Instructions For Form Sar 7 - Eligibility Status Report - Semi-Annual For Cash Aid And Calfresh

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
INSTRUCTIONS AND PENALTIES
SAR 7 ELIGIBILITY STATUS REPORT
For Cash Aid and CalFresh
Need Help? Call the County.
If you do not send in a complete report including, but not limited to, answering all questions on the SAR 7 and attaching proof when
we ask for it, your benefits may be delayed, changed, or stopped. Attach a separate sheet of paper if needed.
Facts you report may result in your benefits going up, down, or being stopped.
Send in your completed report by the 5th of the month after the report month. It is late after the 11th.
Examples
Income
Wages
Self-Employment
Salary
Vacation pay
Tips
Income In-Kind, such as earned housing, free
In-Home Supportive
Interest or dividends
housing/utilities/clothing/food
Services (IHSS)
Strike benefits
Gambling/Lottery winnings
Child/spousal support
Tax refunds
Cash, gifts, loans, scholarships
Insurance or legal
Unemployment
Other private or government disability or
settlements
Social Security
retirement
Rental income and rental
Supplemental Security
Workers Compensation
assistance
Income/State
Veterans or Railroad retirement
Any government benefits
Supplementary Payment
State Disability Indemnity
(SSI/SSP)
Property
Motor vehicles
Checking
Savings
EBT cash aid balance
Savings Bonds
Life insurance policies
Home
Land
Trusts
Housing
Rent
Mortgage
Property taxes
Costs
Utilities
Homeowners insurance
Garbage/trash collection fees
Expenses
Medical expenses
College tuition & supplies
Transportation
Health insurance premiums
Mandatory school fees
Room & Board
Child/dependent Care
Child/spousal support
Housing costs
Gross income means the amount you get before deductions are taken out (Examples of deductions are: Taxes, Social Security or other
retirement contributions, health care plan premiums, garnishments, etc.).
Penalties
PENALTIES FOR CASH AID FRAUD: If on purpose you do not
PENALTIES FOR CALFRESH FRAUD: If on purpose you do
follow Cash Aid rules, your Cash Aid can be lowered for a
not follow CalFresh rules, your CalFresh benefits can be
period of time and you may be fined up to $10,000 and/or sent
stopped for 12 months for the first violation, 24 months for
to jail or prison for up to 3 years.
the second, and forever for the third. You may be fined up
to $250,000 and/or sent to jail/prison for 20 years.
Your Cash Aid can be stopped:
If you are found guilty in any court of law or administrative
hearing because:
For not reporting all facts or for giving wrong facts: 6 months
You traded or sold CalFresh benefits for firearms,
for the first offense, 12 months for the second offense, or
ammunition, or explosives, your CalFresh benefits can be
forever for the third.
stopped forever for the first violation.
For submitting one or more applications to get aid in more
You traded or sold CalFresh benefits for controlled
than one case for the same time period: 2 years for the first
substances, your CalFresh benefits can be stopped for
conviction, 4 years for the second, and forever for the third.
24 months for the first violation and forever for the
For conviction of felony fraud to get aid: 2 years for theft of
second.
amounts under $2,000; 5 years for amounts of $2,000
You traded or sold CalFresh benefits that were worth
through $4,999.99; and forever for amounts of $5,000 or
more.
$500 or more, your CalFresh benefits can be stopped
Forever: for giving the county false proof of residency in
forever.
order to get aid in two or more counties or states at the same
You gave the county false identify or residence
time; giving the county wrong facts for an ineligible child or a
information, so you can get CalFresh benefits in more
child that does not exist; getting more than $10,000 in cash
than one case at the same time, your CalFresh benefits
benefits through fraud; getting a third conviction for fraud in
can be stopped for 10 years.
a court of law or an administrative hearing.
SAR 7 ADDENDUM (4/13) ELIGIBILITY STATUS REPORT - SEMI-ANNUAL FOR CASH AID AND CALFRESH - REQUIRED FORM - SUBSTITUTES PERMITTED

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