Documents

” Volunteer Application to Participate in WtW Name of WtW Volunteer __________________________ Case Number of WtW Volunteer __________________________ Address of WtW Volunteer __________________________ Telephone of WtW Volunteer __________________________ Email address of WtW Volunteer __________________________ County Worker Name __________________________ I, the undersigned, hereby request that I be approved to participate in a WtW activity. Attached is information about what I want to volunteer for. Please provide me with a decision via an adequate notice of action within 10 days that is the same number of days the county gives CalWORKs recipients to provide verification. Thanks you for your assistance in this matter. Dated: __________________________________ Signature of Volunteer WtW Regulations 42-701(v)(1) \”Volunteer\” means a CalWORKs applicant or recipient who, though not required to participate in the Welfare-to-Work Program, chooses to participate. 42-712 .5 Any individual who is not required to participate may volunteer to participate in welfare-to- work activities and may end that participation at any time without loss of eligibility for aid, provided his or her status has not changed in a way that requires participation. .51 For purposes of Section 42-715.5, a volunteer participant is as follows: .511 An individual who is exempt pursuant to Sections 42-712.41 through .49, but who volunteers to participate; or .512 An individual who is not required to participate for reasons other than the exemptions described in Sections 42-712.41 through .49, but who volunteers to participate. Participate in WtW: Case Number of WtW Volunteer 1: Case Number of WtW Volunteer 2: Case Number of WtW Volunteer 3: Email address of WtW Volunteer 1: Email address of WtW Volunteer 2: ”

” Name of WtW Participant: Case # of WtW Participant: Phone Number of Participant: Email Address of Participant: I, the undersigned, hereby request advance pay for transportation and\/or ancillary services, otherwise I will be forced to use my CalWORKs fixed income which is at the same level that a CalWORKs recipient received in 1985, to pay for the costs of transportation and ancillary services in order to participate in my assigned WtW activity. Using my CalWORKs limited money for transportation and ancillary services would be detrimental to my family. Your assistance to assure that I am not forced to use my CalWORKs money for WtW transportation and ancillary services is greatly appreciated. Request for Advance Payment of: Transportation (Please explain) __________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ WtW Request for Advance Pay Per MPP 42-750.21 Ancillary Services, like books, uniforms, tools, ect. (Please explain) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I want representation by the following person I also hereby authorize Name of Person, Organization if any to be my authorized representative in this matter or any other matter relative to my social services case and hereby authorize the county human services agency to release any and all information to her\/him at her\/his request. I further authorize her\/him to request a state hearing on my behalf, including initiating litigation to assure that my rights are protected and enforced. Date: Signature of WtW Supportive Services Advance Payment Regulations MPP 42-750 .21 Payments for supportive services, except child care as described in Chapter 47-100, shall be advanced to the participant when necessary and desired by the participant so that the participant need not use personal funds to pay for these services. WHAT TO DO IF THE COUNTY WON’T COMPLY? If your county is not complying with the law you can email a complaint to the following email addresses: [email protected] INTRUCTION FOR COMPLETING WtW ADVANCE PAYMENT OF SUPPORTIVE SERVICES FORM I. Complete the name of the Participant; 1. The case number that can be found on the various forms that the CalWORKs recipient has, including WtW forms. 2. The phone number of the participant. 3. The email address of the participant. 4. Explain transportation. If it takes more than an hour from your house to the place to your WtW activity, then you are entitled to mileage. The one hour each way includes necessary walking time. 5. For ancillary services put down what you need, how much it costs, and verification that it is needed. If you have any questions, call Kevin Aslanian at 916-712-0071. III. WHAT TO DO AFTER COMPLETING THIS FORM 1. Take this form down to the county welfare office and turn it into the receptionist and make sure to get a receipt. You can also email this form after scanning them and turning them into pdf forms. Email it to the worker, supervisor, county welfare director, deputy director. Your can find the email addresses of the county welfare director at: https:\/\/www.cwda.org\/membership 2. If you do not have the email address of the worker, you can still email them to the director and other 2. If within a reasonable time, like 10-20 days you should ask for a state fair hearing. You can find a form called CCWRO Fair Hearing Filllible Request form -09-2011 to request a hearing at: http:\/\/www.ccwro.org\/index.php?opti on=com_docman&Itemid=70 3. You can designate CCWRO as the authorized representative. 4. You can fax the hearing request to 916-651-5210, which is the fax number for the State Department of Social Services. 5. If you want CCWRO to represent you, you should fax a copy of the hearing request to 916-736-2645. FOR ANY ASSISTANCE CONTACT CCWRO at: http:\/\/ccwro.org Or call 916-712-0071 and ask for Kevin Aslanian Name of WtW Participant: Case of WtW Participant: Phone Number of Participant: Email Address of Participant: Transportation Please explain 1: Transportation Please explain 2: 1: 2: 3: 4: 5: 6: 7: 8: 9: explain 1: explain 2: explain 3: explain 4: explain 5: explain 6: explain 7: I want representation by the following person: assure that my rights are protected and enforced: undefined: ”

