grammar and formatting as necessary. 

• Information reorganized for easier location . 

• Incorporated IINs 07-037 and 07-043. 

• Removed reference to Database reviews; all reviews are either Time on 

Aid (TOA) or Complete TOA reviews. 

• Referenced imaging documents in C-IV. 

• Updated work registration and exception codes. 

• Added revised instructions for TOA reviews. 

• Added section on obtaining information to complete TOA reviews. 


If a customer was within three 

months of reaching his/her 60-month 

CalWORKs time limit, a new WTW 

sanction was not imposed. The 

customer received aid for the 

remaining months and was then 

discontinued for timing-out. 



Remove: 

IINs 07-037, 07-043 


JV:KA:lc 

A WTW sanction will be imposed 

against a customer regardless of 

how much time on aid is remaining. 






Overview This Handbook letter contains: 

Action time 

frame 

Affected 

cases 

Change 

summary 

• Revisions and additions in order to clarify and update information in this 

chapter, and 

• Changes to the Homeless Assistance (HA) program 

Low Level – CalWORKs Eligibility Workers (EWs) must refer to the updates 

and changes to the Special Needs Chapter as needed when taking action on 

a case. 

All cases which are eligible to receive any type of special needs, especially 

HA, can be impacted. 

The Special Needs Chapter has been revised as follows: 

• Corrected grammar and formatting where necessary. 

• Added “PSN requests” section to clarify how long customer has to 

provide verification and steps to take if customer fails to provide. 

• Clarified onset of Pregnancy Special Needs (PSN) for a pregnant woman 

recipient. 

• Added PSN example for “Verification provided after denial.” 

• Clarified HA cases should not be denied once benefits/vouchers have 

been issued. 

• Clarified to whom Permanent HA payments should be issued. 

• Added HA example to clarify the once-in-a-lifetime exemption. 

• Added note to clarify costs associated with HA must not exceed two 

months of an Assistance Unit’s (AU’s) rent. 

• As a result of the enactment of Assembly Bill (AB) 1808, changes were 

made to the HA program effective 07/12/06. Instructions were issued in 

IIN #06-044 ERRATA. 




Change 

summary 

(continued) 

Filing 

instructions 


• No instructions on how to 

proceed when a customer 

failed to provide verification 

for a PSN request 

• A pregnant woman recipient 

was able to receive PSN 

from the first of the month the 

medical verification of 

pregnancy was received 

• EWs were denying the HA 

program once a voucher had 

been issued 

• Handbook did not address 

who should be issued a 

Permanent HA payment. 


Entire chapter 

Remove: 



JV:MM:lc 

• Specific instructions on what to do 

when a customer fails to provide 

verification for a PSN request 

• A pregnant woman is able to 

receive PSN from the first of the 

month of when the request is made 

• A HA program cannot be denied in 

C-IV once a voucher has been 

issued 

• Handbook has been clarified to 

indicate only property owners and 

Property Management Companies 

are to be issued a Permanent HA 

payment. 






Overview This Handbook Letter updates and clarifies School Attendance information. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:wsb 

Low Level – CalWORKs Eligibility Workers (EWs) must refer to the updates 

and changes of this Handbook Letter as needed when taking action on a 

case. 

All cases containing school age children may be impacted. 

The Children and Eligibility Chapter has been updated to redefine rules for 

18-year olds and clarify what action to take when a penalty results in a zero 

grant. 


Rules indicated an 18-year old must 

meet the school attendance 

requirement or be penalized. 

When a school attendance penalty 

and other income resulted in zero 

grant, the case was left open. 



The 18-year old must only be 

enrolled as a full time student or in 

vocational or training program, 

which will not lead to a college 

degree. 

The case will be discontinued 

because the application of the 

penalty makes the Assistance Unit 

(AU) income ineligible. 






Overview This handbook letter revises the examples on evaluating motor vehicles in 

CalWORKs cases to show ineligibility for assistance due to being over the 

resource limit. 

Action time 

frame 

Affected 

cases 

Filing 

instructions 

High Level 



Page 8-12.1 


CWPHB #4495 (01/08) JV:KA:lc CVR LTR PAGE 1 OF 1





Overview This purpose of this handbook letter is to provide information on the 

treatment of military combat zone pay in CalWORKs. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 



Old Policy through 12/13/2007 New policy effective 12/14/2007 

Old policy made no reference to the 

treatment of the portion of military 

pay designated as “combat zone 

pay”. 


Page 9-8 

Distribution All TAD 

JV:KA:wsb 

Combat zone pay is treated as 

earned income in CalWORKs. 





CHAPTER 6 – Citizens/Noncitizens/Refugees 

Overview Senate Bill (SB) 1569 instituted provisions for state-funded cash assistance 

eligibility of qualified noncitizen victims of trafficking, domestic violence, and 

other serious crimes. The purpose of this handbook letter is to provide 

information on the eligibility requirements of noncitizen customers applying 

for CalWORKs who claim the status of a victim of human trafficking or other 

serious crimes as provided in ACL 06-60. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 

All CalWORKs 



No previous policy. Noncitizen customers determined to 

be victims of human trafficking or 

other serious crimes may be eligible 

to state-funded cash assistance. 


Table of Contents, Page 1 and 2 

Remove: 

Table of Contents, Page 3 

Add: 



JV:KA:lc 






Overview The purpose of this handbook letter is to provide clarification on when to lift a 

school attendance penalty. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 




Previous policy did not state that the 

school attendance penalty is lifted 

when the TAD 144 is received 

verifying acceptable attendance. 


Page 4-32 


JV:KA:cs 

The school attendance penalty will 

be lifted when the TAD 144 is 

received verifying acceptable 

attendance. 






Overview The purpose of this handbook letter is to provide clarification on evaluating 

motor vehicles in CalWORKs continuing cases. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 




Previous policy did not include an 

example for evaluating motor 

vehicles on CalWORKs continuing 

cases. 


Page 8-12.1 


An example has been added to 

assist the Eligibility Worker in 

evaluating motor vehicles on 

CalWORKs continuing cases. 

CWPHB #4490 (11/07) JV:KA:lc CVR LTR PAGE 1 OF 1





Overview The purpose of this handbook letter is to clarify what action the Eligibility 

Worker (EW) will take when a customer claims Good Cause for not 

cooperating with the Department of Child Support Services (DCSS). 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 




Previous policy did not include the 

need for the completion of a paper 

CW 2.1Q when the customer claims 

Good Cause. 


requirement to complete the absent 

parent information in C-IV when 

Good Cause is denied. 


Page 2-17 


JV:KA:lc 

Added need to complete paper 

CW 2.1Q when the customer claims 

Good Cause. 

Added the requirement to complete 

the absent parent information in 

C-IV when Good Cause is denied. 







Overview This handbook letter is being issued for general handbook clean up. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 



JV:KA:lc 




requirement to refer customers to 

apply for SSA disability benefits for 

children whose parent(s) receives 

SSA Disability benefits. 

Reference made to the location of 

IRT charts in the ORHB. 


Pages 9-20 and 12-38 

EWs will refer customers to SSA to 



SSA Disability benefits. 

IRT charts are not located in the 

ORHB. They are located in the 

Charts, Tables and Lists chapter of 

the CWPHB. 






Overview An example has been added to the Motor Vehicle Value Determination 

section of this handbook chapter to assist Eligibility Workers in determining 

the value of licensed vehicles that are not excluded. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level 

All CalWORKs 



The previous policy did not include 

an example for evaluating licensed 

motor vehicles that are not exempt 

from the resource eligibility 


Add: 

Page 8-12.1 


JV:KA:lc 

An example has been added to 

clarify how to evaluate licensed 

motor vehicles that are not exempt 

from the resource eligibility 




CALWORKS POLICY HANDBOOK #4486 



Overview This handbook letter updates Chapter 19 Table of Contents. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 



JV:KA:lc 



The previous Table of Contents did 

not include pages 19-3.1 and 

19-4.1. 



Pages 19-3.1 and 19-4.1 have been 

added to the Table of Contents. 






Overview This handbook letter incorporates the July 2007 and August 2007 Maximum 

Aid Payment (MAP) increase as outlined in All County Letter No. 07-34. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Refugee Cash 

Assistance 

(RCA) 

The 2007-2008 State budget and related legislation suspended the 

CalWORKs MAP Cost of Living Adjustment (COLA) for one year. However, 

since the budget and related legislation were not approved until late August 

2007, the months of July 2007 and August 2007 are exempt from this 

one-year COLA suspension. Therefore, a one-time supplement will be 

issued to CalWORKs recipients for the months July 2007 and August 2007. 

High Level 



Old Policy through 06/30/2007 

and 09/01/2007 ongoing 

The CalWORKs MAP COLA has 

been suspended for one year. 


through 08/31/2007 

07/2007 and 08/2007 are exempt 

from the CalWORKs MAP COLA 

suspension. 

The retroactive MAP COLA shall apply to RCA applicants and recipients 

also. 



CHAPTER 19 – Charts, Tables and Lists, Continued 


retroactive 

payments 

Re-evaluating 

July 2007 and 

August 2007 

applications 

For CalWORKs, and RCA purposes, this payment is considered a corrective 

underpayment and is not considered income or a resource in the month paid 

or the following month. The Food Stamp Program will treat the July and 

August CalWORKs MAP COLA as a resource. 

When a customer is found eligible to a retroactive payment and receives a 

corrective underpayment, the payment shall be counted against the 

customer’s TANF and/or CalWORKs 60-month time limit for July 2007 and 

August 2007. 

Applications denied in July 2007 and August 2007 solely for failing the 

recipient eligibility test must be re-evaluated and grant amounts redetermined 

based on the higher MAP levels. 

