Form CW2208 "Your Welfare-To-Work (Wtw) 24-month Time Clock" - California

Form CW2208 or the "Your Welfare-to-work (wtw) 24-month Time Clock" is a form issued by the California Department of Social Services.

The form was last revised in February 1, 2013 and is available for digital filing. Download an up-to-date fillable Form CW2208 in PDF-format down below or look it up on the California Department of Social Services Forms website.

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Download Form CW2208 "Your Welfare-To-Work (Wtw) 24-month Time Clock" - California

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COUNTY
CASE NAME
YOUR WELFARE-TO-WORK (WTW)
24-MONTH TIME CLOCK
CASE NO.
OTHER ID NO.
WORKER NAME
Date:____________________
THIS FORM GIVES YOU INFORMATION ABOUT YOUR WTW 24-MONTH TIME CLOCK.
As of _____________, you have ___________ months left on your WTW 24-Month Time Clock. During your WTW 24-Month
Time Clock, you may participate in many different activities in WTW to help you move toward self-sufficiency.
Months will not count when:
you are in the process of developing a WTW plan.
you are meeting the required number of participation hours in certain activities that meet federal work rules.
you are in Cal-Learn.
you are exempt from participating in WTW.
the county finds that you have a good reason for not participating in WTW. This could include the county not
having the supportive services you need to do your assignment.
you have been sanctioned in WTW.
You have been granted a domestic abuse waiver to the WTW 24-Month Time Clock.
After you have used all months of your WTW 24-Month Time Clock, the types of activities you must do in WTW will change.
You will have fewer allowable activities, and you will need to meet core hourly requirements unless you qualify for an extension
to the WTW 24-Month Time Clock. The core activities may include employment, work experience, and community service.
Vocational education and training may also be allowed for up to one year as a core activity if you have not already used your
12-Month lifetime limit where vocational education can count as a core activity. The chart below shows you the difference in
core activity requirements during and after the WTW 24-Month Time Clock.
Required # of Core Hours
Required # of Core Hours
Weekly Hours of
Number of Adults in the Family (Assistance Unit)
After the 24-Month Clock
During 24-Month Clock
Participation
Single-adult with a child under 6 years old
20
0
20
Single-adult with no children under 6 years old
30
0
20
Two-parent families
35
0
30
If you do not meet these hours with an allowable core activity after using all of your WTW 24-Month Time Clock, you may
be removed from the Assistance Unit and your cash aid may be lowered. In addition to this informing notice received at
application and redetermination, the county will give you a Notice of Action (NOA) between your 18th and 21st months on
the WTW 24-Month Time Clock and when you have used all 24 months of your WTW 24-Month Time Clock.
CONTACT YOUR WORKER RIGHT AWAY IF YOU:
want to change your WTW plan because of the participation requirements;
think you should not have months counted toward the WTW 24-Month Time Clock;
need more information about the WTW 24-Month Time Clock requirements or how to ask for an extension to your
clock.
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.
CW 2208 (2/13) REQUIRED FORM - SUBSTITUTES PERMITTED
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COUNTY
CASE NAME
YOUR WELFARE-TO-WORK (WTW)
24-MONTH TIME CLOCK
CASE NO.
OTHER ID NO.
WORKER NAME
Date:____________________
THIS FORM GIVES YOU INFORMATION ABOUT YOUR WTW 24-MONTH TIME CLOCK.
As of _____________, you have ___________ months left on your WTW 24-Month Time Clock. During your WTW 24-Month
Time Clock, you may participate in many different activities in WTW to help you move toward self-sufficiency.
Months will not count when:
you are in the process of developing a WTW plan.
you are meeting the required number of participation hours in certain activities that meet federal work rules.
you are in Cal-Learn.
you are exempt from participating in WTW.
the county finds that you have a good reason for not participating in WTW. This could include the county not
having the supportive services you need to do your assignment.
you have been sanctioned in WTW.
You have been granted a domestic abuse waiver to the WTW 24-Month Time Clock.
After you have used all months of your WTW 24-Month Time Clock, the types of activities you must do in WTW will change.
You will have fewer allowable activities, and you will need to meet core hourly requirements unless you qualify for an extension
to the WTW 24-Month Time Clock. The core activities may include employment, work experience, and community service.
Vocational education and training may also be allowed for up to one year as a core activity if you have not already used your
12-Month lifetime limit where vocational education can count as a core activity. The chart below shows you the difference in
core activity requirements during and after the WTW 24-Month Time Clock.
Required # of Core Hours
Required # of Core Hours
Weekly Hours of
Number of Adults in the Family (Assistance Unit)
After the 24-Month Clock
During 24-Month Clock
Participation
Single-adult with a child under 6 years old
20
0
20
Single-adult with no children under 6 years old
30
0
20
Two-parent families
35
0
30
If you do not meet these hours with an allowable core activity after using all of your WTW 24-Month Time Clock, you may
be removed from the Assistance Unit and your cash aid may be lowered. In addition to this informing notice received at
