CalWORKs Verification Chart

• Driver’s License
• Photo Identification (from government agency, school, etc.)
• Passport
• USCIS documents with photo

Prior to payment

• Newborn Exception: Refer to “Immediate Medi-Cal Authorization For Newborn. 

• Social Security card.
• “SSA Referral Notice” (MC 194).
• IEVS Abstract.
• Any official notification from Social Security.

Residency

Refer to Residence. 

• Client's written statement.
• For minor parents, CW 25 needed.

For citizenship primary documentation:

• Birth certificate, baptismal certificate, U.S. passport, or certificate of citizenship or naturalization.

For "qualified alien" status:

• I-94 or I-551 for appropriate "qualified alien" status or proof of "exception criteria" being met.
• Correspondence from INS. Refer to Qualified Non-Citizens. 

For each adult applicant:

• Current [TSUM] screen.
• Current [PTOA] screen.
• Documentation of all Out of State TOA information.

• Checks or copies of checks
• Award letters.
• “Veteran's Benefit Referral” (CW 5).
• IEVS Abstract
• Signed statement from person or organization providing the income
• Statement from checking or savings account if income is directly deposited into bank.
• "Sworn Statement" (GEN 853) if unable to obtain other verification.

• Client will provide the EW with verification to document the actual cost if it is less than the Cal- WORKs in-kind chart value.

• Paycheck stubs.
• Statement from employer.
• “Request for Information from Employer” (SCD 549).
• IEVS Abstract.
• GEN 853 if unable to obtain other verification.

• Copy of death certificate.
• OASDI award letter.
• Newspaper account of death.
• Other reliable information, such as physician's statement who treated deceased, family Bible records, SSPM signed affidavit, etc.

• “Medical Report Verification of Physical/Mental Incapacity” (CSF 24) or “Medical Report” (CW 61).
• Written statement from licensed physician, certified psychologist or staff member including diagnosis describing employment and child care limitations and duration.
• Copy of disability award letter.
• DM 1 - DM 3 if permanent disability.
• IEVS Abstract.

• “Support Questionnaire” (CW 2.1Q). If questionable, obtain written statement from A/P or other persons with prior knowledge of marriage relationship, or
• Document evidence of client's actions that indicate absence.

• “Request for Information from Employer” (SCD 549), or Statement from employer giving hours worked, date, reason for leaving and any work offered.
• “Notice of Computation, UIB” (DE 429)
• “Disqualification Notice, DIB” (DE 1080)
• IEVS Abstract

• Copy of current county tax statement.
• Copy of documents showing encumbrances, such as payment books payment receipts, notes, mortgages, etc. If unwritten encumbrance, copy of sworn statement giving initial and maturity dates, balance owed and signature of both parties.
• Receipts for expenses on rental property.

• Current DMV registration.
• Documentation of DMV contact.
• Documentation of evaluation of county property specialist.
• 3 appraisals by auto dealers, insurance adjustors or property appraisers.
• Documentation/Verification if another method used.

• Bank statements, or
• “Release of Information-Financial Institution” (SCD 1280) if verification questionable or not supplied by client. Checkbooks are not acceptable verification.
• Copies of loan balance statements, credit union statements, purchase contracts, stock certificates, U.S. bonds, etc.
• Evaluation by county property specialist.
• 3 appraisals by dealers, adjustors, property appraisers, etc. To be used when value questionable or appreciates.

Prior to payment

• Newborn Exception: Refer to “Immediate Medi-Cal Authorization For Newborn. 

• Photocopy of birth certificate or other acceptable evidence of age. Refer to Age, School Attendance and Immunization, for complete list.

At Intake.

At Annual Redetermination.

When a child age 6-17 is added to an existing AU. Any time when EW determines that it is necessary to verify school attendance.

• “School/Educational Institution Attendance Verification ” (CSF 37).

Pregnancy

Refer to Pregnancy Special Needs

• Written statement from a physician, physician's assistant, state certified nurse midwife, nurse practitioner or by designated medical or clinic personnel with access to the medical record that provides diagnosis and estimated due date.
• When medical verification cannot be obtained, the verification requirement may be initially satisfied by means of a sworn statement or verbal attestation. However, medical verification must be submitted within 30 working days for the pregnancy special need and/or pregnant person only case to continue.

• “Welfare to Work Core / Non-Core Activities” (SCD 298).

• Under 16.
• 16-18 in school.
• Age 60 or older.
• Disabled.
• Nonparent Relative caring for a child who is at risk.
• Cares for ill household member.
• Caretaker of child under 12 months.
• Caretaker for subsequent child.
• Pregnancy.

• “Special Diet Request” (CSF 25)
• Statement from physician.
• “Statement of Facts - Homeless
• Assistance” (CW 42).

• "Special Needs Requisition" (SCD 414)