If the applicant customer’s initial application is re-evaluated and still denied 

due to excess income, no further action is needed. However, if after reevaluating 

the application, the applicant customer now passes the recipient 

financial eligibility tests (QR 30), the applicant customer is required to provide 

the necessary information and documentation for each individual QR 


Closed cases CalWORKs cases discontinued due to excess income for the months of July 

2007 and August 2007 must be reviewed to determine if the increased MAP 

levels would result in those cases being eligible. If found to be eligible using 

the new MAP level, the discontinuance must be rescinded and retroactive 

eligibility redetermined. 

Grants less 

than $10 

Overpayment 

recovery 

Any grant not issued for July and/or August 2007 because it was less than 

$10, and the AU is now eligible to at least $10 due to the July 2007 and 

August 2007 COLA amounts, will be issued with the July 2007 and August 

2007 COLA supplements. 

The July 2007 and August 2007 supplements made to CalWORKs recipients 

as head of their own AU are to be offset against existing cash aid 

overpayments. However, the supplements cannot be used to offset 

supportive services overpayments except when the recipient volunteers. 

Added charts For this COLA change, an additional chart has been added for both the 

Region 1 and Region 2 July 2007 and August 2007 MAP COLA increases. 


Action 

A Notice of Action will be sent to customers eligible to supplements informing 

them of the reason for the July and August 2007 COLA supplement. 



CHAPTER 19 – Charts, Tables and Lists, Continued 

Other 

information 

Filing 

instructions 

SCR 30666 will update the levels in C-IV. 


Pages: 19-3, 19-4 

Add: 

Pages: 19-3.1, 19-4.1 


JV:KA:ker 






Overview This handbook letter is being issued to inform Eligibility Workers (EWs) that 

the potential for receipt of SSA disability benefits for children whose parent(s) 

receives SSI/SSP must be explored. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 



JV:KA:lc 

Information has been added to alert EWs that a referral to SSA for children of 

SSI/SSP recipient customers is required to determine their eligibility for SSA 

disability benefits. 



requirement to refer customers to 



SSI/SSP. 


Page 9-20 

EWs will refer customers to SSA to 



SSI/SSP. 






Overview The purpose of this letter is to inform Eligibility Workers (EW) of the new 

Income Reporting Threshold (IRT) levels for Regions 1 and Regions 2 for 

the period October 1, 2007 through September 30, 2008. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Other 

information 

Filing 

instructions 

High Level 



JV:KA:lc 







through 9/30/2008 will be used. 

There is an SCR to update the IRT levels in C-IV. EWs will need to re-run 

10/2007 EDBC for cases that are denied or discontinued for being over IRT 

before the new IRT levels are added to C-IV. 


Page 19-5 






Overview The purpose of this handbook letter is to inform staff of the new number for 

referring customers to the Department of Child Support Services (DCSS) for 

initial interviews. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

High Level – Begin referring customers to the new number immediately. 

All CalWORKs applications, both full case (Intake) and add person 

(Continuing) applications, which require the completion of the Support 

Questionnaire (CW 2.1Q). 

DCSS has changed the number for customer referrals for initial interviews. 


Customers were referred to 

(866) 402-3944 for DCSS 

interviews. 


Page 2-27 


JV:KA:lc 

Customers will now be referred to 

(866) 921-3693 for DCSS 

interviews. 



SEPTEMBER 5,2007 



Overview The purpose of this handbook letter is to update the wording of current policy 

for adding an adult to CalWORKs after an Employment Services Program 

(ESP) sanction has been cured. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

All CalWORKs cases that involve adding a person after an ESP sanction has 

been cured. 

Changed the wording, “Welfare to Work sanction or penalty lifted “ to 

“Employment Services Program sanction cured”. 


No change No change 


Page 1-36 


JV:KA:lc 






Overview This handbook letter was issued to correct the procedure on determining the 

amount of special needs payments for excessive use of utilities. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level 

CalWORKs cases receiving special need payments for excessive use of 

utilities. 

The amount of special needs payment for excessive use of utilities is 

determined by multiplying $10 by the number of aided AU members, or $5 

per month if proof of the cost is not provided. 


The amount of special needs 

payment for excessive utilities is 

determined by the actual verified 

utility cost in excess of the in-kind 

value for that AU size, or $5 per 

month if proof of the cost is not 

provided. 


11-11 


JV:KA:lc 

The amount of special needs 

payment for excessive utilities is 

determined multiplying $10 by the 

number of aided AU members, or 

$5 per month if proof of the cost is 

not provided. 






Overview The purpose of this letter is to inform staff of the increase in the Victor Valley 

Transit Authority (VVTA) Bus Pass rates effective August 27, 2007. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low 


JV:KA:lc 

All Cal-Learn cases eligible to transportation supportive services. 

The following table summarizes the changes. 


The $5.00 Daily Bus Pass has This Daily Bus Pass was 

increased. 

increased to $5.50. 

The cost of the VVTA Monthly Bus The new cost of the VVTA Monthly 

Passes for customers in Job Search Bus Passes for customers in Job 

or Training Programs was $30.00. Search or Training Programs is 

$40.00. 

The cost of the VVTA Monthly Bus The cost of the VVTA Monthly Bus 

Pass for all other customers was Pass for all other customers is 

$40.00. 

$50.00. 


Page 7-44 



AUGUST 21, 2007 



Overview This handbook letter explains what action the Eligibility Worker (EW) will take 

when the death of the caretaker relative occurs while a child is receiving 


Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Level – Low 

All CalWORKs cases are potentially affected by this update. 

When the EW learns of the death of a parent caretaker or other caretaker 

relative of a child receiving CalWORKs benefits, the EW will determine 

whether the child remains eligible for CalWORKs benefits. 

Old Policy 

through 

08/21/2007 


No policy. The EW will make a determination for continuing 

benefits for an aided child when the EW learns of the 

death of the child’s parent caretaker or relative 

caretaker. 


Page 13-23 

Add: 

Page 13-23.1 


JV:KA:lc 



AUGUST 13, 2007 



Overview The purpose of this handbook letter is to include in this chapter, information 

about the Disaster Unemployment Assistance (DUA) program. 

Action time 

frame 

Change 

summary 

Filing 

instructions 

High 

The Disaster Unemployment Assistance (DUA) program provides benefits to 

individuals who suffered job loss or endured unemployment as a result of the 

freeze in California in January 2007. 


Table of Contents (Page 1 of 1) 


Add: 

Page 9-43.1 


JV:KA:lc 






Overview This letter updates the steps necessary to process a complete QR7. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Level – High 

The update affects all quarterly reporting cases. 

When a QR7 is processed, the QR7 with verifications, must be routed to 

imaging immediately. 


File the QR7 in the case. Immediately route QR7, with 

verifications, to imaging. 


Page 10-23 


JV:KA:lc 



JULY 23, 2007 


CHAPTER 19 – Charts, Tables, and Lists 

Overview The handbook letter updates the changes to the MBSAC and 

Income In-Kind (IIK) charts based on this year’s COLA increases. This 

errata corrects the effective date of the current non-exempt and exempt MAP 

amounts for Regions 1 and 2. 

Specific 

changes 

The following changes were made: 

• Increases to the CalWORKs MBSAC levels for Regions 1 and 2 effective 

7/01/2007 and ongoing. 

• Increases to the Income In-Kind (IIK) levels due to the increase in the 

COLA. 

• Corrects the effective date of the current CalWORKS non-exempt and 

exempt MAP amounts from 07/2005 ongoing to 08/2005 ongoing for both 

Regions 1 and 2. 

Implementation Intake: 

• Begin using the July 1, 2007 MBSAC amounts immediately upon receipt 

for all new and pending applications. 

• Begin using the new Income In-Kind (IIK) amounts effective with the 

August 1, 2007 aid payment. 

Filing 

instructions 

Continuing: 


August 1, 2007 aid payment. This is considered a county-initiated 

change. Staff will be notified when the list is posted along with 

instructions. 

• There will not be a batch run. A list of cases with active Income In-Kind 

(IIK) amounts will be posted. EDBC must be run prior to main payroll in 

7/2007 to prevent overpayments. 


Pages 19-3, 19-4 


JV:KA:lc 



JULY 11, 2007 



Overview Counties recently received policy clarification from the California 

Department of Social Services (CDSS), CalWORKs Bureau, regarding 

how to treat a Maximum Family Grant (MFG) child when that child has 

received 24 consecutive months of Zero Basic Grant (ZBG). This 

Handbook Letter provides instructions for identifying and converting that 

MFG child from MFG to MFG exempt status. 

Action time frame High – Staff immediately 

All cases on the list, “MFG_zero_grant_12” must be reviewed by 

cut-off in July (07/20/2007). 

Affected cases CalWORKs cases affected by this clarification include only those with 

Active MFG children receiving no grant (ZGB). All other CalWORKs 

cases, with or without Active MFG children, are not affected by this 

change. 

MFG_zero_grant_ 

12 list 

A list named “MFG_zero_grant_12” contains all Active CalWORKs cases 

with at least 12 months ZBG and an Active MFG child is posted on the 

C-IV Resource Center. This list contains the following information: 

• Case Number 

• Case Name 

• Worker Number 

• Worker Name 

• Indicator – An entry of “X” indicates that case has received at least 24 

months of ZBG. 

All cases on this list must be reviewed by cut-off in July 

(07/20/2007). 



Chapter 4 – Children and Eligibility, Continued 

Change 

summary 

MFG/ZBG 

criteria 

Identifying 

MFG/ZBG 

cases 

Once an MFG child has received 24 consecutive months of ZBG, that child 

meets an MFG exemption and becomes eligible to receive CalWORKs case 

benefits. 


MFG exemption for nonreceipt of 

aid for at least 24 consecutive 

months did not include time as an 

MFG child on a ZBG CalWORKs 

case. 

MFG exemption of nonreceipt of aid 

for 24 consecutive months does 

include time as an MFG child on a 

ZBG CalWORKs case. 

A case must meet both of the following criteria to be MFG/ZBG: 

• Be an Active CalWORKs program receiving ZBG, and 

• Have at least one Active MFG child. 

MFG/ZBG cases are identified at the following times: 

• Application, both full case (Intake) and add person, 

• Re-Evaluation (RE), 

• QR 7 review, and 

• Review of one-time “MFG_zero_grant_12” list. 

