Form CW 2166 Work Pays Notice - California

Form CW2166 or the "Work Pays Notice" is a form issued by the California Department of Social Services.

Download a fillable PDF version of the Form CW2166 down below or find it on the California Department of Social Services Forms website.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
WORK REALLY PAYS! HERE’S HOW:
You can work and still get CalWORKs cash aid as long as you are low
income and remain eligible. When you add your earnings to your cash
aid, you will have more $$$ for your family. Work also:
Develops your job skills, and helps you get a better job.
Builds a better life for you and your family.
Gives you personal satisfaction.
Builds your self-esteem.
HERE IS AN EXAMPLE OF HOW WORK PAYS FOR MARY AND HER TWO CHILDREN (REGION 1):
Mary works 32 hours a week for $8.00 an hour.
FIGURE YOUR EARNINGS AND CASH AID:
Step 1
Figure your weekly gross earnings:
Step 1
We figure Mary’s weekly gross earnings:
Your hourly wage $________ x your weekly
$8.00 x 32 hours = $256 Weekly Earnings
hours of work_____ = your Weekly Gross
Earnings $__________.
Step 2
We figure Mary’s monthly gross earnings:
Step 2
Figure your monthly gross earnings:
$256 x 4.33 weeks = $1108.48 Monthly
Your Weekly Gross Earnings $______ x
Gross Earnings (4.33 is the average number
4.33 weeks = your Monthly Gross
of weeks per month)
Earnings $______.
Step 3
We figure Mary’s monthly countable earnings:
Step 3
Figure your monthly countable earnings:
Mary’s Monthly Gross Earnings
$ 1108.48
Your Monthly Gross Earnings
Less $225 Earned Income
(from Step 2)
$
Deduction (EID)
-
225.00
Less $225 Deduction
-
225.00
Balance
883.48
Balance
$
Less 50% (half) of Balance
-
441.74
Less 50% (half) of Balance
-
Equals Countable Earnings
$
441.00*
Equals Countable Earnings
$
Step 4
We figure Mary’s cash grant:
Step 4
Figure your cash grant:
Non-exempt Maximum Aid
Non-exempt Maximum Aid
Payment (MAP) for 3 (Region 1)
$
638.00
Payment (MAP) for a family your
Less Mary’s Countable Earnings
-
441.00
size
$
Equals Cash Grant
$
197.00
Less your Countable Earnings
(from step 3)
-
Equals Cash Grant
$
Step 5
We figure Mary’s total monthly income:
Step 5
Figure your total monthly income:
Monthly Gross Earnings
$ 1108.00*
Monthly Gross Earnings
Plus Cash Grant
+
197.00
(from step 2)
$
Equals Total Gross Income
$ 1305.00
Plus Cash Grant (from step 4)
+
Equals Total Gross Income
$
*Countable income is rounded down to whole dollar amounts.
For a translation of this notice, ask your worker.
(Spanish)
TURN PAGE OVER FOR FACTS ABOUT OTHER BENEFITS YOU CAN GET FROM WORKING
CW 2166 (5/13) MULTILINGUAL (REV. 2) - WORK PAYS NOTICE - RECOMMENDED FORM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
WORK REALLY PAYS! HERE’S HOW:
You can work and still get CalWORKs cash aid as long as you are low
income and remain eligible. When you add your earnings to your cash
aid, you will have more $$$ for your family. Work also:
Develops your job skills, and helps you get a better job.
Builds a better life for you and your family.
Gives you personal satisfaction.
Builds your self-esteem.
HERE IS AN EXAMPLE OF HOW WORK PAYS FOR MARY AND HER TWO CHILDREN (REGION 1):
Mary works 32 hours a week for $8.00 an hour.
FIGURE YOUR EARNINGS AND CASH AID:
Step 1
Figure your weekly gross earnings:
Step 1
We figure Mary’s weekly gross earnings:
Your hourly wage $________ x your weekly
$8.00 x 32 hours = $256 Weekly Earnings
hours of work_____ = your Weekly Gross
Earnings $__________.
Step 2
We figure Mary’s monthly gross earnings:
Step 2
Figure your monthly gross earnings:
$256 x 4.33 weeks = $1108.48 Monthly
Your Weekly Gross Earnings $______ x
Gross Earnings (4.33 is the average number
4.33 weeks = your Monthly Gross
of weeks per month)
Earnings $______.
Step 3
We figure Mary’s monthly countable earnings:
Step 3
Figure your monthly countable earnings:
Mary’s Monthly Gross Earnings
$ 1108.48
Your Monthly Gross Earnings
Less $225 Earned Income
(from Step 2)
$
Deduction (EID)
-
225.00
Less $225 Deduction
-
225.00
Balance
883.48
Balance
$
Less 50% (half) of Balance
-
441.74
Less 50% (half) of Balance
-
Equals Countable Earnings
$
441.00*
Equals Countable Earnings
$
Step 4
We figure Mary’s cash grant:
Step 4
Figure your cash grant:
Non-exempt Maximum Aid
Non-exempt Maximum Aid
Payment (MAP) for 3 (Region 1)
$
638.00
Payment (MAP) for a family your
Less Mary’s Countable Earnings
-
441.00
size
$
Equals Cash Grant
$
197.00
Less your Countable Earnings
(from step 3)
-
Equals Cash Grant
$
Step 5
We figure Mary’s total monthly income:
Step 5
Figure your total monthly income:
