Form Qr 2 - Reporting Changes For Cash Aid And Food Stamps
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CASE NAME:
REPORTING CHANGES FOR CASH AID
CASE NUMBER:
AND FOOD STAMPS
WORKER:
WORKER NUMBER:
If you receive Cash Aid, what you MUST report even
If you receive Food Stamps, you MUST report this
when it is not your report month.
information even when it is not your report month.
Anytime your family’s combined gross monthly income,
If you are an Able Bodied Adult Without Dependents
both earned and unearned, is more than the Income
(ABAWD) Food Stamp recipient, you must report
Reporting Threshold (IRT) for your family size, you must
anytime the number of hours you work or are in
report this information to the County within ten
training drop to less than 20 hours a week or 80 hours
(10) days. You can report this information to the County by
a month.
calling your worker or reporting it in writing.
Anytime you have an address change, you must
report your new address to the County.
Your family size is ______________________ your IRT is
$ __________.
Voluntarily reporting information
The County will let you know each time your IRT changes.
You may report changes to the County anytime you think
the change will result in your Cash Aid or Food Stamp
Gross income means the amount of your income before
benefits going up. For example.
any deductions, such as taxes, Social Security and
retirement contributions, overpayment collections, wage
Your income stops or goes down;
garnishments or attachments, etc.
Someone who has income has moved out of your
home;
Failure to report when your income is more than the IRT
Someone moves into your home and has no income;
limit for your family’s size may result in your benefits being
Your minor child becomes pregnant and is eligible for
overpaid. Any overpaid benefits caused by your failure to
Cal-Learn services;
report MUST be repaid. You may also be subject to fraud
CalWORKs special needs that you or someone in your
charges/penalties if you do not report required information
household may have such as, pregnancy special
to the County.
needs, a special diet prescribed by a doctor, etc;
The birth of a child;
How to figure your family’s gross income.
For Food Stamps: Anyone in your household who is
disabled or age 60 or older may report new medical
Each month, add all of your family’s income both earned
costs that are not currently being used to figure your
and unearned (wages or earnings, salary, disability
Food Stamp benefits.
income, unemployment, public benefits, etc.). If the total is
more than the amount shown on this letter, you must
At anytime, you can also ask the County to discontinue
report this income to the County. Families that only have
your entire case or any individual person who leaves the
unearned income or that only get Food Stamps will not be
home or is not required to be in the assistance unit. You
required to report income except on the Quarterly Report
can also ask the County to stop other benefits, such as:
form.
Medi-Cal or Food Stamps. Receiving Medi-Cal and/or
Food Stamps only will not count against your Cash Aid
If you receive Cash Aid, you MUST also report this
time limits.
information even when it is not your report month.
Anyone in your household who has been convicted
of a drug-related felony for possession, use or
distribution of a controlled substance(s), has become
a fleeing felon or is in violation of a condition of
probation or parole and you have not already reported
it.
Anytime you have an address change, you must
report your new address to the County.
QR 2 (6/04) RECOMMENDED FORM
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