Conversion MFG children receiving ZBG CalWORKs, which have received or will have 

received at least 24 consecutive months of ZBG as of 07/31/2007 will have 

the MFG status removed as of 07/31/2007. After reviewing the case and the 

CalWORKs program to verify no cash aid has been received in any California 

county for 24 consecutive months, take the following actions: 

Step Action 

1 In C-IV, on the Non-Compliance Detail page for the MFG record, 

set End Date = 07/31/2007. 

2 In C-IV, run the 08/2007 CalWORKs EDBC to authorize cash aid 

for the child effective 08/2007. The child’s Role will change from 

MMO to MEM. 

Note: If the Food Stamp program is Active, run the 08/2007 

CalWORKs and Food Stamp EDBCs together. Follow the 

instructions in the Food Stamp Policy Handbook regarding 

CalWORKs grant increases and Mid-Quarter changes. 

3 Send appropriate notice(s) to the customer. 

4 Use a TAD 371 to Notify the Local Child Support 

Agency/Department of Child Support Services (LCSA/DCSS) the 

child is no longer MFG effective 08/2007. 




Chapter 4 – Children and Eligibility, Continued 

Task – 

MFG/ZBG 

review 

Filing 

instructions 


JV:KH:lc 

For those cases meeting the MFG/ZBG criteria, set a Task with Short 

Description of “MFG/ZBG review” and a Long Description including the name 

of the MFG child as follows: 

If the 24 th month of ZBG will be … Then set a Task for the … 

Before the next CalWORKs RE is Expected 24 

due, 

th month of ZBG. 

The month of next CalWORKs RE is RE month. 

due, 

After the next CalWORKs RE is RE month. 

due, 



Pages 4-10, 4-11, 4-13, and 4-15 

Add: 

Pages 4-10.1, 4-15.1, and 4-15.2 



JULY 19, 2007 



Overview The purpose of this letter is to inform staff of the increase in the OmniTrans 

Monthly bus pass rate effective July 1, 2007. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low 

All Cal-Learn cases eligible to transportation supportive services. 

The following table summarizes the change. 


The cost of the OmniTrans monthly 

bus passes was $41.00 through 

June 30, 2007. 


Page 7-44 


JV:KA:kc 

The new cost of the OmniTrans 

monthly bus passes is $44.50 and is 




JULY 5, 2007 




counties, via an All County Letter (ACL), the California Tribal Reservations 




Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:KH:lc 

Low Level – Provide new information to staff within the next five weeks. 

The following TANF cases are affected by this change: 

• Intake and Continuing, and 

• Families living on the listed Tribal Reservations and Rancherias. 

This CWPHB Letter updates the list of Tribal Reservations and Rancherias 

with those identified in ACL 07-25 dated 06/27/2007. Additionally, some of 

the counties and years listed in the CWPHB have been changed to reflect 

the correct county where the Tribal Reservation or Rancheria is located 

and/or the correct year unemployment was 50% or greater. 


CWPHB Letter # 4459 contained 



06-23, dated 07/21/2006. 


Pages 18-28 through 18-30.1 

This Handbook letter contains Tribal 



Handbook Letter and the 

information in ACL 07-25, dated 

06/27/2007. 



JUNE 12, 2007 



Overview This handbook letter updates the changes to the MBSAC and 

Income In-Kind (IIK) charts based on this year’s COLA increases. 

Specific 

changes 




• Increases to the Income In-Kind (IIK) levels due to the increase in the 

COLA. 





August 1, 2007 aid payment. 

Filing 

instructions 

Continuing: 


August 1, 2007 aid payment. This is considered a county-initiated 

change. Staff will be notified when the list is posted along with 

instructions. 

• There will not be a batch run. A list of cases with active Income In-Kind 

(IIK) amounts will be posted. EDBC must be run prior to main payroll in 

7/2007 to prevent overpayments. 


Pages 19-3, 19-4 


JV:KA:lc 



JUNE 12, 2007 



Overview This handbook letter provides clarification on the Beginning Date of Aid for a 

Change of Payee. 

Specific 

changes 

Filing 

instructions 

The Beginning Date of Aid for the new payee is determined by the living 

arrangements that existed on the first of the month following the month in 

which the new living conditions existed. 


Page 1-54 


JV:KA:lc 



JUNE 15, 2007 



Overview Deleted information regarding Homecalls taken within 60 days from 

application date. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low 

Cases needing a Homecall. 

Deleted information regarding Homecall referrals on all applications 


Conduct Homecall referrals on 

all applications within 60 days 


Page 17-16 


JV:KA:lc 

Homecalls are no longer required on 

new applications unless they meet one 

of the other requirements. 



MAY 24, 2007 



Overview This Handbook Letter clarifies actions needed when a case exceeds the 

income limits and paid Work Experience (WEX) hours are involved. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 


JV:MM:lc 

Mid Level – CalWORKs Eligibility Workers (EWs) must implement these 

changes as cases with paid WEX income are worked. 

Continuing CalWORKs cases in which an Assistance Unit (AU) member is 

enrolled in a paid WEX activity have the potential of being affected by these 

changes. 

Paid WEX has been added to this Chapter to clarify the steps to take when 

paid WEX hours contribute to the case being over the income limits. 


Previous policy did not include 

separate treatment of paid WEX 

hours when the hours placed the 

case over income limits. 


TOC page 1 of 1 and 9-15 

Add: 

9-27.1 

EWs and Employment Specialists 

(ESs) work together to review, 

adjust, and/or close the paid WEX 

activity, if needed, to eliminate the 

CalWORKs case from being 

discontinued solely due to the paid 

WEX activity. 




MAY 24, 2007 



Overview This Handbook Letter adds information regarding paid Work Experience 

(WEX) and where to refer to for more information. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – CalWORKs Eligibility Workers (EWs) must implement these 

changes as cases with paid WEX income are worked. 

Continuing CalWORKs cases in which an Assistance Unit (AU) member is 

enrolled in a paid WEX activity have the potential of being affected by these 

changes. 

Information has been added to this Chapter to refer EWs to Chapter 9 for 

more information where an AU member is enrolled in a paid WEX activity, 

before discontinuing a case. 


EWs would discontinue a case even 

though an AU member was enrolled 

in a paid WEX activity. 


12-31 and 12-32 


JV:MM:lc 

EWs are referred to Chapter 9 for 

more information before 

discontinuing a case where an AU 

member is enrolled in a paid WEX 

activity. 


CW HB #4466 (05-07) CVR LTR PAGE 1 OF 1


MAY 1, 2007 



Overview The purpose of this handbook letter is to make the change of who conducts 

checks on fleeing felons and probation/parole violators from the Fraud 

Investigation Unit (FIU) to the Quality Review Unit (QRU) 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low 


JV:AG:lc 

All cases with Fleeing Felons and Probation/Parole Violators 

Name change from Fraud Investigation Unit to Quality Review Unit 


The FIU conducts checks on fleeing 

felons and probation/parole 

violators 



The QRU conducts checks on 

fleeing felons and probation/parole 

violators 



MAY 14, 2007 



Overview The purpose of this handbook letter is to introduce into this chapter the EBT 

Host-to-Host. This is the interface process, which replaces the multiple daily 

batch runs, and allows EBT accounts, rush and cancelled EBT benefits to be 

processed in real time. Routine benefits will continue to be processed in the 

nightly batch. Beginning May 21, 2007 the Eligibility Worker (EW) will have 

access to EBT screens and can complete certain actions, in the C-IV system, 

that were previously completed by Office Assistant staff in the Administrative 

Terminal. 

Changes and 

additions 

With EBT Host-to-Host the EW will be able to 

• View the EBT Account List page, and EBT Account Detail page. 

• Search and retrieve EBT Account numbers and cards from JP Morgan. 

• Reactivate Dormant and Expunged Accounts. 

• Add or create a new EBT Account. 

• Create secondary EBT cards. 

• Cancel and reissue EBT cards for mail out. 

• Modify the EBT card Status and Access type. 

• Update the demographic information to the EBT Card Detail page. 

• View transaction searches up to 90 days of online history. 

• Accept and save EDBC without a current EBT account for the case. 

In order to implement the EBT Host-to-Host functionality in C-IV, the 

following changes and additions have been made: 

• The daily EBT batch process is replaced with the Host-to-Host interface 

process. Once EDBC is accepted and saved, the benefit information will 

be sent automatically to JP Morgan via Host-to-Host. 

• All EBT issuance automatically store account numbers upon being 

created. 

• If a rush issuance is not successfully submitted in JP Morgan, C-IV 

displays an informational message on the EDBC List page that the 

issuance will be resubmitted to JP Morgan in the nightly batch. 

• EBT is set as the default issuance method. 

• If there is no current account when running EDBC, C-IV will prompt the 

EW the EBT account has not been set up. The EW has the option to add 

the EBT account or run EDBC without setting up the EBT account. 




New and 

modified EBT 

pages 

New EBT pages and modifications to the existing pages were necessary to 

implement the new functionality 

New pages include: 

• EBT Account Search 

• EBT Card Transaction Search 

• EBT Transaction Detail 

Modified pages include: 

• EBT Account List 

• EBT Account Detail 

• EBT Card Detail (replaces the EBT Card Assignment Detail) 

• Issuance Method detail 

Security Rights Based on job position and security rights, EBT Host-to-Host pages can be 

accessed in the following modes by EWs, Office Assistants (OAs) and 

Authorized Issuance Office Assistants (AIOAs): 

Action Time 

Frame 

Security Rights Page Functions Staff 

View Mode Displays current and historical 

information related to an EBT 

account and card 

Search Mode Displays information in view mode 

by search criteria selected by the 

user 

Edit Mode Allows the user to modify and save 

new information related to an 

account or card 

High 

Affected cases All CalWORKs cases 

All EW and OA 

staff 

All EW and OA 

staff 

All EW staff and 

designated AIOA 




Change 

summary 

Filing 

instructions 


JV:AG:lc 

Beginning May 21, 2007 the EBT Host-to-Host interface process will replace 

the multiple daily batch runs, and allows EBT accounts, rush and cancelled 

EBT benefits to be processed in real time. Routine benefits will continue to 

be processed in the nightly batch. The EW will have access to EBT screens 

and complete certain actions, through the C-IV system, that were previously 

completed by the fiscal and/or clerical staff through the Administrative 

Terminal. 


