Form Sar 22 - Sponsor'S Statement Of Facts Income And Resources - California Health And Human Services Agency

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STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
SPONSORED NONCITIZENS APPLYING FOR OR RECEIVING
CASH AID AND/OR CALFRESH
Important Information For Noncitizens Sponsored
Important Information For Sponsors
By Individuals
The noncitizen you sponsor has applied for Cash Aid
and/or CalFresh. If you signed an affidavit of support, State
As a noncitizen who is sponsored by an individual(s),
regulations require the county welfare department to
you must meet special rules to get Cash Aid and/or
review your income, resources, and property in deciding
CalFresh.
whether or not the noncitizen applicant can get benefits.
Sponsorship is normally for an indefinite period of time.
The Special Rules Are:
This form must be completed and signed by you under
penalty of perjury. If you are living with your spouse or your
Your sponsor’s income and resources will have to be
spouse has signed an affidavit of support, your spouse’s
reviewed to see if you can get benefits. Your
income, resources, and property are also counted.
sponsor must fill out the attached form. Both you and
your sponsor must sign this form.
If the noncitizen’s application for Cash Aid is approved,
If your application is approved, you and your sponsor
each semi-annual period (every six months) you will
have to report your income, resources, and property on
will have to report your income and resources every
either this form or on the Sponsor’s Semi-Annual Income
six months to keep getting Cash Aid and CalFresh
and Resources Report (SAR 72). The noncitizen will give
benefits. If your sponsor does not provide this
you the report form. Your report must be completed and
information, your benefits may be changed or
returned to the noncitizen immediately to ensure the
stopped. Family members who are not sponsored
noncitizen’s continued eligibility. Each semi-annual period,
and are otherwise eligible can keep getting their
resources and a portion of your income will be used to
benefits.
determine the noncitizen’s continued eligibility and
You are the person responsible for getting all the
benefits.
information requested to the county welfare
department for both you and your sponsor. Let
If the noncitizen receives benefits to which he or she is not
the county know if you need help.
entitled because you failed to accurately report information,
you and/or the noncitizen may have to repay these
If your sponsor has abandoned you (you don’t know
benefits.
where they are or they don’t help you out) you might
still be able to get benefits.
SAR 22 COVERSHEET (3/13) REQUIRED FORM – NO SUBSTITUTES PERMITTED

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