Homeless Assistance Application

[EAS 44-211.5]

Statement of Facts - Homeless Assistance (CW 42)

The Assistance Unit (AU) must complete a CW 42 to apply for a Homeless Assistance (HA) payment. The CW 42 is used to gather information specific to HA eligibility. The AU shall provide a sworn statement that the family is experiencing homelessness through a CW 42. There is no requirement for the Social Services Benefits Specialist (SSBS) to interview the client during the processing of a CW 42.

A CW 42 is required for the initial Temporary Homeless Assistance (THA) payment.
A separate CW 42 is required for the Permanent Homeless Assistance (PHA) payment, unless the application for THA and PHA is made simultaneously.

In order for an HA application to be considered complete, the CW 42 must have a valid physical or electronic signature that certifies under penalty of perjury that the AU is experiencing homelessness. Upon receipt of a complete CW 42, including the sworn statement, the SSBS may no longer request additional verification or obtain consent from the family to release information to verify homelessness or obtain a copy of the pay or quit notice for purposes of verification of homelessness.

If the client refuses to complete the CW 42, there is no application. The SSBS must carefully document in the Journal Detail page should this occur.

Informing Requirements

Before issuing the first HA payment, the SSBS must thoroughly review the Important Information section of the CW 42 with the client and inform the client of all of the following:

HA is available once every 12 months, starting from the day the first payment is issued, unless the recipient has a verifiable HA exception.
PHA is paid only if the rent amount meets 80% of the Total Monthly Household Income (TMHI), without special needs.
The THA period is for 16 non-consecutive days.
The family is required to actively seek permanent housing from an appropriate source to get THA.
Evidence of a search for permanent housing is required before the second and subsequent THA payments can be issued.
Verification of incurred shelter costs from an appropriate provider will be required before the second and subsequent THA payments are made.
- When a provider is an individual that is not in the business of renting, a shared housing agreement, a statement from the provider, or a sworn statement from the client that the money was spent on shelter is also adequate verification. The CalWORKs Homeless Assistance (HA) Shared Housing Agreement/Housing Verification (SCD 2575) may be used.
Failure to provide verification of incurred shelter costs from an appropriate provider will result in a presumption of mismanagement of CalWORKs funds. However, if it is not possible to issue a vendor payment, or no providers will accept them, the benefits will be issued directly to the client, as they will remain entitled to their remaining days of benefits, despite a finding of mismanagement.

Fraud Early Detection (FRED) Referral

A completed CW 42 is sufficient for verifying homelessness, and the county may not seek additional verification, except when the family meets the criteria for "questionable homelessness", which means that there is a reason to suspect that the family has permanent housing.

Per Senate Bill (SB) 1065, the SSBS may only make a FRED referral to request assistance in the verification of homelessness when a HA applicant meets the "questionable homelessness" criteria. The SSBS must have evidence to suspect the family has a safe and stable permanent housing in which the family can continue to reside without preventative support to avoid eviction and/or homelessness.

ExampleExample There is evidence that the family is in a permanent housing program, such as the CalWORKs Housing Support Program (CalWORKs HSP, also known as CHSP), and has obtained and remains in a permanent housing placement. This may be considered “questionable homelessness.”

A new referral must be made to the Special Investigations Unit (SIU) each time a HA applicant meets the "questionable homelessness" criteria. A prior suspicion of, or referral for, fraud does not prohibit an applicant from applying for and receiving HA at any future point in time. An HA application must be processed according to the HA timelines even if fraud is suspected.

Refer to Fraud Early Detection (FRED) and Program Integrity Business Processes Handbook Intake Investigation Referrals (FRED).

SSBS Action

Upon indication that an AU is homeless, the SSBS must take the following steps:

Have the client complete the CW 42 and image it.
Thoroughly review the Important Information section of the CW 42 with the client, and inform the client of the information under the Informing Requirements section above.
Assess the AU's immediate housing needs.
Determine if the AU meets the definition of homeless.
Determine whether the AU has received HA once within the last 12 months, or if they are applying as an HA exception.
Review the case in CalSAWS and the Homeless Assistance Payment Indicator (HAPI) screen in MEDS for each adult in the AU for any previous HA payments. Refer to MEDS Handbook Chapter 14: HAPI.
1. If the AU has already exhausted 16 days of THA and/or one payment of PHA within the last 12 months, the SSBS must screen for any other applicable HA eligibility, such as HA exceptions or Expanded THA.
Determine if the AU is eligible or apparently eligible for CalWORKs.
Perform data entries in CalSAWS.
1. The data entered on the Homeless Detail page and the Permanent/Temporary Homeless Detail pages send the appropriate Add transaction to the MEDS network.
If the AU is not eligible for HA:
1. Deny the HA request.
2. Issue a Temporary Shelter and/or Permanent Housing (M44-211D) denial Notice of Action (NOA).
3. Give the client a list of emergency housing and local shelters (found online in the SCC Community Resource Guide) to meet their needs.
4. Record the HA denial in a journal entry and stop here.
If the AU is eligible for HA:
1. Approve the HA request.
2. Issue the appropriate HA approval NOA:
  1. Temporary Shelter and Permanent Housing, Approve (M44-211A), or
  2. Expanded Temporary HA For Applicants Fleeing DV, Approve (M44-211B).
3. Record the HA approval in a journal entry.
4. In addition, for THA:
  1. Advise the client of the requirement to actively seek from appropriate sources and provide evidence of the search for permanent housing.
  2. Give the client a Permanent Housing Search Document (CW 74).
  3. Pay THA for seven (7) calendar days, as homelessness is verified upon the receipt of the complete CW 42.

Example Example Mrs. Jones calls her SSBS on 8/5 to see if the SSBS can assist her with a housing problem. The SSBS inquires as to the type of problem. Mrs. Jones states, “I have been staying with my sister for the last two months. Her landlord found out and told her I had to move by 8/6, or he would evict her. I already gave my sister my share of the August rent. She used it to pay her rent. I need help in finding a place for me and my baby to stay until I can decide what to do.” The SSBS must determine if Mrs. Jones is eligible for HA or meets an HA exception, if she is seeking permanent housing, and if she meets the homeless definition.

Homeless Assistance Application

Statement of Facts - Homeless Assistance (CW 42)

Informing Requirements

Fraud Early Detection (FRED) Referral

SSBS Action

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