Domestic Abuse (DA) - Requesting Domestic Violence (DV) Services

A client can request a DV waiver in writing or verbally through their Associate Employment Counselor (AEC)/Employment Counselor (EC) or Eligibility Worker (EW). When requesting in writing, the Sworn Statement (GEN 853) and Request for Good Cause (WTW 27) are two written methods for requesting the waiver/exemption.

CalWORKs Exemption Determination Form (CW 2186B)

Once the AEC/EC is notified that an exemption/waiver is either denied, approved, or extended, the AEC/EC must issue a copy of the CalWORKs Exemption Determination (CW 2186B) form to the client. The CW 2186B must also be completed for the following denial instances:

• Denials due to no-shows
• Denials due to the client declining a referral.

Example: A client who requests a DV waiver but later decides to decline the referral to the CalWORKs Social Worker (SW)/Domestic Violence (DV) Advocate must be issued a CW 2186B, informing them that the exemption was denied due to their decision to decline the referral.