Form Wtw Eoa3 - Notice Of Action
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1
2NOTICE OF ACTION
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALWORKS EDUCATIONAL OPPORTUNITY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
AND ATTAINMENT (EOA) PROGRAM
Notice Date : ________________________________________________________________
Case
DENY FORM
Name
: ________________________________________________________________
Number
: ________________________________________________________________
Worker
Name
: ________________________________________________________________
Number
: ________________________________________________________________
Telephone : ________________________________________________________________
Address
: ________________________________________________________________
(ADDRESSEE)
________________________________________________________________
Questions? Ask your Worker.
State Hearing: If you think this action is
wrong, you can ask for a hearing. The
back of this page tells how. Your benefits
may not be changed if you ask for a
hearing before this action takes place.
MESSAGE:
You committed public assistance fraud and
The County denied your $500 once in a
were not eligible for the $500 education
lifetime education bonus for graduating from
bonus payment.
high school or its equivalent that you
You committed public assistance fraud and
applied for on _________________________.
were not eligible for the $1,000 stipend
payment.
The County denied your $1,000 once in a
The county no longer has funding available
lifetime education stipend for enrolling in an
for this program.
education or training program that you
applied for on _________________________.
You were sanctioned or removed from cash
aid for not complying with Welfare-to-Work
Here’s why:
rules in _____________ and were not eligible
You did not provide proof of graduating
for the $500 education bonus payment.
from high school or its equivalent on or after
You were sanctioned or removed from cash
January 1, 2018.
aid for not complying with Welfare-to-Work
You did not provide proof that you enrolled in
rules in _____________ and were not eligible
an education or training program that started
for the $1,000 stipend payment.
on or after January 1, 2018.
Other _______________________________
ou provided proof but the verification was
Y
denied for these reasons:
_________________
_______________________________________
________________________________________
Enrollment in a term of an education or training
program was not in your Welfare-to-Work plan.
You already received this $500 education
bonus on _______________. It is a once in a
lifetime payment.
You already received this $1,000 stipend on
_________. It is a once in a lifetime payment.
Rules: These rules apply: ACL 17-115 and
ACL 17-115E. You may review them at your welfare
You did not have time left on your CalWORKs
office.
48-month time limit when the client graduated
from high school or its equivalent or term of
CalFresh and CalWORKs cash aid: This notice DOES
higher education began.
NOT stop or change your CalFresh or cash aid benefits.
PAGE ___OF ___
WTW EOA3 (12/17) REQUIRED FORM - NO SUBSTITUTE PERMITTED
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