If you answer Yes to any of these questions, you may be exempt for a month or longer from the CalWORKs 48-month time limit, Welfare-to-Work 24-Month Time Clock and/or participation requirements.
Answering: please answer all of the questions, and be sure to sign and date the back of this form.
Once in a lifetime: the exemption for the parent or caretaker of a child age 0 - 23 months is available only once in a lifetime starting 1/1/2013.
Return: if you are under 16 years old or 60 years or older, you do not have to return this form for the Welfare-to-Work exemptions.
Domestic abuse: you do not have to complete this form to get a waiver to the time limits.
State Hearing: if you do not agree with the county, you may ask for a State Hearing.
| Question | Answer |
|---|---|
| Form Name | CW 2186A |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 38 |
| Avg. time to fill out | 7 min |
| Edition | 12/12 |
| Issuing agency | California Department of Social Services |
| Who signs | You, on the back of the form |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | CW 2186A, CW2186A, CW-2186A, CalWORKs Exemption Request Form |
| Official source | CW 2186A (Rev 12/12), California Department of Social Services |
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