CalWORKs Eligibility Handbook - Human Services Agency of San ...

CalWORKs Handbook
c. Part C - Check the appropriate box for the required service. In
addition to requesting a new SSN and card, there are other
common situations listed which may be selected.
d. Part D - Enter:
1st line: Last name, first name and middle initial of the individual for
whom the referral is being made.
2nd line: Date of birth and sex of the individual.
3rd line: The 14-digit MEDS number: e.g., 38-30-0123456-0-11,
where:
a) 38 is the county number,
b) 30 is the first two digits of the aid type,
c) 0123456 is the case number with a leading zero,
d) 0 is the second digit of the FBU and
e) 11 is the individual's person number.
4th line: The individual's SSN, if applicable.
5th line: The Case Name.
e. Part E - Enter the EW name, the date the form was ompleted,
the EW number and the EW phone number.
f. Part F - Add comments, if necessary.
2. Once the form is completed,
a. File the original (white copy) in Section 1 of the case record;
b. Give or mail the second (yellow) copy to the individual to take to
the SSA office, with instructions as to how the stamped form
must be returned. Be sure to communicate the Department's
need for a copy of the Social Security card upon its receipt by the
client.
B. Requirements to Apply for a Social Security Number
On the reverse side of the MC 194 there is an explanation of the
documention which is necessary to apply for an SSN. Also, in order to
process an application for a minor child the following is required:
1. The child's official birth certificate
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