Form Cw 2186A PDF Details

Are you an expat living in the United States? If so, you may need to file a Form Cw 2186A. This form is used by individuals who reside outside of the United States and are claiming tax treaty benefits on their U.S. source income. Read on for more information about this form and how to file it. When it comes to taxes, there can be a lot of confusion for those who are not familiar with the process. If you are an expat living in the U.S., there may be some specific forms that you need to fill out in order to comply with U.S. tax laws. One such form is Form Cw 2186A – Tax Treaty Benefits Claimed on U. S .Source Income by Resident of Possession Outside United States . Let's take a closer look at this form and what it entails.

QuestionAnswer
Form NameForm Cw 2186A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names17-year, 60-month, cw2186a, CW

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CalWORKs TIME LIMIT and WELFARE-TO-WORK PARTICIPATION EXEMPTION REQUEST FORM

PLEASE PRINT

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR NAME

 

COUNTY USE ONLY

 

 

 

 

 

 

 

 

 

 

ADDRESS

STREET

COUNTY

 

 

 

 

 

 

 

 

CITY

 

ZIP

CASE NAME

 

 

 

 

 

 

 

 

PHONE

 

 

CASE NO.

 

OTHER ID NO.

(

)

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS? ASK YOUR WORKER.

WORKER NAME

 

WORKER PHONE NO.

 

 

 

( )

 

 

 

 

 

 

 

 

 

 

 

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 Welfare-to-Work activities as a condition for receiving aid.

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 60-month time limit and Welfare-to-Work participation. You may need to give information to help the county decide if you should be exempt. Please answer all of the questions. The county cannot answer these questions for you. Please be sure to

sign and date the back of this form.

YES

■

■

■

■

YES

■

■

■

■

■

■

NO

Welfare-to-Work Participation

■1. Are you pregnant and does a doctor state that you cannot work or participate in Welfare-to-Work activities for 32 hours per week if you are a one-parent assistance unit or for 35 hours per week if you are a two-parent assistance unit?

■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 60-Month Time Limit and Welfare-to-Work Participation Exemptions

■5. Are you a 16-or 17-year old who has a high school diploma or its equivalent and is enrolled or plan- ning to enroll in a educational, vocational or technical school training program?

■6. Are you physically or mentally unable to work or participate in a Welfare-to-Work activity for 32 hours per week if you are a one-parent assistance unit or for 35 hours per week if you are a two-parent assistance unit on a regular basis for at least 30 calendar days? Please provide any medical proof of your disability.

■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 Welfare-to-Work activity?

■9. Are you eligible for, participating in, or exempt from Cal-Learn? You are not eligible for this exemption if you are 19 years old but are not participating in Cal-Learn as a volunteer.

■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 60-month time limit, not the Welfare-to-Work participation exemption.)

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 WELFARE-TO-WORK PARTICIPATION EXEMPTION REQUEST FORM (BACK)

Welfare-to-Work Participation Exemptions - You do NOT have to return this form for these exemptions.

You will not be required to participate in the Welfare-to-Work program if any of the reasons apply to you.

●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 60-Month Time Limit Exemptions - You do NOT have to request these exemptions, on this form. You may contact your worker if any of these reasons apply to you.

A month of aid will not count against your 60-month time limit if any of the reasons listed below apply to you.

●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 60-Month Time Limit and Welfare-to-Work Participation Waivers

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 Welfare-to-Work activities, the county may waive the CalWORKs 60-month time limit and/or the Welfare-to-Work participation requirements. You do not have to complete this form to get a waiver to the time limits. You may contact your worker to request a domestic abuse waiver.

●You will be informed in writing whether or not you are exempt from the CalWORKs time limit and/or Welfare-to-Work participation and the reason why.

●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

Form Cw 2186A isn’t the one you’re looking for?

Related Documents