EBT accounts, rush and cancelled 

benefits were processed through 

multiple daily batch runs. 

The EBT Host-to-Host allows EBT 

accounts, rush and cancelled EBT 

benefits to be processed in real 

time. 


Page 1 Table of Contents 

Page 13-1 through 13-4, 13-6, 13-8, 13-12, 13-13, 13-19, 13-21, 13-31, 

13-33, and 13-35, 



MARCH 28, 2007 



Overview This handbook letter contains revisions and additions in order to clarify 

information in this chapter. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – Eligibility Workers (EWs) need to note changes to the sanction 

example. 

CalWORKs cases imposing Welfare-to-Work (WTW) sanctions. 

Example had incorrect effective date of sanction. 


Page 7-18 


JV:MM:lc 



MARCH 28, 2007 





Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – Eligibility Workers (EWs) need to implement these changes for 

Cal-Learn mileage reimbursements as they occur. 

Cal-Learn 

Update current Cal-Learn mileage reimbursement for travel. 


$.23 cents a mile $.26 cents a mile starting with travel 

claims received in March. 


Page 7-42 


JV:MM:lc 



MARCH 9, 2007 



Overview This Handbook Letter explains the changes in the Child Support Referral 

Process. Beginning 04/02/2007 customers will no longer be required to have 

contact with the Department of Child Support Services (DCSS) prior to 

processing the CalWORKs application. 

Action time 

frame 

Affected 

cases 

Change 

summary 

High Level – CalWORKs Eligibility Workers (EWs) must implement these 

changes effective 03/15/2007 for all Child Support referrals (Support 

Questionnaire, CW 2.1Q), whether for full case or add person applications. 

All CalWORKs applications, both full case (Intake) and add person 

(Continuing) applications, for which completion of the Support Questionnaire 

(CW 2.1Q) is mandatory. 

The Child Support Services Referral Procedures section has been revised as 

follows: 

• Removed separate procedures for Districts with and without in-house 

Child Support Officers (CSOs) and replaced with Countywide 

procedures. 

• Added information on the six critical data fields on the Support 

Questionnaire (CW 2.1Q) and instructions on completion of those fields. 

• Added information regarding the TAD/CS 2.1 form used to provide 

customers with instructions to contact DCSS, the phone number, and 

contact timeframe. 

• Removed page of old phone and fax numbers for DCSS offices. 

Updated information will be available on the TAD website. 

Note: DCSS is in the process of obtaining a Toll-Free (800) Number. Staff 

will be notified when it is available. 



Chapter 2 – Deprivation, Continued 

Change 

summary, 

continued 

Filing 

instructions 

The table containing Old Policy and New Policy related to this change is 

listed below. 


• Incomplete Support 

Questionnaires were referred to: 

– In District CSO, or 

– DCSS office for telephone 

interview 

• CalWORKs applications held 

pending response from DCSS or 

in office CSO 

• All TAD districts except Barstow, 

Needles, 29 Palms, and Yucca 

Valley had in office Child 

Support Officers (CSOs) 

• Barstow, Needles, 29 Palms, 

and Yucca Valley referred 

customers to DCSS to complete 

a phone interview. 

• DCSS phone and fax numbers 

located in CWPHB. 



Remove: 



JV:KH:bw 

• All customers, for whom the 

Support Questionnaire is 

mandatory, are requested to 

contact DCSS within 10 days of 

application via the TAD/CS 2.1 

form 

• CalWORKs application no 

longer held pending response 

from DCSS 

• No TAD district has in office 

CSOs 

• All districts refer customers to 

DCSS to complete phone 

interviews using the TAD/CS 2.1 

form. 

• DCSS phone and fax numbers 

located on TAD website. 

• Information regarding the six 

critical data fields has been 

included. 






Overview CDSS advises the counties via an All County Letter (ACL) each year listing 

the California tribal reservations and rancherias that have provided 

information to them on unemployment rates of fifty percent or higher for the 

60 – month time limit exemption for those individuals living in Indian country. 

Action time 

frame 

Affected 

cases 

Change 

summary 

Filing 

instructions 

Low Level – Provide new information to staff within the next five weeks. 

The following TANF cases are affected by this change: 

• Intake and continuing, 

• Families living on the listed tribal reservations or rancherias. 

This CWPHB LTR updates the list of tribal reservations and rancherias 

identified in ACL 05-16 dated 7/13/05 and ACL 06-23 dated July 21, 2006. 

Additionally, some of the counties listed in this CWPHB LTR have been 

changed to reflect the correct county where the tribal reservation or rancheria 

is located. Policy change effective dates are noted below: 

Old Policy through 07/21/2006 New Policy Effective Dates 

CWPHB LTR #4438 (4/05) 

contained tribal and rancheria 

information up to and including 

ACL 04-20 dated 5/30/04. 


CWPHB – Pages 18-28, 18-29, and 18-30 

Add: 

CWPHB – Page 18-30.1 

Distribution TAD - CWPHB 

JV:CN:lc 

CWPHB LTR #4459 (2/07) contains 

tribal and rancheria information found 

in the following ACL’s: 

• ACL 06-23 effective 7/21/06 

• ACL 05-16 effective 7/13/05 








Action time 

frame 

Affected cases Cal-Learn 

Change 

summary 

Mid Level – Cal-Learn Eligibility Workers (EWs) need to implement these 

changes for new cases whenever any action is taken on the case. 

The Cal-Learn sections have been revised and updated to show: 

• Change Adolescent Family Life Program (AFLP) references to Maternal, 

Child and Adolescent Health (MCAH) 

• Increase accuracy by improving communication between the Cal-Learn 

EW and the MCAH Case Manager 

• MCAH contact information 

• Expanded registration and approval process 

• Case Manager is no longer required to send the CL 1, CL 2, CL 3, CL 4, 

and CL 8 to the Cal-Learn EW 

• Updated transportation supportive service costs 

• Added good cause section and process for not making adequate 

progress in school 

Remove form SB CW 28 as it is obsolete 


• No follow up was required 

• Any emails did not include the 

MCAH Supervising Office 

Assistant. 

• Forms sent between Cal-Learn 

EW and Case Manager were 

paper. 

• There was no structure as to 

who would Pend the Cal-Learn 

case or when. 

• Cal-Learn EW must follow up 

case actions with the Case 

Manager within 5 business days. 

• Emails to Case Manager must 

include the MCAH Supervising 

OA. 

• Forms sent between Cal-Learn 

EW and Case Manager will now 

be emailed. 

• EW will Pend the Cal-Learn 

program before sending case to 

Cal-Learn EW. 



Chapter 7 – Work Requirements, Continued 

Filing 

instructions 


Table of Contents – Page 2 of 2 


Add: 

Page 7-56 


JV:MM:wsb 






Overview This handbook letter is to include the exemption for physically/mentally 

incapacitated – SSI referral to the Exemption Table. 

Specific 

changes 

Filing 

instructions 

A change was made to the Exemption Table on pg 7-10 to add 

physically/mentally incapacitated-SSI referral to the SSI Advocate. 

Page 12.1 was added with information on who can use the exemption, 

the documentation required, referral process and review requirements. 


Page 7-10 

Add: 

Page 7-12.1 

Distribution “CalWORKs” 

JV:AG:lc 






Overview This handbook letter is to include in this chapter information on Referral to 

the SSI Advocate due to physical/mental incapacity. 

Specific 

changes 

Filing 

instructions 

The following change was made: 

Page 2-7: Added the block for Referral to SSI Advocate 


Page 2-7 





November 20, 2006 



Overview This handbook letter makes changes to the MBSAC and IIK charts based on 

this year’s COLA increases. The 80% and 160% MAP levels were also 

removed from the chart due to changes to the Homeless Assistance Program 

in July 2006. 

Specific 

changes 




• Increases in the IIK levels due to the increase in the COLA. 

• Removal of the 80% and 160% MAP levels due to changes in Homeless 

Assistance effective July 1, 2006 which now uses Total Monthly 

Household Income (TMHI). 

• Aid code 35 for Two-Parent families changed from State only to Federal 

claiming effective 10/2006. The claiming for months prior to 10/2006 will 

remain State only. 




• Begin using the new Income In-Kind (IIK) amounts effective January 1, 

2007. 

Filing 

instructions 

Continuing: Begin using the new Income In-Kind (IIK) amounts effective 

January 1, 2007. This is considered to be a county-initiated change. 

Note: Applications denied from (July 2006 through December 2006) due to 

exceeding MBSAC will be reviewed for possible eligibility. Instructions for 

this will come out under a separate IIN) 




JV:AG:lc 





CHAPTER 6 –Citizens, Noncitizens, and Refugees 

Overview This handbook section updates material for the Repatriation Program. 

Specific 

changes 

Filing 

instructions 


JV:CN:wsb 

The following changes have been made to the Repatriation Program section 

of the CalWORKs Policy Handbook: 

• Addition of Code of Federal Regulation (CFR) citations 

• Addition of the SSA 3955 to the forms table on page 6-53 

• Minor grammatical and formatting changes 


Pages 6-51 through 6-53 of the CalWORKs Policy Handbook 



AUGUST 11, 2006 


CHAPTER 5 – Residency 

Overview This Handbook letter contains minor grammatical changes, revisions and 

additions in order to clarify and update information in this Chapter. 

Revisions and 

Additions 

Filing 

instructions 


JV:MM:lc 

The following revisions and additions were made to the Residency Chapter: 

• Changed any reference from second person to third person on pages 

5-1, 5-7 through 5-9, and 5-12. 

