Notification to Household and Designation of an AR

At application and recertification all CF applicants and recipients must be informed that they may designate an AR to act on behalf of the household.

The designation may be made in one of three ways:

• On the application or recertification form itself;
• Using the EBT Request for a Designated Alternate Cardholder/Authorized Representative (CSF 64), which must be signed by the head of the household; or
• Via a signed written statement such as a note signed by the head of household.

The following forms may also be used to designate an AR:

• Application for CalFresh Benefits (CF 285);
• Application for CalFresh, Cash Aid, and/or Medical/Health Care Programs (SAWS 1 and SAWS 2 Plus);
• Recertification for CalFresh Benefits (CF 37)

Note: A household may designate an AR anytime during the certification period.

The name and contact information of each AR, as well as the roles and responsibilities they have been designated to fulfill on behalf of the household, must be contained in the household’s case file.

The household may designate multiple AR’s to fulfill distinct roles and responsibilities. The distinct roles and responsibilities are selected in the Collect Authorized Representative Detail window in CalSAWS. Please refer to Program Directive 2018-19 for more information.

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AR(s) designated by the household at initial application, recertification, or during the certification period will remain the AR(s) for the duration of the certification period, unless a household communicates to the Eligibility Worker that they would like to remove or change the AR(s).