Form Temp 2190 - Calworks Retroactive Payment For Transportation Review Request Form
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IMPORTANT NOTICE FOR
AVISO IMPORTANTE PARA LOS
CalWORKs RECIPIENTS
BENEFICIARIOS DE CalWORKs
Were you in a job while you were required to participate in the
¿Estuvo usted en un empleo mientras se le requería que
CalWORKs Welfare-to-Work Program or while you were an exempt
participara en el Programa para la Transición de la Asistencia
volunteer? A job includes work such as work study and OJT.
Pública al Trabajo ( Welfare to Work - WtW) del Programa de
California de Oportunidades de Trabajo y Responsabilidad hacia
Did the county refuse to pay the transportation costs necessary
los Niños (CalWORKs) o mientras era un voluntario exento? Un
for you to get to and from your job?
empleo incluye al trabajo tal como empleo para estudiantes
If you answered yes to either of the questions above, you may be
(work study) y entrenamiento en el empleo (OJT).
able to get money for the transportation costs you were not paid for.
¿El Condado se rehusó a pagar los gastos de transporte
To have the County Welfare Department review your case, you
necesarios para que usted fuera y viniera a su trabajo?
must fill out a Transportation Review Request Form. The form is
Si su respuesta es “Sí” a cualquiera de las preguntas anteriores,
printed on the other side of this Notice. Complete the form and
es posible que usted pueda recibir dinero por los gastos de
return it to the worker or welfare to work office that gave you your
transporte que no le pagaron.
work assignment no later than November 30, 2001.
Para que el departamento de bienestar público del Condado
revise su caso, tiene que completar un “Formulario de petición
para una revisión del transporte para recibir un pago retroactivo de
CalWORKs”. El formulario está impreso al reverso de este aviso.
Complete el formulario y devuélvalo a su trabajador o a la oficina
de bienestar público que le dió la asignación de trabajo a más
tardar el 30 de noviembre de 2001.
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TEMP 2190 (6/01) MULTILINGUAL
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