CalWORKs Policy - Department of Public Social Services

The PA 4033, National Voter Registration Act Reporting
Form (out of drawer), is used by the district Staff Assistant
to track, record and monitor the data until LEADER is
programmed. Thereafter, the PA 4033 should be
forwarded to and retained by the BWS Special Assistant.
The PA 4033 form should be forwarded on a quarterly
basis on the 15 th of the month or next business day in the
event of a holiday or nonwork day.
NOTE: The PA 106 must be retained by the Staff
Assistant for two years.
What information should be provided to applicants
about mailing the Voter Registration Form?
Applicants must be informed that they may mail the
completed form directly to the Registrar-Recorder’s
Office (address is preprinted and postage-paid), or it may
be returned to district staff for forwarding to the
designated place for transmittal.
Designated staff must batch and forward the completed
Voter Registration Forms every Friday to:
Los Angeles County
Registrar-Recorder’s Office/County Clerk
12400 East Imperial Highway, Room 2013
Norwalk, California 90650
CW 40-105.1 -
Responsibilities
What are the applicant’s/participant’s
responsibilities?
During an initial application and redetermination process,
the applicant or participant is responsible to assume as
much responsibility within his/her capabilities (i.e.,
physical, emotional, educational or other limitations).
Responsibilities may include:
• Completion of all required documents;
• Providing required documents that are available or in
his/her possession;
• Reporting all known facts that may affect his/her
eligibility;
• Reporting any changes within five calendar days of the
occurrence; and
• Cooperation in Quality Control Reviews.