Form WTW15 "Simplified CalFresh Program Unpaid Work Experience (Wex) and Unpaid Community Service Hours Worksheet" - California

What Is Form WTW15?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2013;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form WTW15 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form WTW15 "Simplified CalFresh Program Unpaid Work Experience (Wex) and Unpaid Community Service Hours Worksheet" - California

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
SIMPLIFIED CALFRESH PROGRAM UNPAID WORK EXPERIENCE
(WEX) AND UNPAID COMMUNITY SERVICE HOURS WORKSHEET
Complete this form to determine the maximum number of hours a county may
assign an individual to unpaid community service and/or unpaid WEX, up to
20 hours per week for a single-parent with a child under 6, 30 hours per week
for a single-parent with no children under 6 or 35 hours per week for two-parent
families.
( Note:
A county need not assign an individual all of the hours
determined by the formula below) . If the assignment is less than 20 hours per
week for a single-parent with a child under 6, 30 hours per week for a single-
GRANT/CALCULATION MONTH (MONTH PRIOR TO THE ACTIVITY
parent with no children under 6 or 35 hours per week for two-parent families the
PARTICIPATION MONTH)
individual is required to participate in other activities to meet his or her work
participation requirement.
ACTIVITY PARTICIPATION MONTH
PARTICIPANT’S NAME
CASE NO.
1. Actual Cash Grant Authorized for the Grant/Calculation Month, Including
Underpayments and Supplemental Payments On or Before the 10th of the
Month. (After Penalties and Overpayments. Do Not Include Any Amount
$
Used to Subsidize Grant-Based OJT Community Service.)
2. Actual CalFresh Allotment Authorized for the Grant/Calculation Month,
Including Underissuances paid On or Before the 10th of the Month. (After
Overissuance Adjustments.) To determine prorated amount for mixed
CalFresh households, use this formula:
_______ x ________
=
Total Household CF Allotment ($________)
(CF
(# of
Amount/
CalWORKs
+ $
# of CF Recipients in Household (_______)
Person)
Recipients)
3. Total Benefits Paid for the Grant/Calculation Month.
(Total of line 1 and line 2)
= $
4. Monthly Minimum Wage Calculation Amount for the Grant/Calculation
Month. (Divide line 3 by the appropriate minimum wage)
$ __________
÷
$ ____________
=
(line 3)
(Minimum Wage )
5. Maximum Average Unpaid WEX/Community Service Hours for the
Grant/Calculation Month.
(Divide line 4 by 4.33)
____________
÷ 4.33
=
(Round Down)
(line 4)
DATE
COMPLETED BY
AGENCY
DISTRICT NUMBER (IF APPLICABLE)
WTW 15 (9/13) RECOMMENDED FORM
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
SIMPLIFIED CALFRESH PROGRAM UNPAID WORK EXPERIENCE
(WEX) AND UNPAID COMMUNITY SERVICE HOURS WORKSHEET
Complete this form to determine the maximum number of hours a county may
assign an individual to unpaid community service and/or unpaid WEX, up to
20 hours per week for a single-parent with a child under 6, 30 hours per week
for a single-parent with no children under 6 or 35 hours per week for two-parent
families.
( Note:
A county need not assign an individual all of the hours
determined by the formula below) . If the assignment is less than 20 hours per
week for a single-parent with a child under 6, 30 hours per week for a single-
GRANT/CALCULATION MONTH (MONTH PRIOR TO THE ACTIVITY
parent with no children under 6 or 35 hours per week for two-parent families the
PARTICIPATION MONTH)
individual is required to participate in other activities to meet his or her work
participation requirement.
ACTIVITY PARTICIPATION MONTH
PARTICIPANT’S NAME
CASE NO.
1. Actual Cash Grant Authorized for the Grant/Calculation Month, Including
Underpayments and Supplemental Payments On or Before the 10th of the
Month. (After Penalties and Overpayments. Do Not Include Any Amount
$
Used to Subsidize Grant-Based OJT Community Service.)
2. Actual CalFresh Allotment Authorized for the Grant/Calculation Month,
Including Underissuances paid On or Before the 10th of the Month. (After
Overissuance Adjustments.) To determine prorated amount for mixed
CalFresh households, use this formula:
_______ x ________
=
Total Household CF Allotment ($________)
(CF
(# of
Amount/
CalWORKs
+ $
# of CF Recipients in Household (_______)
Person)
Recipients)
3. Total Benefits Paid for the Grant/Calculation Month.
(Total of line 1 and line 2)
= $
4. Monthly Minimum Wage Calculation Amount for the Grant/Calculation
Month. (Divide line 3 by the appropriate minimum wage)
$ __________
÷
$ ____________
=
(line 3)
(Minimum Wage )
5. Maximum Average Unpaid WEX/Community Service Hours for the
Grant/Calculation Month.
(Divide line 4 by 4.33)
____________
÷ 4.33
=
(Round Down)
(line 4)
DATE
COMPLETED BY
AGENCY
DISTRICT NUMBER (IF APPLICABLE)
WTW 15 (9/13) RECOMMENDED FORM