Form Wtw 32 - Welfare To Work Compliance Plan
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
WELFARE TO WORK COMPLIANCE PLAN
INSTRUCTIONS TO THE COUNTY: This form is only used for the compliance process. This form does not replace the WTW 2, Welfare
to Work Plan - Activity Assignment, or the WTW 3, Welfare to Work Plan Activity Assignment Change, which must be modified to
communicate any changes in the individual’s Welfare to Work requirements and supportive services needs, once this plan is no longer
in effect.
CLIENT’S NAME (PLEASE PRINT):
CASE #:
DATE:
CASEWORKER’S NAME (PLEASE PRINT):
WORKER #:
PHONE #:
(
)
The county has decided that you did not have a good reason for not doing your Welfare to Work activity. The county told you
about your Welfare to Work problem in the Notice of Action sent to you on _________________________.
The county will NOT lower your cash aid if you:
1)
Agree to a compliance plan; and
2)
Do what the compliance plan says to correct your participation problem. This means you must do the activity in this plan for up to
60 calendar days from the date you begin the activity, or for the length of the activity, whichever is shorter.
After you do what this compliance plan says, your compliance period ends, but you will still need to do other Welfare to Work activities.
MY COMPLIANCE PLAN
ACTIVITY #1:
ACTIVITY #2:
BEGINS:
BEGINS:
ENDS:
ENDS:
LOCATION:
LOCATION:
PHONE #:
PHONE #:
(
)
(
)
SCHEDULE:
SCHEDULE:
TOTAL HOURS/WEEK:
TOTAL HOURS/WEEK:
COMMENTS/OTHER INSTRUCTIONS:
I understand that:
My cash aid will be lowered if I do not agree to the compliance plan or I agree to the plan but do not do what it says without a good
reason.
If the activity that the county asked me to do before is no longer available or right for me, I may have to do another activity.
The county cannot ask me to do an activity for a time longer than the length of the activity that led to my nonparticipation.
If I do not agree to a compliance plan, or if I agree to one but do not do what it says without a good reason, I will not get another
chance to fix this problem before my cash aid is lowered.
If I do not agree with any part of my plan, I may suggest my own plan for the county to consider. If the county agrees with all or
some of my suggestions, it will change my plan to include those ideas.
The county will pay for supportive services (transportation, child care, and work- or training-related expenses) that I need to do the
activity in my compliance plan. The county will give me more information about these services in other notices.
Once I do what the compliance plan says, compliance is over. I may then have to continue in the same activity, or start a new
activity. If I have a Welfare to Work plan, it will be updated to tell me of any changes in my Welfare to Work requirements and
supportive services needs.
I can file for a State hearing if I disagree with the county about any part of my compliance plan.
I understand that I will receive a copy of this compliance plan and if I have any questions about the information in the plan, I
can ask my worker.
DATE:
CLIENT’S SIGNATURE:
If you are sending this plan to your worker by mail,
it must be signed and postmarked by ___________,
CASEWORKER’S SIGNATURE:
DATE:
or your cash aid may be lowered.
WTW 32 (10/03) REQUIRED FORM - SUBSTITUTE PERMITTED
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