• Added “for instructions” in “Temporary absence” section on page 5-2. 

• Changed “they’ve” to “they have” in “Any California county to San 

Bernardino County” section on page 5-4 

• On page 5-5: 

– Added parentheses for more clarity in last sentence of “Temporary 

absences from the state” section. 

– Changed “Eligibility while living outside of California” section to reflect 

grant instead of warrant mailed. 

• On page 5-6: 

– Clarified the EW will take action, and 

– Added reference to Income Chapter under “The policy” section. 

• Spelled out SSN acronym in step 5 of chart on page 5-8. 

• Added “for” in note on page 5-10. 

• On page 5-13: 

– Deleted second paragraph under “The policy” section as it no longer 

applies to EWs since C-IV, and 

– Clarified EW needs to take action on last section of page. 

• Deleted part of sentence in step 2 of chart on page 5-14 since EW cannot 

stop benefits from going out with C-IV. 


Pages 5-1 through 5-2, 5-4 through 5-10, and 5-12 through 5-14 





CHAPTER 3 – Assistance Unit/Responsible Persons 

Overview This Handbook Letter makes revisions and additions in order to clarify the 

information in this Chapter. Some of the items clarified include: 

• Adoption breaks the parent for child and sibling for sibling mandatory 


• Penalized persons (immunization, school attendance, and IPV) and 

Maximum Family Grant (MFG) children are AU Members. 

• SSI only and SSP only recipients are classified as Non-Persons. 

• Foster Care Non-persons include Federal, State, and local (County Pay) 

Foster Care. 

Revisions and 

additions 

Some of the items added include: 

• How to determine whom the payee/caretaker relative when the parent 

and nonparent relative share care and control depends on which person 

has majority care and control. 

• Pregnant Woman Only (PWO) Assistance Unit (AU) requirements. 

• Definition and impact of strikers on the AU. 

• List of the 22 designated public hospitals in California. 

The revisions to the Assistance Unit/Responsible Persons Chapter were 

made to the following pages: 

• Table on Contents: 

– Added a page reference for the Pregnant Woman Only (PWO) AU 

map. 

– Revised page numbers beginning with page 3-11 to accommodate 

additions and revisions made to this Chapter. 

• Assistance Unit/Responsible Persons Overview map (page 3-1): 

– Added EAS reference, 44-206, to References block. 

– Revised page numbers beginning with 3-11 to accommodate 

additions and revisions made to this Chapter. 

• Nonparent Caretaker Relative: Needy or Non-Needy? map (pages 3-9 

and 3-10): 

– Added page 3-10. 

– Added Needy vs. non-needy block to clarify the terms are used solely 

to indicate whether or not the nonparent caretaker relative is included 

in the AU. 

– Added When a parent and nonparent relative share care and control 

block to assist workers in determining which person is the 

payee/caretaker relative when both persons share care and control. 



Chapter 3 – Assistance Unit/Responsible Persons, Continued 

Revisions and 

additions, 

(continued) 

• Assistance Unit Overview map (page 3-11): 

– Changed page number from 3-10 to 3-11. 

– Added EAS reference, 44-206, to References block. 

– Added a page reference for the Pregnant Woman Only (PWO) AU 

map and revised page numbers beginning with 3-12 to accommodate 

additions and revisions made to this Chapter to the In this section 

block. 

• Assistance Unit Basics map (pages 3-12 and 3-13): 



– Added Mandatory inclusion and adoption block to clarify adoption 

breaks the parent for child and sibling for sibling mandatory inclusion 

links and provide an example. 

• Classifying Family Members map (page 3-14): 

– Page number change from 3-12 to 3-14. 

• Assistance Unit (AU) Members map (pages 3-15 and 3-16): 

– Changed page numbers from 3-13 and 3-14 to 3-15 and 3-16 

respectively. 

– Added Note to the Mandatory inclusion block reminding workers 

adoption breaks to parent for child and sibling for sibling mandatory 


– Added Note to the The impact of AU Members block advising workers 

exceptions exist, and to see the Penalized persons and MFG children 

blocks. 

– Added Penalized persons block to advise workers while penalized 

persons are AU Members, their needs are not included in the AU and 

Family MAP counts. 

– Added MFG children block to advise workers MFG children are AU 

members and to explain their treatment. 

– Added grandchildren to the list of examples in the Optional persons 

block. 

• Pregnant Woman Only (PWO) AU map (page 3-17): 

– Added this map to explain the requirements for a PWO AU or AU of 

one and the Cal-Learn exception to the requirements. 

• Non-AU Members map (page 3-18): 


– Minor word change made in the Who they are block. 

– Minor word additions and changes made in the Who they aren’t block. 

• Excluded Members map (pages 3-19 and 3-20): 



– Removed MFG children from the list in the Who they are block. 

– Added MFG children block to advise workers MFG children are 

considered AU members although their treatment is similar to 

Excluded Members. 

– Added Strikers block to explain when a customer is and isn’t 

considered a striker and to explain a striker’s impact on the AU. 




Revisions and 

additions, 

(continued) 

• Non-persons map (pages 3-21 through 3-23): 

– Changed page numbers 3-17 and 3-18 to 3-21 and 3-22 respectively. 


– Added SSI only and SSP only recipients and Kin-GAP children and 

clarified Foster Care to include Federal, State, and local (County Pay) 

to the Who are they block. 

– Renamed SSI/SSP recipients block to SSI/SSP, SSI only, and SSP 

only recipients block, and added references to SSI only and SSP only 

recipients. 

– Added clarification to the Foster Care children block the Foster Care 

can be Federal, State, or local (County Pay). 

• AU Classification Table (page 3-24): 


– Moved MFG child from Excluded Member to AU Member; added SSI 

only and SSP only to Non-person; and clarified Foster Care to include 

Federal, State, and local in the table in the Classification table block. 

• Temporary Absence Overview map (page 3-25) 


– Revised page numbers beginning with 3-21 to accommodate 

additions and revisions made to this Chapter to the In this section 

block. 

• Temporary Absence of a Family Member map (page 3-26) 


– Added clarification to the The basic rule block advising workers 

temporary absence discontinues follow the family composition 

change rules of Voluntary Mid-quarter changes. 

• Temporary Absence: Exceptions to the Rule (pages 3-27 and 3.28): 



– Added clarification to the “Any hospitalized person other than a child 

in a public hospital” row in the When/And/Then table in the 

Exceptions to the one full calendar month rule block to advise 

workers that hospital stay is not time limited. 

– Added Public hospitals block to list the 22 designated public hospitals 

in California. 

• Examples of Temporary Absence map (pages 3-29 and 3-30): 



– Added statement to the Introduction block to advise workers a person 

leaving the home is a Voluntary and not a Mandatory report. 

– Renumbered previous Example 4 to Example 5. 

– Revised Examples 1, 2, and 5 for Quarterly Reporting actions. 

– Added a new Example 4 to address the action when a parent is in a 

drug rehabilitation treatment facility. 




Filing 

instructions 



Page 3-1 


Add: 


JV:KH:wsb 







Overview This Handbook Letter provides the 10/2006 through 09/2007 Income 

Reporting Threshold (IRT) charts. 

IRT effective 

date 

Region 1 and 

Region 2 

levels 

10/2006 IRT 

and C-IV 

Filing 

instructions 

The new IRT chart amounts are effective 10/01/2006. Begin using the new 

IRT amounts 10/01/2006. 

The IRT chart amounts for Region 1 and Region 2 are the same for 10/2006 

through 09/2007. Historically, the amounts for a Reporting Size of two were 

different. As a result of the two-year suspension of the Maximum Aid 

Payment Cost of Living Adjustment (MAP COLA), the amounts are the same. 

At this time, the 10/2006 IRT chart amounts have not been implemented in 

C-IV. This means: 

• Notices generated by C-IV will not include the updated IRT amounts. 

• C-IV may fail CalWORKs EDBCs for 10/2006 and ongoing based on the 

10/2005 IRT amounts. When this occurs, if the customer remains eligible 

using the 10/2006 IRT amounts: 

– Complete a CalWORKs budget outside of C-IV; 

– Override program configuration and, if necessary, payment; and 

– Journal all actions taken. 


Page 19-7 


JV:KH:bw 



JULY 24, 2006 



Overview This Handbook letter revises the policy for referring CalWORKs denials to 

Medi-Cal. Previously, only those CalWORKs denials wherein the applicant 

customer had requested Medi-Cal on the SAWS 1 were referred to Medi-Cal. 

Now, all CalWORKs denials, with a few exceptions, will be referred to a 

Medi-Cal unit for an eligibility determination. 

New policy All CalWORKs denials, whether for the entire application or only one person 

(includes add person applications), will be immediately referred to a Medi-Cal 

unit for a Medi-Cal eligibility determination. The only exceptions to this policy 

are as follows: 

• The customer withdraws the CalWORKs application by specifically 

stating in writing he/she is withdrawing his/her request for Medi-Cal also; 

• The applicant is deceased; 

• The applicant is a Foster Care or Kin-GAP child; 

• The applicant is in jail or other ineligible institution; 

• The applicant is out of state; and/or 

• The applicant is receiving SSI. 

Effective date The revised policy described in this Handbook Letter is effective immediately 

upon receipt. 

Imaging Imaging of the denied CalWORKs application will be requested by the: 

• Medi-Cal EW when the denied application is referred to Medi-Cal; or 

• CalWORKs EW when the denied application is not referred to Medi-Cal. 

Filing 

instructions 


JV:KH:lc 



Remove: 

Page 1-11.1 



JULY 3, 2006 


CHAPTER 6 – Citizens/Noncitizens/Refugees 

Overview This Handbook Letter makes a revision in the Citizens/Noncitizens/Refugees 

Chapter of the CalWORKs Policy Handbook (CWPHB) due to the imaging 

process currently used. 

Revision The revision to the Citizens/Noncitizens/Refugees Chapter was made to the 

following page: 

• When TAD receives the birth certificate (page 6-4): 

– Changes process of mailing customers the birth certificates after they 

have been imaged into C-IV. 

