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CalWORKs Policy - Department of Public Social Services

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NOTE: If verification provided<br />

appears inconsistent<br />

or the EW suspects<br />

false information, a<br />

fraud referral must be<br />

initiated.<br />

Not Allowed to<br />

Live in Home<br />

Health/Safety<br />

Live Apart for<br />

12 Months<br />

Same verification used for<br />

“whereabouts unknown.”<br />

Verified by DCFS via<br />

CA/CW 25 (LEADER<br />

generated), Supplemental<br />

Statement <strong>of</strong> Facts – Minor<br />

Parent.<br />

Minor parent’s rent/utility<br />

receipts.<br />

Statement from a landlord<br />

or house/roommate.<br />

Other documentation<br />

showing that the minor has<br />

maintained a separate<br />

residence for 12 months.<br />

EW collateral phone call.<br />

PA 853 that is completed<br />

and signed by the minor<br />

parent can only be<br />

accepted when verification<br />

cannot be obtained.<br />

NOTE: If verification provided<br />

appears inconsistent<br />

or the EW suspects<br />

false information, a<br />

fraud referral must be<br />

initiated.<br />

Legal<br />

Emancipation<br />

Marriage license.<br />

Court document.<br />

Letter from the armed<br />

forces.<br />

EW collateral phone call<br />

(pending verification).<br />

PA 853 that is completed<br />

and signed by the minor<br />

parent can be accepted<br />

only when verification<br />

cannot be obtained.<br />

Submit a PA 230 and<br />

control via FAC.

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