|
|
Redetermination Forms
The following forms are sent to the client by CSS along with the updated Statement of Facts and SAWS 2A SAR following a completed Telephonic Signature Phone Interview:
| Form Number | Title of Form |
| CW 2184 | CalWORKs 60-Month Time Limit Informing Notice |
| EBT 2216 | EBT Surcharge Fee |
| PUB 429 | Earned Income Tax Credit |
| PUB 910169 | California Families Grow Healthy With WIC |
| SCD 830 | Important Notice About Domestic Abuse |
| SCD 833 | CalWORKs Immunization Rules |
| SCD 1255 | Important Notice to All Clients |
| SCD 2304 | Additional Information Notices |
| SCD 2331C | Make the Most of Your Time in the CWES Program |
| SCD 2610 | BenefitsCal Flyer |
| SCD 2382 | Electronic Notification Option |
| WTW 5 | Welfare to Work Program Notice |
Note: Forms that are available online are not required to be sent to the client. Form SCD 2304, "Additional Information Notices" must be sent to client providing instructions to review the forms online.
The following forms must be mailed along with the appointment notice to the client by the EW when scheduling a Face-to-Face or a non-Telephonic Signature Telephone RD.
| Form Number | Title of Form |
| Required Forms (Must be Imaged to case when completed) | |
| SAWS 2 Plus | Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs |
| SAWS 2A SAR | Rights And Responsibilities And Other Important Information |
| CCP 7 | CalWORKs Stage One Child Care Request Form and Payment Rules |
| CSF 67 | EBT Card and PIN Responsibility Statement (For review purposes only at RD) |
| CW 2.1 | Child /Spousal And Medical Support Notice and Agreement |
| CW 2.1Q | Support Questionnaire |
| CW 2223 | Demographic Questionnaire for CW, RCA, ECA, TCVAP and CF Programs |
| GEN 1365 | Notice of Language Services |
| SCD 103 | Acknowledgment of Limited Sharing of Information For The Administration Of The CalWORKs Program |
| SCD 508 | Would You Like to Register to Vote? |
| Additional Forms For CalFresh Recipients | |
| FS 22 QR | Applying for Food Stamp Benefits |
| FS 23 QR | How to Report Household Changes |
| SAWS 1 | Application for Cash Aid, CalFresh, and/or Medi-Cal |
| Required Informational Forms and Publications | |
| CW 103 | Transitional Medi-Cal (available online) |
| CW 2184 | CalWORKs 60-Month Time Limit Informing Notice |
| EBT 2216 | EBT Surcharge Fee |
| PUB 13 | Your Rights Under California Law (available online) |
| PUB 183 | Child Health & Disability Prevention (CHDP) Program (available online) |
| PUB 275 | Family Planning - Making the Commitment to a Healthy Future (available online) |
| PUB 388 | California Electronic Benefit Transfer (EBT) Card |
| PUB 429 | Earned Income Tax Credit |
| PUB 910169 | California Families Grow Healthy With WIC |
| SAR 7 Addendum | Instructions & Penalties Semi-Annual Eligibility/Status Report (available online) |
| SCD 830 | Important Notice About Domestic Abuse |
| SCD 833 | CalWORKs Immunization Rules |
| SCD 1255 | Important Notice to All Clients |
| SCD 1500 | Direct Deposit Program Brochure (available online) |
| SCD 2304 | Additional Information Notices (available online) |
| SCD 2331C | Make the Most of Your Time in the CWES Program |
| SCD 2341 | myBCW |
| SCD 2382 | Electronic Notification Option |
| WTW 5 | Welfare to Work Program Notice |
Related Topics
Annual CalWORKs Redeterminations
Completion and Documentation of All Actions and Forms