Form AR 2 SAR Reporting Changes for Calworks and Calfresh - California

Form AR2 SAR is a California Department of Social Services form also known as the "Reporting Changes For Calworks And Calfresh". The latest edition of the form was released in March 1, 2015 and is available for digital filing.

Download a fillable PDF version of the Form AR2 SAR down below or find it on California Department of Social Services Forms website.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
REPORTING CHANGES FOR CalWORKs
CASE NAME:
AND CALFRESH
CASE NUMBER:
WORKER NUMBER:
Penalty for not reporting
Because you get
CalWORKs
CalFresh, you must
report within 10 days when your TOTAL income reaches
If you do not report when your income is more than your
a certain level. You must report anytime your household’s
household’s IRT limit you may get more benefits than you
total monthly income is more than your current Income
should. You must repay any extra benefits you get based
Reporting Threshold (IRT).
on income you do not report. If you do not report on
purpose to try to get more benefits, this is fraud, and you
may be charged with a crime.
Benefit Type
CalWORKs
CalFresh
Because you get CalWORKs, you MUST ALSO report
Family Size
the things below within 10 days of when they happen:
Your Current Income
1. Anytime someone moves into or out of your
household.
Your IRT is
2. Anytime someone joins, or is in your household,
who is in violation of a condition of probation or
Note: If your IRT for CalFresh is listed as “N/A”, you are not
parole.
required to report income changes for CalFresh until
3. Anytime someone joins, or is in your household,
your next SAR 7 or recertification, whichever comes
who is running from the law.
first. However, if you have an IRT amount listed for
4. Anytime you have an address change.
CalWORKs, you must report when your gross income
goes over that amount.
If you get CalFresh, you MUST ALSO report the
How to report?
following:
If your total income is over the IRT amount listed above, you
If you are an Able Bodied Adult Without
G
must report this to the County within 10 days. You can
Dependents (ABAWD), you must report anytime
report this information to the County by calling the County
your work or training hours drop to less than 20
or reporting it in writing.
hours a week or 80 hours a month.
By “total monthly income” we mean:
Voluntarily reporting information
Any money you get (both earned and unearned).
You may also voluntarily report changes to the County
The amount before any deductions are taken out.
anytime. Reporting some changes may get you more
(Examples of deductions are: taxes, Social Security
benefits. For example:
or other retirement contributions,
Someone in the house becomes pregnant.
garnishments, etc.)
G
Someone on cash aid has a special need, such
G
What will happen?
as: a pregnancy, a special diet prescribed by a
doctor, household emergency, etc.
Your benefits may be lowered or stopped based on
For CalFresh, if someone disabled or age 60 or
income over your IRT.
G
older has new or higher out of pocket medical
Your IRT may change when your income changes or
costs.
when someone moves in or out of your home.
The County will let you know in writing each time
your IRT changes.
You also need to report during your annual
redetermination/recertification (RD/RC) all income
the RD/RC form asks about, even if you already
reported that money.
AR 2 SAR (3/15) REPORTING CHANGES FOR CALWORKS AND CALFRESH - REQUIRED FORM - SUBSTITUTES PERMITTED
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
REPORTING CHANGES FOR CalWORKs
CASE NAME:
AND CALFRESH
CASE NUMBER:
WORKER NUMBER:
Penalty for not reporting
Because you get
CalWORKs
CalFresh, you must
report within 10 days when your TOTAL income reaches
If you do not report when your income is more than your
a certain level. You must report anytime your household’s
household’s IRT limit you may get more benefits than you
total monthly income is more than your current Income
should. You must repay any extra benefits you get based
Reporting Threshold (IRT).
on income you do not report. If you do not report on
purpose to try to get more benefits, this is fraud, and you
may be charged with a crime.
Benefit Type
CalWORKs
CalFresh
Because you get CalWORKs, you MUST ALSO report
Family Size
the things below within 10 days of when they happen:
Your Current Income
1. Anytime someone moves into or out of your
household.
Your IRT is
2. Anytime someone joins, or is in your household,
who is in violation of a condition of probation or
Note: If your IRT for CalFresh is listed as “N/A”, you are not
parole.
required to report income changes for CalFresh until
3. Anytime someone joins, or is in your household,
your next SAR 7 or recertification, whichever comes
who is running from the law.
first. However, if you have an IRT amount listed for
4. Anytime you have an address change.
CalWORKs, you must report when your gross income
goes over that amount.
If you get CalFresh, you MUST ALSO report the
How to report?
following:
If your total income is over the IRT amount listed above, you
If you are an Able Bodied Adult Without
G
must report this to the County within 10 days. You can
Dependents (ABAWD), you must report anytime
report this information to the County by calling the County
your work or training hours drop to less than 20
or reporting it in writing.
hours a week or 80 hours a month.
By “total monthly income” we mean:
Voluntarily reporting information
Any money you get (both earned and unearned).
You may also voluntarily report changes to the County
The amount before any deductions are taken out.
anytime. Reporting some changes may get you more
(Examples of deductions are: taxes, Social Security
benefits. For example:
or other retirement contributions,
Someone in the house becomes pregnant.
garnishments, etc.)
G
Someone on cash aid has a special need, such
G
What will happen?
as: a pregnancy, a special diet prescribed by a
doctor, household emergency, etc.
Your benefits may be lowered or stopped based on
For CalFresh, if someone disabled or age 60 or
income over your IRT.
G
older has new or higher out of pocket medical
Your IRT may change when your income changes or
costs.
when someone moves in or out of your home.
The County will let you know in writing each time
your IRT changes.
You also need to report during your annual
redetermination/recertification (RD/RC) all income
the RD/RC form asks about, even if you already
reported that money.
AR 2 SAR (3/15) REPORTING CHANGES FOR CALWORKS AND CALFRESH - REQUIRED FORM - SUBSTITUTES PERMITTED

Download Form AR 2 SAR Reporting Changes for Calworks and Calfresh - California

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