Filing 

instructions 


JV:MM:lc 


Page 6-4 




JUNE 12, 2006 



Overview The Handbook Letter updates the Domestic Abuse providers, including: 

• Their addresses and phone numbers, and 

• The TAD offices they serve. 

Updates The changes to the Domestic Abuse providers are as follows: 

• House of Ruth: 

– No longer serves Fontana TAD customers; and 

– Has a new Ontario address. 

• Option House: 

– Now serves Fontana TAD customers; and 

– No longer serves San Bernardino “Mass” or Colton TAD customers. 

• D.O.V.E.S.: 

– Serves Redlands and San Bernardino “Mass” TAD mountain area 

customers; 

– No longer has a Running Springs address; and 

– Has new Big Bear and Crestline Outreach phone numbers. 

• High Desert Domestic Violence: 

– No longer serves Victorville, Hesperia, or Adelanto TAD customers; 

– Now serves Colton, San Bernardino “Mass”, and Del Rosa TAD and 

San Bernardino ESP customers; and 

– Has a new phone number; and 

– Accepts collect calls. 

• Desert Sanctuary: 

– No longer has a toll free number; but 

– Now accepts collect calls. 

• Victor Valley Domestic Violence: 

– Is a new provider serving Victorville, Hesperia, and Adelanto TAD 

customers. 

Effective date The information in this Handbook letter is effective 07/01/2006. 

Filing 

instructions 


JV:KH:lc 


Page 1-61 



MAY 12, 2006 



Overview This Handbook Letter makes revisions and additions to clarify information in 

the Budgeting Chapter of the CalWORKs Policy Handbook (CWPHB). Some 

of the items clarified include: 

• Income averaging includes the conversion of both stable and fluctuating 

income into an average monthly amount. 

• When a customer receives pay on every scheduled pay date, even 

though the amounts are different, the income is considered stable 

because the pattern of receipt is stable. 

• Ongoing income for which the amount changes from month to month 

should be considered stable instead of fluctuating if the pattern of receipt 

is stable. 

Revisions and 

Additions 

The revisions to the Budgeting Chapter were made to the following pages: 

• Income Averaging map (pages 12-19 through 12-20.1): 

– Rearranged and added blocks in this section. 

– Added information to the Introduction block income averaging 

includes the conversion of both stable and fluctuating income into an 

average monthly amount. 

– Clarified the definition of Stable Income in the Stable income block by 

changing the wording from “same level” to “same frequency”. Also, 

added a Note when a customer receives pay on every scheduled pay 

date, even though the amounts are different, the pattern of receipt is 

stable. 

– Added a Fluctuating income block to this section. The block had 

originally only been only in the Fluctuating income map. 

– Renamed the Guidelines block Income averaging guidelines and 

changed the order of the bulleted statements. 

– Added an Income averaging block, which includes a Step/Action chart 

for averaging income. 

– Moved the Conversion factors block to the Stable Income map. 

– Removed the How to average income block. 



Chapter 12 – Budgeting, Continued 

Revisions and 

additions, 

continued 

Filing 

instructions 

• Stable Income map (pages 12-21 through 12-22): 

– Clarified the definition of Stable Income in the Stable income block by 

changing the wording from “same level” to “same frequency”. Also, 

added stable income received on a weekly or biweekly basis must be 

converted to a monthly total by using the conversion factors for 4.33 

and 2.167 respectively. 

– Added a Conversion factors block regarding the weekly and biweekly 

conversion factors of 4.33 and 2.167 respectively. This block was 

previously located in the Income Averaging map. 

– Added a new Step 1 to the Step/Action chart in the Calculating 

benefits using stable income block and combined the original Steps 2 

and 3 into one Step. Step 1 advises the Eligibility Worker (EW) to 

convert income to average monthly amounts. The previous steps 

remain, but have been renumbered from 1, 2 and 3 to 2 and 3 

respectively. Also, added a Note to remind EWs Journals must be 

completed to justify what income was used and why. 

– Revised the example in the Example block to include earnings paid 

weekly instead of monthly. 

• Fluctuating Income map (pages 12-23 through 12-26): 

– Added a Note to the Fluctuating income block to clarify when ongoing 

income fluctuates from month to month and the pattern of receipt is 

stable the income is stable and not fluctuating. 

– Revised the Estimating fluctuating income block to remind EWs they 

must use the customer’s income if the customer provides one and it is 

not questionable. 

– Added an Income – Questionable or unable to estimate block to 

explain the process for determining income when either the 

customer’s income estimate is questionable or the customer cannot 

provide an estimate. 

– Added information to the Estimating – Income block to remind the EW 

to include with the SAWS 2 all other information reported by the 

customer prior to processing the application. 

– Removed the Calculating benefits using reasonably anticipated 

income block. 

– Added an Averaging fluctuating income block to explain the process 

for averaging income. 



Add: 

Page 12-20.1 


JV:KH:lc 



MAY 10, 2006 



Overview This Handbook Letter makes revisions and additions to clarify information in 

the Reporting Chapter of the CalWORKs Policy Handbook (CWPHB). 

Specifically, this Letter adds clarification regarding the treatment of a midquarter 

decrease in income reported on the QR 7. While verification is 

needed to issue a supplemental payment, only the report of the change and 

the customer’s signature on the QR 7 is needed to use the change in the 

Next QR Payment Quarter. 

Revisions and 

Additions 

Filing 

instructions 

The revisions to the Reporting Chapter were made to the following pages: 

• QR 7 Completeness – Part 3 map (page 10-19): 

– Added clarification to Question 8: Expected changes in next three 

months block to clarify when verification is required. 

• Changes in Income map (pages 10-40 and 10-40.1): 

– Added clarification to Verification requirements block action to issue a 

mid-quarter supplemental cannot be taken without verification of the 

decrease or discontinued income. 

– Added a block for Mid-quarter income change reported on the QR 7. 

This adds the information from Flyer #06-041 TAD to the CWPHB. 

An example is also included. 


Page 10-19 and 10-40 

Add: 

Page 10-40.1 


JV:KH:lc 






Overview This Handbook Letter makes revisions and additions in order to clarify 

information in this Chapter. Some of the items clarified include: 

• The determination of Beginning Date of Aid (BDA) when deprivation is 

Unemployment. An example of how to determine the qualifying 28-day 

period is included. 

• Support Questionnaire (CW 2.1Q) forms are not completed for unborns 

until they are born. This includes completion of the Support 

Questionnaire page in C-IV. 

• When the applicant is a Pregnant Woman Only (PWO) and deprivation is 

Absence, only the Notice an Agreement for Child, Spousal and Medical 

Support (CW 2.1NA) is completed. The Support Questionnaire 

(CW 2.1Q) is not completed until the unborn is born. 

• When to apply two 25% Child Support penalties to an Assistance Unit 

(AU). 

• When to remove a Child Support sanction and add the person to the AU 

when the sanction is cured. 

Revisions and 

Additions 

The revisions to the Deprivation Chapter were made to the following pages: 

• Table of Contents: 

– Added a page reference for the Absence Deprivation for Unborns and 

Child Support Requirements map. 

• Overview map (page 2-2): 

– Added a page reference for the Absence Deprivation for Unborns and 

Child Support Requirements map to the Topic/See Page table in the 

In this section block. 

• Deprivation: General Information map (page 2-3): 

– Added block named Evaluating deprivation to remind EWs 

deprivation is only evaluated once per quarter based on Data Month 

information. 

• Unemployment Deprivation map (pages 2-8 through 2-9.1): 

– Added definitions for “Four-week period” and “Week” to Definitions 

block. 

– Added block named TAD 282 U/FFP to remind EWs the TAD 282 

U/FFP, Unemployment Deprivation Worksheet, is required to 

determine Unemployment deprivation. 

– Added block named Example of applicant hours to provide an 

example of how the Beginning Date of Aid (BDA) is determined when 

deprivation is Unemployment. 



CalWORKs POLICY HANDBOOK LETTER #4444, Continued 

Revisions and 

additions, 

continued 

Filing 

instructions 


JV:KH:lc 

• Absence Deprivation map (page 2-12): 

– Added two notes to the Determining Absence Deprivation block to 

clarify which Child Support forms, if any, to complete if the child is an 

unborn. 

• Absence Deprivation for Unborns and Child Support Requirements map 

(page 2-12.1): 

– New map added to clarify which forms to complete, if any, if the child 

is an unborn. The map also has information regarding what to do if 

the applicant is a Pregnant Woman Only (PWO). 

• Child Support Requirements map (page 2-15): 

– Added clarification to the Child Support requirements block the 

Support Questionnaire (CW 2.1Q) is completed unless potentially 

eligible child is an unborn. 

– Added a note to Minor Parent requirements block to remind EWs not 

to complete the Support Questionnaire (CW 2.1Q) until the unborn is 

born. 

• Child Support Non-Cooperation map (page 2-19): 

– Added clarification to the DCSS 25% penalty block to explain when to 

apply two 25% Child Support penalties. 

– Added clarification to the Subsequent cooperation block to explain 

when to remove the sanction and add the person when a Child 

Support sanction is cured. 

• Child Support Unmarried Father UMF Requirements map (page 2-25): 

– Added note to Child support forms block to remind EWs not to 

complete a Support Questionnaire (CW 2.1Q) for an unborn’s absent 

or unmarried father until the unborn is born. 


Table of Contents and pages 2-2, 2-3, 2-8, 2-9, 2-12, 2-15, 2-19, and 2-25 

Add: 

Pages 2-9.1 and 2-12.1 






Overview This Handbook letter adds CalWORKs Aid Code information to the Chapter 

19 of the CalWORKs Policy Handbook (CWPHB). 

Added 

information 

Filing 

instructions 

This Handbook letter adds the following information to the CWPHB: 

• Descriptions and examples of the CalWORKs family types, 

• CalWORKs aid codes, including Diversion and TANF 60-month and 

CalWORKs 60-month time out aid codes, and 

• Charts to assist in determining the correct aid code to use. 



