Form Wtw 38 - Welfare-To-Work 24-Month Time Clock Notice
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1STATE OF CALIFORNIA
COUNTY OF
WELFARE-TO-WORK
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
24-MONTH TIME CLOCK NOTICE
Notice Date
:
Case Name
:
Number
:
Worker
Name
:
Number
:
Telephone
:
Address
:
:
Questions? Ask your Worker.
(ADDRESSEE)
Beginning ____________________, months will start counting
CONTACT YOUR WORKER RIGHT AWAY IF YOU DISAGREE
toward your Welfare-To-Work 24-Month Time Clock. We will start
WITH THE INFORMATION ON THIS NOTICE
counting months toward your Welfare-To-Work 24-Month Time
Clock because you did not do all of the hours in “federal” activities
Welfare-To-Work Worker’s Name:
you agreed to in your Welfare-To-Work plan.
____________________________________________________
You will get a separate notice if your worker needs to make an
appointment to talk to you about a participation problem.
Telephone Number:____________________________________
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
Benefits. Keep using your plastic Benefits Identification
Card(s). You will get another notice telling you about any
changes to your health benefits.
CalFresh: This notice DOES NOT stop or change your CalFresh
benefits. You will get a separate notice telling you about any
changes to your CalFresh benefits.
CalWORKs: This notice DOES NOT stop or change your
CalWORKs benefits. You will get a separate notice telling you
about any changes to your CalWORKs benefits.
Receiving Medi-Cal and/or CalFresh only DOES NOT count
against your cash aid time limits.
Rules: These rules apply; WIC § 11322.8, 11322.85(a)(2) and (b).
WTW 38 (6/13) REQUIRED FORM - SUBSTITUTE PERMITTED
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