Instructions For Form Qr 7 - Eligibility/status Report - Quarterly For Cash Aid And Food Stamps

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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
ELIGIBILITY/STATUS REPORT
For Cash Aid and Food Stamps
Need Help? Call your worker.
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If you do not send in a complete report including, but not limited to, answering all questions on the QR 7/SAWS QR 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.
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Facts you report may result in your benefits going up, down, or be stopped.
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Send in your completed report by the 5th of the month after the report month.
Examples
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Income
Wages
Self-Employment
Salary
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Vacation pay
Tips
Income In-Kind, such as earned housing, free
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Child/spousal support
Interest or dividends
housing/utilities/clothing/food
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Insurance or legal
Strike benefits
Gambling/Lottery winnings
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settlements
Tax refunds
Cash, gifts, loans, scholarships
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Rental income and rental
Unemployment
Other private or government disability or
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assistance
Social Security
retirement
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Any government benefits
Supplemental Security
Workers Compensation
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State Disability Indemnity
Income/State
Veterans or Railroad retirement
Supplementary Payment
(SSI/SSP)
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Property
Motor vehicles
Checking
Savings
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EBT balance
Savings Bonds
Life insurance policies
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Home
Land
Trusts
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Housing
Rent
Mortgage
Property taxes
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Costs
Utilities
Homeowners insurance
Garbage/trash collection fees
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Expenses
Medical expenses
College tuition & supplies
Transportation
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Health insurance premiums
Mandatory school fees
Room & Board
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Child/dependent Care
Child/spousal support
Housing costs
Penalties
PENALTIES FOR CASH AID FRAUD: If on purpose you do not
PENALTIES FOR FOOD STAMP FRAUD: If on purpose you
follow Cash Aid rules, your Cash Aid can be lowered for a
do not follow Food Stamp rules, your Food Stamps 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:
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If you are found guilty in any court of law or
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For not reporting all facts or for giving wrong facts: 6 months
administrative hearing because:
for the first offense, 12 months for the second offense, or
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You traded or sold Food Stamps for firearms,
forever for the third.
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ammunition, or explosives, your Food Stamps can be
For submitting one or more application to get aid in more
stopped forever for the first violation.
than one case for the same time period: 2 years for the first
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conviction, 4 years for the second, and forever for the third.
You traded or sold Food Stamps for controlled
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For conviction of felony fraud to get aid: 2 years for theft of
substances, your Food Stamps can be stopped for 24
amounts under $2,000; 5 years for amounts of $2,000
months for the first violation and forever for the second.
through $4,999.99; and forever for amounts of $5,000 or
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You traded or sold Food Stamps that were worth $500 or
more.
more, your Food Stamps can be stopped forever.
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Forever: for giving the county false proof of residency in
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You gave the county false identify or residence
order to get aid in two or more counties or states at the same
information, so you can get Food Stamps in more than
time; giving the county wrong facts for an ineligible child or a
one case at the same time, your Food Stamps can be
child that does not exist; getting more than $10,000 in cash
stopped for 10 years.
benefits through fraud; getting a third conviction for fraud in
a court of law or an administrative hearing.
QR 7 ADDENDUM (12/08) ELIGIBILITY/STATUS REPORT - QUARTERLY FOR CASH AID AND FOOD STAMPS - REQUIRED FORM - SUBSTITUTES PERMITTED

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