Add: 


JV:KH:lc 



SAN BERNARDINO COUNTY HUMAN SERVICES SYSTEM 

September 6, 2005 

CAL-WORKS POLICY HANDBOOK LETTER #4442 


Overview This Handbook Letter provides the 10/2005 through 09/2006 Income 

Reporting Threshold (IRT) charts and includes new information for a 

Reporting Size of zero (0). 

IRT effective 

date 

Family Size of 

zero 

Filing 

instructions 

The new IRT chart amounts are effective 10/2005. Begin using the new IRT 

amounts 10/01/2005. 

A new line has been added to the IRT Chart to reflect the IRT amount for a 

Reporting Size of zero (0). This amount is used when the only eligible 

Assistance Unit (AU) member is a Maximum Family Grant (MFG) child and 

the Reporting Size would be zero. 

Example: Mom is receiving SSI income and the only eligible child is MFG. 

The CalWORKs program remains open because the MFG child is eligible for 

cash-based Medi-Cal and special needs. The IRT amount of an AU of zero 

(0) is $227. This is the amount at which an MFG AU becomes income 

ineligible. 


Page 19-7 


JV:KH:lc 




AUGUST 29, 2005 



Overview This Handbook letter contains revisions and additions in order to clarify 

information in this Chapter. 

Revisions and 

Additions 

The revisions to the Applications Chapter were made to the following pages: 

Application Overview Map (pages 1-3 through 1-6.1): 

• In the Definitions block – Added definition for customer and changed 

“Applicant” to “Applicant customer” and “Recipient” to “Recipient 

customer”. 

• In the Application types block – Removed Reapplication from Application 

types. Reapplications are a type of Restoration. 

• Added the Restoration types block, which includes a table of Restoration 

types and the appropriate Restoration Reasons to use. 

• In the Obtaining the Statement of Facts block – Revised information in 

the fifth bullet to reflect the current practice of making the changes in C- 

IV, printing a new SAWS 2, and having the customer sign the correct 

version when an error or incorrect answer is discovered. 

• In the Who must be included on the Statement of Facts block – added 

the phrase “of applicant child(ren)” to the first and second bullets. 

• In the The face-to-face interview block – added phrase “if a joint 

CalWORKs/Food Stamp application” to third bullet, and added a bullet for 

“Availability of Child Care”. 

• In the Retrieval of case records block – added a note to remind the EW 

to review all documents available in C-IV. 

Obtaining and Evaluating Evidence Map (page 1-7): 

• Added the County’s obligation to assist customer block to inform the EW 

of the requirement to assist the customer in obtaining information. 

CalWORKs Denial – Medi-Cal Application Referral Process Map (pages 1-9 

through 1-11.1) 

• Replaced previous information with the information in IIN # 05-028, Medi- 

Cal referral when CalWORKs denied. This IIN will be obsoleted. 

Rescind of Denial Map (page 1-12): 

• In the When to rescind denial block – made minor word changes. 

Social Security Number (SSN) Map (page 1-13): 

• In the Confirming Social Security Numbers block – added note military ID 

cannot be used to verify/confirm an SSN for CalWORKs. 




Revisions and 

Additions, 

continued 

Beginning Date of Aid (BDA) for New Applications Map (page 1-17): 

• Added the BDA rule – add person application while full case application 

pending block to explain the BDA for the add person in this situation. 

The BDA is the later of the add person’s date of application or the date 

the add person meets all eligibility conditions. 

Immediate Need (IN) Map (pages 1-19 and 1-22): 

• Added the Criteria Notes block – these were removed from the Criteria 

block and moved to their own block. 

• In the IN timeframes and action block – corrected issuance of EDE to 

EBT. 

Re-Evaluations (REs): Basic Information Map (page 1-29): 

• In the Policy block – added information regarding the REs dates for ICTs. 

The first month of the RE period for an ICT in is the first month of aid in 

this County. 

• In the Aligning the RE periods block – added reminder to align 

companion Medi-Cal programs also. 

Re-Evaluation (RE) Procedure Map (page 1-30): 

• In the RE procedure block – added a reminder to review Application 

Overview Map for information about SAWS 2 forms completion and who 

must attend the interview before the Step/Action chart and added a note 

to remind EWs to complete the RE for the companion Medi-Cal programs 

with the CalWORKs RE. 

Setting Re-Evaluation (RE) Dates Map (pages 1-32 and 1-33): 

• In the Setting RE dates for applications block – added Joint ICT 

application to the chart and added “(Change Reporting)” after NQR to 

align with the information in the FSPHB. 

• In the Continuing cases: Examples of aligning RE dates block – added 

an example for adding Food Stamps during CalWORKs RE. 

• In the Add person: RE dates block – removed Note. 

Add Person Map (pages 1-36 through 1-37): 

• In the Eligibility determination process – application block – made minor 

word changes. 

• In the Add person reporting block – made minor word changes. 

Beginning Date of Aid (BDA) for Add Persons Map (page 1-39): 

• Added the Penalized persons block to add information regarding when to 

end date a penalty when it has been cured. The penalty is end dated the 

end of the month in which the penalty is cured. 

Beginning Date of Aid (BDA) Examples Map (page 1-41.1); 

• Added the Example – add person while full case application still pending 

block – this includes an example of that situation. 

Adding a Person to the Assistance Unit (AU) Map (page 1-43): 

• In the Application process – add person block – added a reminder to 

schedule WtW orientation if add person is an adult. 




Revisions and 

Additions, 

continued 

Filing 

instructions 


JV:KH:lc 

Rules for Newborns Map (page 1-49): 

• In the Rules for newborns block – revised to reflect clarification received 

from DSS. Newborn will be added to Medi-Cal when the customer 

reports the newborn’s date of birth, name, and gender. The CW 8A must 

be completed and all other CalWORKs eligibility requirements must be 

met prior to adding the newborn to CalWORKs. Also added a note to 

remind EWs when adding the newborn as a Case and Program Person in 

C-IV, if the newborn is already in MEDS, match that CIN and do not 

create a new one. 

Unborn/Pregnancy Special Needs (PSN) Map (page 1-51): 

• In the Intake instructions block – added information pregnant 

teens/minors only can receive CalWORKs in their first and second 

trimesters if they are Cal-Learn participants. 

Issuing Diversion: Basic Rules MAP (page 1-70): 

• In the Payment method block – revised information when Diversion 

issued to the customer. This can also be done by warrant. 

Diversion Issued via Warrant/EBT Map (page 1-73): 

• In the Diversion warrants block – made a word change and added 

warrant to issuance. 

When a Diversion Recipient Reapplies for CalWORKs Map (page 1-79): 

• In the The impact of Diversion on reapplication block – made a minor 

word change in the If/Then chart. 

Statewide Finger Imaging System (SFIS) Requirements Map (pages 1-85 

and 1-85.1): 

• In the Who must comply: CalWORKs block – added information about 

18-year-olds aided as children. These persons must SFIS by the RE 

immediately following their 18 th birthdays. 


Pages 1-3 through 1-7, 1-9 through 1-13, 1-17, 1-19, 1-22, 1-29, 1-30, 1-32, 

1-33, 1-36, 1-37, 1-39, 1-41, 1-43, 1-49, 1-51, 1-70, 1-73, 1-79, and 1-85 

Add: 

Pages 1-6.1, 1-11.1, 1-41.1, and 1-85.1 

Remove: 

IIN #05-028 filed before page 1-9 



June 27, 2005 

CalWORKs POLICY HANDBOOK LETTER # 4439 


Overview The Overpayments and Underpayments section of the Budgeting Chapter 

has been updated with information regarding Recovery Accounts, including: 

• Updated definitions, 

• Clarifies overpayment procedures, 

• Added Quality Review Specialist responsibilities. 

Filing 

instructions 


JV:MC:lc 








Overview Chapter 19 – Charts, Tables, and Lists is being added to the CalWORKs 

Policy Handbook. This Chapter includes the Region 1 and Region 2 

Regionalized Grants, Maximum Aid Payment (MAP), Minimum Basic 

Standard of Adequate Care (MBSAC), Income In-Kind (IIK), and Income 

Reporting Threshold (IRT) charts. 

New Chapter The CalWORKs Regionalized Grants, MAP, MBSAC, IIK, and IRT charts are 

being removed from the Operations and Reference Handbook and added to 

the CalWORKs Policy Handbook. The new chapter, 19, is named “Charts, 

Tables, and Lists.” 

07/2005 MAP 

COLA 

MAP, MBSAC, 

and IIK charts 

Filing 

instructions 

The 2005-2006 State budget and related legislation suspended the 

CalWORKs MAP Cost of Living Adjustment (COLA) for two years. The MAP 

levels in effect 06/2005 will remain in effect through 06/30/2007. However, 

since the budget and related legislation were not approved as of 07/01/2005, 

the month of 07/2005 is exempted from the two-year MAP COLA 

suspension. Therefore, MAP increases in 07/2005 and then decreases to 

the previous levels effective 08/2005. 

Information regarding the issuance of the 07/2005 COLA supplements will be 

issued when C-IV has advised the County of the expected issuance date(s). 

There are two separate MAP, MBSAC, and IIK charts for Region 1 and 

Regions 2. The two separate charts include the: 

• 07/2005 COLA for MBSAC and IIK for 07/2005 ongoing and the MAP 

amounts for 07/2005 only. 

• 07/2005 COLA for MBSAC and IIK for 07/2005 ongoing and the MAP 

amounts for 08/2005 ongoing. 

Add: 

Chapter 19 


JV:BB/KH:lc 



APRIL 19, 2005 


Overview The CalWORKs Policy Handbook (CWPHB) has been revised due to the 

implementation of cash Electronic Benefit Transfer (EBT). A brief synopsis 

of general changes and major changes in each chapter are located in the 

blocks on the following pages. 

