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

Download Form CW 2166 Work Pays Notice - California

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