Form Wtw 31 - Request To Meet Welfare-To-Work Rules To Get My Cash Aid Back
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
REQUEST TO MEET WELFARE-TO-WORK RULES TO GET MY CASH AID BACK
INSTRUCTIONS TO THE CLIENT: Your family gets less cash aid because you did not meet Welfare-to-Work rules. If you
want your cash aid back, you can fill out this form and return it to your Welfare-to-Work worker right away.
Instead of filling out this form and mailing it to your Welfare-to-Work worker, you can also call your worker to tell
him or her that you want your cash aid back. If you do not know your worker’s address or telephone number, call
the county at:______________________________ .
REQUEST TO MEET WELFARE-TO-WORK RULES TO GET MY CASH AID BACK
To get my cash aid back, I must agree to do what the county says about meeting Welfare-to-Work rules.
This means that I must do an activity assigned in a “Plan To Meet Welfare-To-Work Rules and Get My Cash Aid Back” for
up to 30 calendar days from the date that I sign the plan or for the length of the activity, whichever is shorter.
To get my cash aid back, I understand that the county cannot ask me to do an activity for a time longer than the length of
the activity that led to my removal from cash aid.
I also understand that if the activity that the county asked me to do before is no longer available or right for me, I must do
other activities to get my cash aid back.
NAME (PLEASE PRINT):
SIGNATURE:
CASE # OR SOCIAL SECURITY #:
PHONE #:
DATE:
(
)
WELFARE-TO-WORK WORKER’S NAME (PLEASE PRINT):
DO YOU NEED FREE LEGAL HELP?
You can get free legal help with this matter from the following:
State Welfare Rights Organization
Local Legal Aid Office
Phone #: (
)
Phone #: (
)
WTW 31 (8/15) RECOMMENDED FORM
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