Effective date Beginning in May 2005, the on-line EBT System will be implemented in San 

Bernardino County for cash aid. The EBT system will store data used to 

control the issuance of CalWORKs, Food Stamps, and Refugee Cash 

Assistance (RCA) benefits. 

Filing 

instructions 


Entire Handbook 


JV:MC/KH/JV:lc 

Keep and add to new Handbook: 

IIN #03-055 – Craig Clarifications, Questions and Answers 

File in front of Chapter 15 – Medi-Cal 

IIN #05-007 – Fry v. Saenz Lawsuit 

File in front of page 4-6 


CalWORKs Policy Handbook 

General 

changes 

Chapter 1 - 

Applications 

Chapter 2 - 

Deprivation 

Chapter 3 – AU/ 

Responsible 

Persons 

Chapter 4 – 

Children and 

Eligibility 

Chapter 5 - 

Residency 

Chapter 6 – 

Citizens/ 

Noncitizens/ 

Refugees 

The following general changes were made to all chapters: 

• Deleted references to warrants and replaced with payments (except in 

the Benefit Issuance Chapter) 

The Applications Chapter has been updated as follows: 

• Immediate Need payments will be issued via EBT, customers will no 

longer be given the choice of payment delivery. 

There were no substantial changes made to the Deprivation Chapter. 

There were no substantial changes made to the AU/Responsible Persons 

Chapter. 

The Children and Eligibility Chapter has been revised as follows: 

• Deleted all references to the 18/24-month time limits. The 18/24-month 

time limits were eliminated November 30, 2004. 

The Residency Chapter has been updated as follows. 

• Deleted references to picking up counter warrants at auditing, as benefits 

are issued via EBT. 

• Deleted references to the requirement to conduct a diligent search for 

housing, as regulations do not require a diligent search. 

• Deleted references to the requirement to make a Homecall or Fraud 

referral when the customer says he/she does not have an address. 

• Added the requirement that the No Address customer must to come into 

the district office between the first and tenth of every month to pick up 

their mail, Notices of Action (NOAs), and report any changes. The 

CalWORKs will only be discontinued if the customer fails to submit the 

QR 7 by the extended filing date. 

• Added information to remind staff that the No Address customer must 

continue to participate in Welfare-to-Work activities. 

There were no substantial changes made to the 

Citizens/Noncitizens/Refugees Chapter. 



CalWORKs Policy Handbook, Continued 

Chapter 7 – 

Work 

Requirements 

Chapter 8 – 

Resources 

Chapter 9 – 

Income 

Chapter 10 – 

Reporting 


Special Needs 


Budgeting 

The Work Requirements Chapter has been revised as follows: 

• Deleted all references to the 18/24-month time limits. The 18/24-month 

time limits were eliminated November 30, 2004. 

• Deleted all references to the ESP/CalWORKs EW, as the specialized 

function was eliminated with implementation of C-IV. 

• Deleted the section on “Relocation Assistance,” as the program has been 

eliminated due to lack funds. 

• Page 7-9: Added Fry children to the list of exemption reasons. 

• Pages 7-19 and 7-27: A sanction is considered cured when the customer 

contacts the ES and indicates his/her desire to cooperate. The customer 

is added back to the AU the first of the month following the date he/she 

contacted the ES indicating their desire to cooperate. 

• Page 7-22: ESP sanctions and time limits have been revised. Sanctions 

will be applied regardless of the remaining time on aid the individual has. 

• Page 7-41: The mileage reimbursement for Cal-Learn is $0.23 a mile. 

There were no substantial changes made to the Resources Chapter. 

There were no substantial changes made to the Income Chapter. 

The Reporting Chapter has been revised as follows: 

• Added reference to the Drug Felon eligibility changes in Food Stamps. 

The Special Needs Chapter has been updated as follows: 

• Homeless customers will receive benefits via EBT and will no longer pick 

up counter warrants at auditing. 

The Budgeting Chapter has been revised as follows: 

• Updated budgeting examples with current MAP levels. 

• Revised MBSAC and MAP Chart to reflect persons with immunization, 

school attendance, and IPV penalties are not included in the Family or 

AU MAPs. 





Benefit 

Issuance 




Medi-Cal 


Court Orders 

The Benefit Issuance Chapter has been revised as follows: 

• Subjects reordered to list issuance information in order of frequency of 

issuance type. 

• Add information about EBT including: 

– General information 

– Terms and definitions 

– Intake process 

– How to issue an EBT card for homebound customers 

– EBT card use at Automated Teller Machines (ATMs) and Point of 

Sale (POS) terminals 

– EBT card problems and returned cards 

– EBT cardholders and Authorized Representatives (ARs) 

– Payee changes 

– Exemption of EBT program 

– Inactive, Dormant, and Expunged EBT accounts 

– Resource and residence determinations 

• Direct Deposit benefits will be issued via EBT instead of warrant when 

Electronic Fund Transfer (EFT) rejects. 

• Warrant will only be issued if the customer meets the EBT exemption. 

• The Department of Child Support Services (DCSS) completes stop 

payments on Child Spousal Support Disregard (CSSD) 

payments/warrants. 

The Discontinuance Chapter has been revised as follows: 

• Added discontinuances show in C-IV as the first of the month following 

the discontinuance. 

• Added request to notify other departments/workers of discontinuance 

action [Employment Services Program (ESP), Department of Child 

Support Services (DCSS), Child Care EW, etc.]. 

• Removed sanction of 18/24-month time limit being reached. 

• Revised information about penalized individuals. They remain members 

of the AU, but their financial needs are not included in the CalWORKs 

cash aid grant. 

• Added reminder to review of eligibility to Transitional Food Stamps (TFS). 

There were no substantial changes made to the Medi-Cal Chapter. 

There were no substantial changes made to the Court Orders Chapter. 





Fraud/QC/ 

Appeals 


Time Limits 

The Fraud/QC/Appeals Chapter has been revised as follows: 

• Added the Quality Review Unit (QRU) is responsible for completion of 

CalWORKs and TANF Time on Aid (TOA) reviews. 

• Revised information about an IPV penalized individual. The individual 

remains an AU member and his/her financial needs are not included in 

the CalWORKs grant. 

• Revised CalWORKs felony drug conviction ineligible to the conviction 

must be after December 31, 1997. 

• Added beginning 01/01/2005, some drug felons may be eligible to Food 

Stamps. 

There were no substantial changes made to the Time Limits Chapter. 






Overview This handbook updates the policy regarding when the customer can 

complete a stop payment on a lost or stolen warrant. 

Change in 

policy 

Filing 

instructions 

The customer may complete a stop payment if he/she has not received the 

warrant by second mail day. Auditing will process the stop payment 

(HSS 50A) and issue a replacement warrant within two days from the date 

the HSS 50A is received by auditing. 


13-2, 13-3 

Add: 

13-3.1 

Distribution All CalWORKS 

JV:lc 




Chapter 18 – Time Limits 


Overview Chapter 18 – Time Limits of the CalWORKs Policy Handbook has been 

revised to provide for the combination of the Maintenance Team (MT) Unit 

and Time Limit (TL) Unit duties into one unit, the Quality Review Unit (QRU), 

located in District Offices, effective 1/3/2005. Minor revisions and general 

clean up were also made. 

Revisions made include the following: 

• Changes all references to MT Unit or TL Unit to Quality Review Unit 

(QRU) 

• Combines all duties of the MT and TL Units into duties of the QRU 

• Adds definition of QRU 

• Deletes reference to Welfare to Work (WtW) 18/24-month clock, as it 

became obsolete effective 12/1/2004 

• Changes setting of a Task for CalWORKs 60-month review from the 59 th 

CalWORKs month to the 60 th month 

• Specifies date for 60-month CalWORKs Time on Aid (TOA) review Task 

be set as the 15 th day of the estimated 60 th month 

• Adds “Aid code 33 tracking” block to Who is Tracked section 

• Adds information about “Other codes in WDTIP TRAC” with WDTIP 

website information 

• Adds instructions for the EW to run, save and accept EDBC in the TANF 

60 th month of aid when a Task has been set by the QRU to change the 

aid code to the appropriate state-only aid code 

• Adds “Time Limit entries in C-IV” block to TOA Review: New Application 

and Add Person section 

• Specifies erroneous claim instructions for the Legacy and C-IV systems 

• Clarifies that the EW will not save and accept EDBC at approval, add 

person or timed-out person actions; EDBC will be saved and accepted by 

the QRU in these instances, after TOA information is reviewed 

• Adds instructions to provide cases to the QRU for review if cases are not 

pulled for TOA review by the QRU for REs, TANF 58, CalWORKs 54 and 

CalWORKs timed-out actions 

• Adds GEMS review to all Database reviews 

• Adds information that Time Limits folders do not need to be created in 

imaging offices 

• Removes the Welfare Database (WD) section 

• Adds information about Reports created as Tasks in C-IV 

• Adds information about auto-generated batch Notices of Action (NOAs) 

and NOA messages to the TOA Notices section 

• Removes WDTIP TRAC System section from the end of the Chapter 



Chapter 18 – Time Limits, Continued 

Special 

instructions 

Filing 

instructions 

Effective 1/3/2005, the duties of the Maintenance Team Unit and Time Limit 

Unit will be combined and completed by Quality Review Unit (QRU) staff 

located in District Offices. 

Cases with adults who have reached the CalWORKs 60-month time limit will 

no longer be sent to the Time Limit Unit in the Ontario TAD 15 District Office 

for review; these cases will be forwarded to QRU staff located in the District 

Office where the case is assigned. 

QRU staff will save and accept EDBC for intake, add persons, and timed-out 

person actions. The Intake or Continuing EW will continue to be responsible 

for all aspects of the case other than Time Limit related data, and will be 

responsible for running EDBC before submitting the case to the QRU to 

ensure expected results are received, however, EDBC will not be saved and 

accepted until the Time on Aid review is complete. The entire case will 

continue to be submitted to the QRU in these situations. 

Chapter 18 – Time Limits 




DM:bw 


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