Form Cw 2190b Calworks 48-Month Time Limitextender Determination Denial Form
Download a blank fillable Form Cw 2190b Calworks 48-Month Time Limitextender Determination Denial Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cw 2190b Calworks 48-Month Time Limitextender Determination Denial Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COUNTY
CASE NAME
CalWORKs 48-MONTH TIME LIMIT
EXTENDER DETERMINATION DENIAL FORM
OTHER ID NO.
CASE NO.
WORKER NAME
Questions? Ask your worker.
Date____________________
On _________________________, a 48-month time limit extender was requested for______________________________________ .
(DATE)
(NAME)
Based on the facts in your case, the county made the following decision.
The 48-month time limit extender is DENIED. You do not meet the rules to qualify for a time limit extender at this time and will not be
aided. If your condition changes, call your worker to ask for a time limit extender.
Reason for Denial:____________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
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.
Rules:
These rules apply; you may review them at your welfare office: MPP 42-302.1, 42-302.11, 42-302.12, 42-302.2,
42-302.3 - .34 and Senate Bill 72 (Chapter 8, Statutes of 2011).
CW 2190B (6/11) REQUIRED FORM - NO SUBSTITUTE PERMITTED
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal