Form Wtw 1 - Welfare-To-Work Plan Rights And Responsibilities
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
PARTICIPANT NAME
WELFARE-TO-WORK PLAN
CASE NAME
RIGHTS AND RESPONSIBILITIES
CASE NUMBER
I.D. NUMBER
This is an overview of the rights and responsibilities of
The county must help you arrange and pay for child care,
par ticipants in Welfare-to-Work activities under the
transportation, and work and training costs. If necessary, the
California Work Opportunity and Responsibility to Kids
county can make advance payments to you for these
(CalWORKs) Program. Your Welfare-to-Work Plan tells
supportive services.
how you and the county will work together so that you can
This plan and any changes to it will apply to you and the
get and keep a job. Your plan includes this form, the
county as long as you participate in Welfare-to-Work. But, the
Activity Assignment, and the Welfare-to-Work Handbook.
county may have to change or stop all or part of this plan if: 1)
The Welfare-to-Work Handbook tells you about Welfare-to-
there are changes in law or regulations; 2) the county cannot
Work activities, ser vices, and rules. The Activity
get or pay for services from the provider; or 3) you stop
Assignment tells you the Welfare-to-Work activity that you
receiving cash aid under the CalWORKs program. The
will be participating in.
county will inform you of any changes in writing.
The county must do certain things to help you while you
are in Welfare-to-Work. The county must explain Welfare-
to-Work to you and answer any questions.
YOUR RIGHTS
As a Welfare-to-Work participant, you have the following rights which will help you take part in Welfare-to-Work.
You have the right to the following:
Employment Services
Receive direction and support from the county to help you improve your ability to get a job. This can possibly
include on-the-job training and job skills training or education.
Receive a referral to places that offer personal counseling, mental health, substance abuse, or domestic abuse
services, at no cost to you, if you need them to help you participate.
Supportive Services
Receive payment for child care, transportation, and work and training-related expenses if you need them to
participate in or attend any Welfare-to-Work appointment or activity. These are called supportive services. If you
need them, but do not get them, you may have good cause for not participating.
Receive details of your supportive service arrangements in writing.
Receive advance payment, if you need it to avoid using your own money, for approved supportive services.
Welfare-to-Work Plan
Ask for a change or reassignment to another activity within 30 days from the beginning of your first training or
education assignment under your initial Welfare-to-Work plan.
Change your mind about the activities assigned in your Welfare-to-Work plan. If you change your mind, you must
tell your Welfare-to-Work worker within three (3) working days after signing your Welfare-to-Work plan Activity
Assignment form (WTW 2).
Automatically get a neutral third party to assess your employment and or training needs if you disagree with the
assessment or you and the county cannot agree on a plan to meet your assessed employment needs.
Ask for a different provider if you object to the religious character of any provider to which you have been assigned.
Not to participate in any religious activity offered by a service provider. Participation in such an activity is voluntary.
Resolve Problems with your Welfare-to-Work Plan
Not participate if the services you and the county agree you need are not provided.
Not participate if the county decides you have any other good reason.
Explain the reason if you fail to do what Welfare-to-Work requires.
Have a second chance to cooperate and participate in Welfare-to-Work through the compliance process.
Ask for legal advice at anytime regarding your participation in Welfare-to-Work from your local legal aid or welfare
rights office by calling (
) _______________________ .
PHONE NUMBER
Employment Problems
Leave a job or not accept a job if the county decides you have a good reason.
Complaints
Protest any county action you do not agree with by filing a formal grievance with the county or asking for a State
hearing by calling 1-800-952-5253, or for the hearing or speech impaired who use TDD, call 1-800-952-8349.
WTW 1 (12/05) REQUIRED FORM - SUBSTITUTE PERMITTED
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