Monthly Gross Earnings
$ 1108.00*
Monthly Gross Earnings
Plus Cash Grant
+
197.00
(from step 2)
$
Equals Total Gross Income
$ 1305.00
Plus Cash Grant (from step 4)
+
Equals Total Gross Income
$
*Countable income is rounded down to whole dollar amounts.
For a translation of this notice, ask your worker.
(Spanish)
TURN PAGE OVER FOR FACTS ABOUT OTHER BENEFITS YOU CAN GET FROM WORKING
CW 2166 (5/13) MULTILINGUAL (REV. 2) - WORK PAYS NOTICE - RECOMMENDED FORM
WORK PAYS IN SO MANY OTHER WAYS
EARNED INCOME TAX CREDIT
SUPPORTIVE SERVICES
The federal Earned Income Tax Credit (EITC) is a special
tax break for people who work full or part time. This
While in CalWORKs, you and the county will agree on
means extra cash in your pocket. Claiming your EITC is
goals and activities to help you get a job and support your
easy. Just file your tax return form 1040 or 1040A and
family without cash aid. You have the right to available
Schedule EIC. You can still get an EITC refund even if you
supportive services you need to do the activities and
do not owe any income tax.
assignments. This can be transportation, child care,
ancillary costs (fees, uniforms, supplies, etc.), and
The EITC refund is not counted as income when your
counseling services to help with the transition to work. You
CalWORKs cash grant, CalFresh, or Medi-Cal benefits are
may be able to get some of these supportive services paid
figured.
for in advance.
You can get the EITC refund going back three years if you
CHILD CARE
filed your income tax but did not claim your EITC. You just
CalWORKs can pay for part of all or your child care. You
need to turn in an amended income tax return. There is no
can get paid child care while you look for a job, work, or
late penalty for those earlier years.
take part in other approved CalWORKs activities, such as
training or county meetings. Your child care will be paid to
You can get free tax help from Volunteer Income Tax
the eligible child care provider that you choose.
Assistance (VITA) sites. For a VITA site near you, or other
tax information, call the IRS at 1-800-829-1040.
If you are looking for work, working, in a training program,
or taking part in a county approved activity, you can get
paid child care for the entire time you are on cash aid.
Federal and State 48-Month Time limits
After you go off cash aid, you can keep getting child care
for up to 24 months, as long as you are below a certain
As of July 1, 2011, a parent or caretaker relative can only
income level.
get CalWORKs cash aid for up to a lifetime total of
After you have received 24 months of child care, you may
48 months. Cash aid received from CalWORKs, Tribal
continue to get child care if funding is available and your
TANF and/or from any other state counts toward the
family remains eligible. The county or the local Alternative
48-month limit.
Payment Program agency will help you to find additional
services.
There are times when you can get aid past 48-months.
These situations allow aid to continue past the time
JOB RETENTION SERVICES
limit, or stop a month of aid from counting toward the
time limit. Some of these exceptions are:
Some counties provide job retention services for eligible
former recipients, as part of the CalWORKs program.
The limit does not apply to children.
Job retention services can be case management,
A month on cash aid does not count toward the
transportation, or other services that help you keep a job
48-month time limit when the person is:
or get a better job. Ask your worker what services your
✔ Age 60 or older.
county can give you. Months you get job retention services
✔ Exempt from taking part in Welfare-to-Work
do not count against the California 48-month time limit, and
activities for certain reasons.
do not count against the Federal limit as long as you are
✔ Disabled for 30 days or more.
employed.
✔ And other reasons your worker can tell you.
You may get job retention services for up to 12 months IF:
Other states may have different rules for the
You got CalWORKs AND
48-month time limit.
You went off cash aid because you got a job OR
You went off cash aid and you got a job within
12 months.
HEALTH COVERAGE IS IMPORTANT FOR YOU
AND YOUR FAMILY
Your health coverage may continue when your CalWORKs
cash aid stops.
Depending on the reason your cash aid stops, you and
your child(ren) may be eligible for continued
no-cost or low-cost health coverage under the
Medi-Cal or Healthy Families programs.
CW 2166 (5/13) MULTILINGUAL (REV. 2)

Download Form CW 2166 Work Pays Notice - California

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