STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE TO OTHER PARENT
COUNTY NAME
CASE NAME
CASE NO.
OTHER ID NO.
WELFARE TO WORK WORKER’S NAME
WELFARE TO WORK WORKER’S PHONE NO.
(ADDRESSEE)
Notice Date:__________________________
This is to let you know that there is a problem with ______________________________ ‘s
participation in Welfare to Work.
We have sent him/her a notice about his/her Welfare to Work problem and how he/she can correct it.
If he/she does not correct the problem, then his/her part of your family’s cash aid may be cut.
If we decide that you must begin to participate or increase your participation, we will send you
another letter to inform you about a Welfare to Work orientation/appraisal or meeting that you must
attend to discuss what you must do to meet Welfare to Work program requirements. If you do not
attend the orientation/appraisal or the meeting as scheduled, your part of your family’s cash aid may
also be cut, unless you have a good reason for not participating.
Some good reasons for not participating in Welfare to Work are not having transportation or child
care, or you are exempt (for example, you are 60 years of age or older or you cannot participate
because you are disabled).
Even if your cash aid is also cut, your children will still get their cash aid. However, for you to get
cash aid back, you must correct your Welfare to Work participation problem. For the other parent to
get their cash aid back, the other parent must correct their own Welfare to Work participation
problem.
Please call your Welfare to Work worker if you have any questions about the information in
this notice.
WTW 4 (8/04) REQUIRED FORM-SUBSTITUTE PERMITTED