CalWORKs Policy - Department of Public Social Services

CW 80-310 FORMS
CW 2.1, Notice of
Agreement for Child,
Spousal, and Medical
Support
CW 2.1Q, Support
Questionnaire
CW 4, Immediate Need
Payment Request
CW 5, Veterans Benefits
Verification and Referral
CW 7, Monthly Eligibility
Report
CW 8, Statement of
Facts for an Additional
Person
Used for each absent parent, during redetermination
interview if the form is not already on file or when a
new absent parent is reported.
Used to collect information regarding an
absent/non-custodial parent so that the County may
be assigned rights to any child or spousal support
payment that the participant receives while receiving
aid.
Used to determine if the applicant/participant is
eligible for Immediate Need payment.
Used to:
• verify the status and/or amount of the
veteran’s benefit being received;
• refer applicants/participants to the County’s
Veteran Service Office (CVSO); and
• obtain new veteran benefits when the
information on the statement of facts form
indicates possible eligibility for benefits.
Form renumbered to QR 7
Used to add a person to the AU and to determine
eligibility for the pregnancy special need allowance
when an AU member becomes pregnant and the
unborn was not included on the last SAWS 2.
Exception:
When the father of an unborn returns to the home at
any time after application but before the child’s birth
and there is no eligible child, a CW 8 is required.
CW 8A, Statement of
Facts To Add A Child
Under 16
CW 13, Caretaker
Relative Agreement
CW 23, Senior Parent
Statement of Facts
CW 25A, Payment
Used to collect the information necessary to
determine eligibility when adding a child.
Used to designate the caretaker relative as agreed
by two persons who live in separate homes when
both could qualify as the caretaker relative of a
child.
Used to collect information about the senior
parent/legal guardian’s income to determine a minor
parent’s eligibility.
Form renumbered to QR 25A