In the bustling landscape of California's social services, the CW 2186A form emerges as a crucial document for those navigating the CalWORKs program, offering a potential pause from the stringent requirements imposed on beneficiaries. This form is an essential tool for individuals and families who, due to personal circumstances, seek exemption from the Welfare-to-Work participation mandate or the program's 60-month time limit on receiving aid. The heart of this form lies in its detailed queries, designed to uncover conditions that might hinder an individual's ability to engage in work or related activities, ranging from pregnancy, caregiving responsibilities for young or dependent children, to significant educational commitments. Additionally, the form extends its reach to cover those grappling with disabilities or health issues, providing a space for them to convey their need for exemption with the backing of medical proof. It's not just about capturing a snapshot of the individual's current state but also about offering pathways for those with unique situations, such as residing in high-unemployment areas or grappling with the aftermath of domestic abuse, to seek waivers. The CW 2186A does more than just gather information; it acts as a bridge for dialogue between the applicant and the county's decision-makers, ensuring that those in need are aware of their rights, the exemptions available to them, and the process to contest decisions they feel do not accurately reflect their circumstances. Through this form, California commits to adjusting its aid programs to the nuanced realities of its residents' lives, affirming the state's dedication to providing support that transcends one-size-fits-all solutions.
| Question | Answer |
|---|---|
| Form Name | Form Cw 2186A |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 17-year, 60-month, cw2186a, CW |
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CalWORKs TIME LIMIT and |
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PLEASE PRINT |
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YOUR NAME |
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COUNTY USE ONLY |
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OTHER ID NO. |
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QUESTIONS? ASK YOUR WORKER. |
WORKER NAME |
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WORKER PHONE NO. |
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Most adults can only receive 60 months (5 years) of cash aid from the CalWORKs program. Unless exempt, an individual is required to participate in CalWORKs
INSTRUCTIONS TO THE CLIENT:
If you answer “Yes” to any of these questions, you may be exempt for a month or longer from the CalWORKs
sign and date the back of this form.
YES
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YES
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■1. Are you pregnant and does a doctor state that you cannot work or participate in
■2. Are you the parent or caretaker of a child age ______ or under? (Depending on the County, you may be exempt if your child is 12 weeks old or under, six (6) months old or under, or 12 months old or
under.) This exemption is available only once.
■3. If you have used exemption #2, have you recently become the parent or caretaker of another infant? (Depending on the County, you may be exempt for 12 weeks to 6 months.)
■4. Are you a full time volunteer in the Volunteers in Service to America (VISTA) Program?
NO |
CalWORKs |
■5. Are you a
■6. Are you physically or mentally unable to work or participate in a
■7. Are you the nonparent caretaker of a child who is a dependent or ward of the court, or at risk of being placed in foster care?
■8. Do you need to stay home to take care of someone in the household who cannot take care of him/herself, which makes it hard for you to work or participate in a
■9. Are you eligible for, participating in, or exempt from
■10. Are you living in Indian Country, as defined by federal law, in which 50 percent of the adults are unemployed? (This exemption applies only to the
PLEASE READ THE BACK OF THIS FORM TO FIND OUT ABOUT MORE EXEMPTIONS.
CW 2186A (12/05) REQUIRED FORM - NO SUBSTITUTE PERMITTED
CalWORKs TIME LIMIT and
You will not be required to participate in the
●You are under 16 years old.
●You are 16, 17, or 18 years old and in high school or adult school.
●You are 60 years or older.
CalWORKs
A month of aid will not count against your
●You did not receive CalWORKs cash aid because your grant was less than $10.
●Your cash grant is fully repaid by child support collection.
●You are only receiving supportive services such as child care, transportation, and case management.
●You are 60 years or older.
CalWORKs
If you or a family member are a past or present victim of domestic abuse and the county determines that your condition or situation prevents or impairs your ability to be regularly employed or to participate in
●You will be informed in writing whether or not you are exempt from the CalWORKs time limit and/or
●You may be asked to give the county proof of your reason for requesting an exemption.
●If you do not agree with the county, you may ask for a State hearing.
●Depending on your situation, you may be evaluated each month to determine if you continue to be exempt.
YOUR SIGNATURE
DATE
CW 2186A (12/05) REQUIRED FORM - NO SUBSTITUTE PERMITTED