CalWORKs Policy - Department of Public Social Services

to apply to register to vote here today?” If the
applicant changes his/her mind and decides to register
to vote, ask the applicant to change the answer on the
PA 106 form and initial and date the changes. Provide
the applicant with the appropriate language forms.
• If an individual refuses to answer the questions, print
their name, the date and include your initials in the
appropriate box at the bottom of the PA 106 form.
(This should be a rare event; you should not leave
blank boxes unless they refuse. If you see a blank
response to the voter registration question, you should
first ask the potential registrant, “If you are not
registered to vote where you live now, would you like
to apply to vote here today?”)
Can homeless applicants/participants register to
vote?
Yes, all homeless individuals may vote if they opt to do
so. When an individual is homeless, the Voter
Registration Form (VRF) is completed as follows:
• Box # 2 may be left blank.
• Box #3 should describe and indicate the precise
location of the residence, with names of the cross
streets at the nearest corners, and/or range of
numbers in a given block, and/or the proximity to
an identifiable landmark such as a park, public
building, etc. (i.e., northwest corner of Oak and 1 st
Street, Los Angeles, CA 90099). Use available
space in Box #2 if necessary.
• A mailing address must always be provided so that
voting material (Sample Ballot, Polling Place
Location, etc.) can be sent to that person.
What should the Eligibility Worker do with the
completed PA 106, Would You Like To Register To
Vote? (out of drawer) form?
The PA 106 must be reviewed by the Eligibility Supervisor
before forwarding to the district Staff Assistant for tracking
the recorded information.
Who should track/retain the data collected on the PA
106, Would You Like to Register to Vote? (out of
drawer) form?
Upon receipt of the PA 106, Would You Like to Register to
Vote? (out of drawer) form, the district Staff Assistant is
responsible for tracking/collecting the reported data.