Form Cw 2186b Calworks Exemption Determination
Download a blank fillable Form Cw 2186b Calworks Exemption Determination in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cw 2186b Calworks Exemption Determination with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CASE NAME
CASE NO.
CalWORKs EXEMPTION DETERMINATION
OTHER ID NO.
COUNTY
WORKER NAME
Questions? Ask your worker.
On ______________________, ____________________________________ asked for an exemption. The county made the following
(DATE)
(NAME)
determination:
A. WELFARE-TO-WORK 24-MONTH TIME CLOCK AND PARTICIPATION EXEMPTION
■
1.
This exemption is APPROVED. Reason for exemption:_______________________________________________________
___________________________________________________________________________________________________
Starting on _____________________, you are not required to participate in Welfare-to-Work and each month of aid for the
)
(DATE
period that your condition or circumstance lasts will not count toward your Welfare-to-Work 24-Month Time Clock. Your
exemption will end on _______________________.
)
(DATE
If your exemption should continue, you must provide information to show that it should continue before the ending date above,
or you will be expected to participate in Welfare-to-Work.
You can ask to volunteer to participate in Welfare-to-Work and will be told what activities and/or services are available.
Your condition may be looked at again to see if you should continue to be exempt. If you are no longer exempt, you will be
expected to participate in Welfare-to-Work and each month of aid may count toward the Welfare-to-Work 24-Month Time
Clock.
■
2.
This exemption is DENIED. Reason for denial: _____________________________________________________________
___________________________________________________________________________________________________
You are required to participate in Welfare-to-Work and each month of aid may count toward your Welfare-to-Work 24-Month
Time Clock. You will get a notice from the county telling you when to attend Welfare-to-Work activities and/or services.
B. CalWORKs 48-MONTH TIME LIMIT EXEMPTION
■
1.
This exemption is APPROVED. Reason for exemption:_______________________________________________________
___________________________________________________________________________________________________
Starting on _____________________, each month of aid for the period that your condition or circumstance lasts will not count
(DATE)
toward your CalWORKs 48-month time limit. Your exemption will end on _____________________.
(DATE)
If your exemption should continue, you must provide information to show that it should continue before the ending date above,
or each month of aid will count toward your 48-month time limit.
Your condition may be looked at again to see if you should continue to be exempt. If you are no longer exempt, each month
of aid will count toward your CalWORKs 48-month time limit.
■
2.
This exemption is DENIED. Reason for denial:_____________________________________________________________
___________________________________________________________________________________________________
Each month of aid will continue to count toward your CalWORKs 48-month time limit.
CONTACT YOUR WORKER IF YOU THINK THIS NOTICE IS WRONG. YOU MAY ALSO ASK FOR A STATE HEARING. “YOUR
HEARING RIGHTS” FORM ON THE BACK SIDE OF THIS PAGE
TELLS YOU HOW TO ASK FOR A STATE
HEARING.
Rules: These rules apply; you may review them at your welfare office: MPP 42-302.1, 42- 302.2, 42-302.21, 42-302.3 - .34,
42-712, and Senate Bill 1041 (Chapter 47, Statutes of 2012).
CW 2186B (12/12) REQUIRED FORM - NO SUBSTITUTE PERMITTED
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal