Form Sar 3 - Mid-Period Status Report For Cash Aid And Calfresh Page 2

Download a blank fillable Form Sar 3 - Mid-Period Status Report For Cash Aid And Calfresh 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 Sar 3 - Mid-Period Status Report For Cash Aid And Calfresh 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

MANDATORY INFORMATION - continued
CF
Fill out this section to report reduced work or training hours for Able-Bodied Adults without Dependents
(ABAWDs). (ABAWDs are adults between 19 and 50 who are not caring for minor children.)
The number of hours worked or in training dropped below 20 hours a week or 80 hours a month
to ______ hours per week or ______ hours per month.
Name of person(s)________________________________________
Relationship to you _______________________________________
Explain what happened____________________________________
_______________________________________________________
Date of change __________________________________________
VOLUNTARY INFORMATION (All households/Assistance Units)
I would like to report the following information:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
CERTIFICATION
I UNDERSTAND THAT: If on purpose I do not report all facts or give wrong facts about my income, property, or family
status to get or keep getting aid or benefits, I can be charged with a crime. And, I may be charged with committing a felony
if more than $950 in cash aid and/or CalFresh is wrongly paid out.
I declare under penalty of perjury under the laws of the United States and the State of California that the facts contained
in this report are true and correct and complete.
WHO MUST SIGN
For Cash Aid: you and your aided spouse, Registered Domestic Partner, or the other parent (of cash
BELOW:
aided children), if living in the home.
For CalFresh:
the head of household, household member or the household’s authorized
representative.
Signature or Mark
Date Signed
Home Phone
Contact Phone
Signature of Spouse, Registered Domestic Partner
Date Signed
Signature of Witness to Mark, interpreter or
Date Signed
other person completing form
or other Parent of Cash Aided Children
PAGE 2 OF 2
SAR 3 (2/15) RECOMMENDED FORM

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Qr 3 - Mid-quarter Status Report For Cash Aid And Food Stamps - 2006 - State Of California - Health And Human Services Agency Form Qr 3 - Mid-quarter Status Report For Cash Aid And Food Stamps - 2006 - State Of California - Health And Human Services Agency Legal
Form Ar 3 Mid-year Status Report For Calworks And Calfresh Form Ar 3 Mid-year Status Report For Calworks And Calfresh Legal
Form Sar 2 - Reporting Changes For Cash Aid And Calfresh Form Sar 2 - Reporting Changes For Cash Aid And Calfresh Legal
Instructions For Form Sar 7 - Eligibility Status Report - Semi-annual For Cash Aid And Calfresh Instructions For Form Sar 7 - Eligibility Status Report - Semi-annual For Cash Aid And Calfresh Legal
Form Qr 2 - Reporting Changes For Cash Aid And Food Stamps Form Qr 2 - Reporting Changes For Cash Aid And Food Stamps Legal
Form Uc-1 Np - Employer Status Report For Unemployment Compensation Form Uc-1 Np - Employer Status Report For Unemployment Compensation Legal
Form Pk-3 - Employer's Registration Report For Newark Payroll Tax - 2007 Form Pk-3 - Employer's Registration Report For Newark Payroll Tax - 2007 Financial
Form Py-3 - Employer's Registration Report For Newark Payroll Tax - 2008 Form Py-3 - Employer's Registration Report For Newark Payroll Tax - 2008 Financial
Form N-3 - Procedure Qualification Record (pqr) For Qualification, Pretest, And Verification Results Form N-3 - Procedure Qualification Record (pqr) For Qualification, Pretest, And Verification Results Business
Form Rpd-41306 - Combined Fuel Tax Report For Distributors, Suppliers And Wholesalers Form Rpd-41306 - Combined Fuel Tax Report For Distributors, Suppliers And Wholesalers Financial

Related Categories

Parent category: Legal
Download
Go
Page of 2