Form ABCD239.7A "Notice of Administrative Disqualification - California Work Opportunity and Responsibility to Kids (Calworks) Program" - California

What Is Form ABCD239.7A?

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 August 1, 2001;
  • 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;

Download a fillable version of Form ABCD239.7A 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 ABCD239.7A "Notice of Administrative Disqualification - California Work Opportunity and Responsibility to Kids (Calworks) Program" - California

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STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF
ADMINISTRATIVE DISQUALIFICATION
Notice Date
:
CALIFORNIA WORK OPPORTUNITY
Case
Name
:
and RESPONSIBILITY TO KIDS
Number
:
Worker
(CalWORKs) PROGRAM
Name
:
Number
:
Telephone
:
Address
:
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing:
You cannot appeal the
disqualification action in a state hearing.
DISQUALIFICATION ACTION
The following action disqualified you from the CalWORKs Program:
A state hearing decision on __________________ found you committed an intentional program violation (IPV).
A court decision on ____________________ found you committed an IPV.
You signed a Disqualification Consent Agreement on ____________________ .
You signed an Administrative Disqualification Hearing Waiver on ____________________ .
You were disqualified from the CalWORKs Program in ______________________ .
(COUNTY)
A copy of the above action was sent or given to you.
DISQUALIFICATION PENALTIES
Penalties for violations committed before January 1, 1998
Six months for the first violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Twelve months for the second violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible
to receive.
Two years for the first violation for filing more than one application for the same period of time or for giving false documentation for
children who are not eligible or do not exist.
Four years for the second violation for filing more than one application for the same period of time or for giving false documentation for
children who are not eligible or do not exist.
Permanently for the third violation for:
Not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Filing more than one application for the same period of time or for giving false documentation for children who are not eligible or do
not exist.
Penalties for violations committed on or after January 1, 1998
Six months for the first violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Twelve months for the second violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible
to receive.
Two years for the first violation for:
A felony conviction, in a state or federal court, that does not meet the conditions for permanent penalty and the overpayment is
less than $2,000.
For filing, on purpose, more than one application for the same type of aid, for the same period of time.
Four years for the second violation for filing, on purpose, more than one application for the same type of aid, for the same period
of time.
Five years for a felony conviction, in a state or federal court, that does not meet the conditions for permanent penalty and the
overpayment is between $2,000 and $5,000 in cash aid.
Permanently:
For the third violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
For the third violation for filing, on purpose, more than one application for the same type of aid, for the same period of time.
For giving false documentation for children who are not eligible or do not exist.
For lying about or misrepresenting your place of residence in order to get more than one cash aid grant at the
same time from two or more states or counties.
For a felony conviction, in a state or federal court, for fraudulently receiving or attempting to get more than $5,000 in cash aid.
For fraudulently receiving more than $10,000 in cash aid.
According to the violation checked above, this means that:
You cannot get aid as of _____________________ for ____________ months/years.
You cannot get aid for _________ months/years. Since you are not eligible now, this penalty will start when you reapply and are
otherwise eligible.
You have been permanently disqualified from the CalWORKs Program as of __________________________ .
COMMENTS:
Rules: These rules apply. You may review them at your welfare office: Manual of Policies and Procedures Sections: 20-352.213, 20-353.1, 20-353.2 and 22-003.11.
ABCD 239.7A (8/01) REQUIRED FORM — NO SUBSTITUTES PERMITTED
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF
ADMINISTRATIVE DISQUALIFICATION
Notice Date
:
CALIFORNIA WORK OPPORTUNITY
Case
Name
:
and RESPONSIBILITY TO KIDS
Number
:
Worker
(CalWORKs) PROGRAM
Name
:
Number
:
Telephone
:
Address
:
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing:
You cannot appeal the
disqualification action in a state hearing.
DISQUALIFICATION ACTION
The following action disqualified you from the CalWORKs Program:
A state hearing decision on __________________ found you committed an intentional program violation (IPV).
A court decision on ____________________ found you committed an IPV.
You signed a Disqualification Consent Agreement on ____________________ .
You signed an Administrative Disqualification Hearing Waiver on ____________________ .
You were disqualified from the CalWORKs Program in ______________________ .
(COUNTY)
A copy of the above action was sent or given to you.
DISQUALIFICATION PENALTIES
Penalties for violations committed before January 1, 1998
Six months for the first violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Twelve months for the second violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible
to receive.
Two years for the first violation for filing more than one application for the same period of time or for giving false documentation for
children who are not eligible or do not exist.
Four years for the second violation for filing more than one application for the same period of time or for giving false documentation for
children who are not eligible or do not exist.
Permanently for the third violation for:
Not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Filing more than one application for the same period of time or for giving false documentation for children who are not eligible or do
not exist.
Penalties for violations committed on or after January 1, 1998
Six months for the first violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
Twelve months for the second violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible
to receive.
Two years for the first violation for:
A felony conviction, in a state or federal court, that does not meet the conditions for permanent penalty and the overpayment is
less than $2,000.
For filing, on purpose, more than one application for the same type of aid, for the same period of time.
Four years for the second violation for filing, on purpose, more than one application for the same type of aid, for the same period
of time.
Five years for a felony conviction, in a state or federal court, that does not meet the conditions for permanent penalty and the
overpayment is between $2,000 and $5,000 in cash aid.
Permanently:
For the third violation for not reporting, on purpose, all facts or giving wrong facts to get aid you were not eligible to receive.
For the third violation for filing, on purpose, more than one application for the same type of aid, for the same period of time.
For giving false documentation for children who are not eligible or do not exist.
For lying about or misrepresenting your place of residence in order to get more than one cash aid grant at the
same time from two or more states or counties.
For a felony conviction, in a state or federal court, for fraudulently receiving or attempting to get more than $5,000 in cash aid.
For fraudulently receiving more than $10,000 in cash aid.
According to the violation checked above, this means that:
You cannot get aid as of _____________________ for ____________ months/years.
You cannot get aid for _________ months/years. Since you are not eligible now, this penalty will start when you reapply and are
otherwise eligible.
You have been permanently disqualified from the CalWORKs Program as of __________________________ .
COMMENTS:
Rules: These rules apply. You may review them at your welfare office: Manual of Policies and Procedures Sections: 20-352.213, 20-353.1, 20-353.2 and 22-003.11.
ABCD 239.7A (8/01) REQUIRED FORM — NO SUBSTITUTES PERMITTED