application and redetermination, the county will give you a Notice of Action (NOA) between your 18th and 21st months on
the WTW 24-Month Time Clock and when you have used all 24 months of your WTW 24-Month Time Clock.
CONTACT YOUR WORKER RIGHT AWAY IF YOU:
want to change your WTW plan because of the participation requirements;
think you should not have months counted toward the WTW 24-Month Time Clock;
need more information about the WTW 24-Month Time Clock requirements or how to ask for an extension to your
clock.
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.
CW 2208 (2/13) REQUIRED FORM - SUBSTITUTES PERMITTED
TO ASK FOR A HEARING:
YOUR HEARING RIGHTS
Fill out this page.
You have the right to ask for a hearing if you disagree with
Make a copy of the front and back of this page for your records.
any county action. You have only 90 days to ask for a
If you ask, your worker will get you a copy of this page.
hearing. The 90 days started the day after the county gave or
Send or take this page to:
mailed you this notice. If you have good cause as to why
you were not able to file for a hearing within the 90 days, you
may still file for a hearing. If you provide good cause, a
hearing may still be scheduled.
OR
If you ask for a hearing before an action on Cash Aid,
Call toll free: 1-800-952-5253 or for hearing or speech impaired
Medi-Cal, CalFresh (Food Stamps), or Child Care takes place:
who use TDD, 1-800-952-8349.
Your Cash Aid or Medi-Cal will stay the same while you wait for a
To Get Help: You can ask about your hearing rights or for a legal
hearing.
aid referral at the toll-free state phone numbers listed above. You
Your Child Care Services may stay the same while you wait for a
may get free legal help at your local legal aid or welfare rights office.
hearing.
Your CalFresh (Food Stamps) will stay the same until the hearing
or the end of your certification period, whichever is earlier.
If the hearing decision says we are right, you will owe us for any
extra Cash Aid, CalFresh (Food Stamps) or Child Care Services
If you do not want to go to the hearing alone, you can bring a
you got.
To let us lower or stop your benefits before the hearing,
friend or someone with you.
check below:
HEARING REQUEST
■ ■
■ ■
Yes, lower or stop:
Cash Aid
CalFresh (Food Stamps)
I want a hearing due to an action by the Welfare Department
■ ■
Child Care
of ________________________________ County about my:
Cash Aid
CalFresh (Food Stamps)
Medi-Cal
While You Wait for a Hearing Decision for:
Other (list)___________________________________________
Welfare to Work:
You do not have to take part in the activities.
Here's Why: ____________________________________________
You may receive child care payments for employment and for
_______________________________________________________
activities approved by the county before this notice.
_______________________________________________________
If we told you your other supportive services payments will stop, you
will not get any more payments, even if you go to your activity.
_______________________________________________________
If we told you we will pay your other supportive services, they will be
paid in the amount and in the way we told you in this notice.
_______________________________________________________
To get those supportive services, you must go to the activity the
_______________________________________________________
county told you to attend.
If the amount of supportive services the county pays while you
If you need more space, check here and add a page.
wait for a hearing decision is not enough to allow you to
I need the state to provide me with an interpreter at no cost to me.
participate, you can stop going to the activity.
(A relative or friend cannot interpret for you at the hearing.)
Cal-Learn:
My language or dialect is: ____________________________
You cannot participate in the Cal-Learn Program if we told you
NAME OF PERSON WHOSE BENEFITS WERE DENIED, CHANGED OR STOPPED
we cannot serve you.
We will only pay for Cal-Learn supportive services for an
BIRTH DATE
PHONE NUMBER
approved activity.
STREET ADDRESS
OTHER INFORMATION
CITY
STATE
ZIP CODE
Medi-Cal Managed Care Plan Members: The action on this notice may stop
SIGNATURE
DATE
you from getting services from your managed care health plan. You may wish
to contact your health plan membership services if you have questions.
NAME OF PERSON COMPLETING THIS FORM
PHONE NUMBER
Child and/or Medical Support: The local child support agency will help
collect support at no cost even if you are not on cash aid. If they now collect
I want the person named below to represent me at this
support for you, they will keep doing so unless you tell them in writing to stop.
hearing. I give my permission for this person to see my
They will send you current support money collected but will keep past due
money collected that is owed to the county.
records or go to the hearing for me. (This person can be a
friend or relative but cannot interpret for you.)
Family Planning: Your welfare office will give you information when you ask
for it.
NAME
PHONE NUMBER
Hearing File: If you ask for a hearing, the State Hearing Division will set up a
file. You have the right to see this file before your hearing and to get a copy of
STREET ADDRESS
the county's written position on your case at least two days before the hearing.
CITY
STATE
ZIP CODE
The state may give your hearing file to the Welfare Department and the U.S.
Departments of Health and Human Services and Agriculture.
(W&I Code
Sections 10850 and 10950.)
NA BACK 9 (REPLACES NA BACK 8 AND EP 5) (REVISED 4/2011) - REQUIRED FORM - NO SUBSTITUTE PERMITTED
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