” 1 REQUEST TO MEET WELFARE-TO-WORK RULES TO GET MY CASH AID BACK PER ACWDL 3-13-20, 3-30-20 & 6-29-20 HOW TO GET MORE Cash Aid during the coronavirus pandemic: Your family gets less cash aid because you did not meet Welfare-to-Work rules. If you want your cash aid back, you can fill out this form and return it to your Welfare-to-Work worker right away. REQUEST TO MEET WELFARE-TO-WORK RULES TO GET MY CASH AID BACK I agree to participate in the WtW program when the county asks me to do so. I understand that during the coronavirus pandemic I will not be asked to participate. After the pandemic, if asked to participate, I will need help with: __ Child Care __ Transportation __ Other NAME (PLEASE PRINT): SIGNATURE: CASE # OR SOCIAL SECURITY #: PHONE #: ( ) DATE: WELFARE-TO-WORK WORKER’S NAME (PLEASE PRINT): BIRTHDATE YOUR EMAIL ADDRESS DO YOU NEED FREE LEGAL HELP? Coalition of California Welfare Rights Organizations (CCWRO) 1111 Howe Ave., Suite 635, Sacramento, CA 95825 Telephone (916) 712-0061 ccwro.org HOW TO USE THIS FORM? You can give this to your worker. You can mail us this form and we will give it to your worker if you authorize us to do so. If you want us to help you, you have to sign below authorizing us to help you. I, the undersigned authorize CCWRO and any person working with them to be my authorized representative for all purposes, including filing for a state hearing: Date___________ Your Signature______________________________________________________ NAME PLEASE PRINT: CASE OR SOCIAL SECURITY: PHONE: DATE: Date: Check Box1: Off Check Box3: Off Check Box2io0: Off birthdate: BIRTHDATE YOUR EMAIL ADDRESS: WTW WORKER: ”

” Name of WtW Participant: Case # of WtW Participant: Phone Number of Participant: Email Address of Participant: I, the undersigned, hereby request advance pay for transportation and\/or ancillary services, otherwise I will be forced to use my CalWORKs fixed income which is at the same level that a CalWORKs recipient received in 1985, to pay for the costs of transportation and ancillary services in order to participate in my assigned WtW activity. Using my CalWORKs limited money for transportation and ancillary services would be detrimental to my family. Your assistance to assure that I am not forced to use my CalWORKs money for WtW transportation and ancillary services is greatly appreciated. Request for Advance Payment of: Transportation (Please explain) __________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ WtW Request for Advance Pay Per MPP 42-750.21 Ancillary Services, like books, uniforms, tools, ect. (Please explain) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I want representation by the following person I also hereby authorize Name of Person, Organization if any to be my authorized representative in this matter or any other matter relative to my social services case and hereby authorize the county human services agency to release any and all information to her\/him at her\/his request. I further authorize her\/him to request a state hearing on my behalf, including initiating litigation to assure that my rights are protected and enforced. Date: Signature of WtW Supportive Services Advance Payment Regulations MPP 42-750 .21 Payments for supportive services, except child care as described in Chapter 47-100, shall be advanced to the participant when necessary and desired by the participant so that the participant need not use personal funds to pay for these services. WHAT TO DO IF THE COUNTY WON’T COMPLY? If your county is not complying with the law you can email a complaint to the following email addresses: [email protected] INTRUCTION FOR COMPLETING WtW ADVANCE PAYMENT OF SUPPORTIVE SERVICES FORM I. Complete the name of the Participant; 1. The case number that can be found on the various forms that the CalWORKs recipient has, including WtW forms. 2. The phone number of the participant. 3. The email address of the participant. 4. Explain transportation. If it takes more than an hour from your house to the place to your WtW activity, then you are entitled to mileage. The one hour each way includes necessary walking time. 5. For ancillary services put down what you need, how much it costs, and verification that it is needed. If you have any questions, call Kevin Aslanian at 916-712-0071. III. WHAT TO DO AFTER COMPLETING THIS FORM 1. Take this form down to the county welfare office and turn it into the receptionist and make sure to get a receipt. You can also email this form after scanning them and turning them into pdf forms. Email it to the worker, supervisor, county welfare director, deputy director. Your can find the email addresses of the county welfare director at: https:\/\/www.cwda.org\/membership 2. If you do not have the email address of the worker, you can still 2. If within a reasonable time, like 10-20 days you should ask for a state fair hearing. You can find a form called CCWRO Fair Hearing Filllible Request form -09-2011 to request a hearing at: http:\/\/www.ccwro.org\/index.php?opti on=com_docman&Itemid=70 3. You can designate CCWRO as the authorized representative. 4. You can fax the hearing request to 916-651-5210, which is the fax number for the State Department of Social Services. 5.If you want CCWRO to represent you, you should fax a copy of the hearing request to 916-736-2645. FOR ANY ASSISTANCE CONTACT CCWRO at: http:\/\/ccwro.org Or call 916-712-0071 and ask for Kevin Aslanian mailto:[email protected] https:\/\/www.cwda.org\/membership http:\/\/www.ccwro.org\/index.php?opti http:\/\/ccwro.org\/ Name of WtW Participant: Case of WtW Participant: Phone Number of Participant: Email Address of Participant: Transportation Please explain 1: Transportation Please explain 2: Transportation Please explain 3: Transportation Please explain 4: Transportation Please explain 5: Transportation Please explain 6: Transportation Please explain 7: Transportation Please explain 8: Transportation Please explain 9: Transportation Please explain 10: Transportation Please explain 11: explain 1: explain 2: explain 3: explain 4: explain 5: explain 6: explain 7: I want representation by the following person: assure that my rights are protected and enforced: undefined: ”