CalWORKs Policy - Department of Public Social Services

CW 43-107 – Unrelated Adult
Male (UAM)
What is required when an unrelated adult
male (UAM) is living in the home?
When a CalWORKs mother reports that an
UAM is living in the home, a CW 71 (out of
drawer), Statement of Cash Aid Mother and
Unrelated Adult Male, must be completed. The
form determines the financial arrangements
between the UAM and the aided mother. The
mother and the UAM must sign (under penalty
of perjury) the CW 71. The form must be
completed:
• At Intake;
• At the annual redetermination;
• When a new UAM relationship is
established;
• When a change occurs in the UAM’s
contribution to the AU.
Aid cannot be denied/discontinued if the
mother states that the UAM refused to sign the
CW 71. Although, the UAM may refuse to sign
the CW 71, the form must be returned within
ten working days (via FAC) after the EW
initiates the request. Aid is
denied/discontinued if the CW 71 is not
returned within the time frame.
NOTE: The financial contribution is based on
the mother’s statement listed on the
CW 71.
See Future Action Control – User for
LEADER procedures.
Can aid be denied if an unmarried minor
parent refuses to provide necessary
information regarding his/her parents’
ability to support?
Yes, aid is denied/discontinued if the
unmarried minor parent refuses to provide
necessary information about his/her parents.
See CW 82-500 Child Support Enforcement
Regulations for more information.