Self-Certification Form For Motor Vehicles - Calworks printable pdf download

Self-Certification Form For Motor Vehicles - Calworks

REASON FOR THIS TRANSMITTAL

[ ] State Law Change

[ ] Federal Law or Regulation

February 28, 2015

Change

[ ] Court Order

[ ] Clarification Requested by

ALL COUNTY LETTER NO. 15-27

One or More Counties

[X] Initiated by CDSS

TO:

ALL COUNTY WELFARE DIRECTORS

ALL CALWORKS PROGRAM SPECIALISTS

ALL CALFRESH PROGRAM SPECIALISTS

ALL CONSORTIUM PROJECT MANAGERS

SUBJECT:

CALIFORNIA WORK OPPORTUNITY AND RESPONSIBILITY TO KIDS

(CalWORKs): SELF-CERTIFICATION FORM FOR MOTOR VEHICLES - CW 80

FORM INSTRUCTION

REFERENCE: ASSEMBLY BILL (AB) 74 (CHAPTER 21, STATUTES OF 2013); WELFARE AND

INSTITUTIONS (W&I) CODE SECTION 11155; MANUAL OF POLICIES AND

PROCEDURES (MPP) SECTIONS 42-215.4; AND ALL COUNTY LETTERS

(ACLs) No. 92-104, No. 13-89 AND No. 13-111

The purpose of this ACL is to transmit the revised CW 80 form and provide additional

instruction for its use. ACL 13-111 was released on December 31, 2013, which provided

County Welfare Departments (CWDs) with implementation instructions associated with the

passage of Assembly Bill 74 and Senate Bill 98, which became effective January 1, 2014.

ACL 13-111 included a new form, the Self-Certification Form for Motor Vehicles – CalWORKs

(CW 80), for clients to identify and self-certify the value of vehicles. CWDs will then use the

information provided from the CW 80 form to determine the Assistance Unit’s (AU’s) resource

eligibility for CalWORKs. Any equity value that exceeds the $9,500 limit shall be counted

toward the AU’s resource level.

The CW 80 is a required, substitutes permitted form, that will be completed by the client at

initial application (along with the SAWS 2 Plus), mid-period if a new vehicle was acquired since

their last report, and at redetermination. CWDs will be required to include the CW 80 form

along with the M42-207A Notice of Action (NOA) form sent to the client. CWDs must begin

using the new CW 80 (2/15) as soon as administratively possible, but no later than

April 1, 2015. This form may be programmed into county automation systems or printed and

used as hard stock, depending on CWD preference.

Self-Certification Form For Motor Vehicles - Calworks