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Evidence Required
An Unrelated Adult Male (UAM) living in the home is considered a bona fide lodger, roomer, or boarder upon the Sworn Statement (GEN 853) of the mother to this effect, supported by evidence such as the following:
- 1040 tax return, indicating that income from the roomer and/or boarder is reported, or
- Possession of a license to operate a rooming house, or
- Evidence that quarters furnished are separate and apart from those occupied by the family, or
- Receipts which indicate payment of room rent and/or board.
Once the initial determination is made, additional verification is only required if there is a substantial reason, which must be documented in the case record, to believe that the UAM is not a bona fide roomer and/or boarder.
Required Statement
[EAS 43-107]
A Statement of Cash Aid Mother and Unrelated Adult Male (UAM) (CW 71) signed by the CalWORKs mother and the UAM living with the family must be provided. The CW 71 is signed under penalty of perjury. If either the mother or the UAM does not understand English, the CW 71 must be provided in a language that each understands, before it is signed.
If the CW 71 cannot be completed, a sworn statement limited to the fiscal and monetary arrangements between the mother and the UAM must be provided. The sworn statement must be signed by both the mother and the UAM and include the following:
- The actual amount of the financial payment(s) made by the UAM for their share of the family's cost of housing, utilities, food, household operations, and special needs which are shared by the family,
- The actual amount of the financial contribution made by the UAM in cash or in kind for needs of the members of the family budget unit allowed by the CalWORKs standard of assistance, and
- The amount of the UAM's monthly earnings and other income, if known.
The CW 71 or sworn statement is required at:
- Intake,
- Redetermination,
- The time of a restoration if an Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs (SAWS 2 Plus) is taken, and
- Any time the EW or client determines that there is a change in the family situation that might affect the UAM contribution.
The recipient may submit an amended CW 71 or sworn statement for the current month if she decides to change her living or income arrangements. The CW 71, sworn statement, or SAR 7 are acceptable notifications of changes in the contribution. The actual contribution MUST BE reported on the SAR 7.
Refusal to Sign
When the UAM refuses to sign a CW 71 or sworn statement, the mother must still sign and submit a CW 71 or sworn statement. Information regarding the UAM's refusal must be sent to the District Attorney (DA). Refer to Referrals to DA-Welfare Fraud.
If the mother refuses to comply with the requirement to complete and sign the CW 71 or sworn statement, CalWORKs must be denied or discontinued. If she appears unable to comprehend or assist in establishing eligibility, action must be taken in accordance with EAS section 40-157.213: when it is not possible for her to obtain necessary evidence, the EW shall obtain it for her.
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