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UAM Evidence Required
A 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 substantial reason, which must be documented in the case record, to believe that the unrelated male is not a bona fide roomer and/or boarder.
Required Statement (CW 71)
[EAS 43-107]
A "Statements of CalWORKs Mother and Unrelated Adult Male" (CW 71) signed by the CalWORKs mother and the UAM living with the family must be provided.
The CW 71 is required at intake, at redetermination, at the time of a restoration if a SAWS 2 is taken, and at any time the EW or client determine that there is a change in the family situation which might affect the UAM contribution. The recipient may submit an amended CW 71 for the current month if she decides to change her living or income arrangements. The CW 71 or SAR 7 are acceptable notifications of changes in the contribution. The actual contribution MUST BE reported on the semi-annual SAR 7.
- Discussion and completion of the CW 71 is LIMITED only to the fiscal and monetary arrangements between the mother and the UAM.
- The CW 71 is signed by the mother and the UAM under penalty of perjury. If either the mother or the UAM do not understand English, the CW 71 must be provided in a language which each understands, before it is signed.
- If the mother refuses to comply with the requirement to complete and sign the CW 71, 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 40-128.3 and 40-157.213. Refer to Redeterminations and Semi-Annual Report (SAR 7) and Reporting Responsibilities.
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