Form Cw 60 PDF Details

At the heart of financial transparency and accountability in the realm of public assistance within the Golden State lies the CW 60 form, a crucial document devised by the California Department of Social Services. This form functions as a bridge of information, allowing financial institutions to legally share details of an applicant's financial status with county officials, thus playing a pivotal role in determining eligibility for aid. The obligation to provide Social Security Numbers for all household members seeking aid, under the auspices of federal and state regulations, underscores the form's gravity. This precise procedure, underscored by the potential consequences of non-cooperation, which can range from denial to discontinuance of aid, highlights the rigorous standards set forth for public assistance eligibility. By requiring detailed information on accounts including but not limited to checking, savings, and stocks, and by granting this authorization for a period of 60 days, the CW 60 form encapsulates a broad spectrum of financial disclosure. Such disclosures ensure those applying understand their rights, including the cessation of this authorization, while simultaneously navigating the intricacies of public assistance with full transparency.

QuestionAnswer
Form NameForm Cw 60
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescalifornia information institution cdss, cw 60 form, cw information institution form get, information financial form cdss get

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

RELEASE OF INFORMATION - FINANCIAL INSTITUTION

You and any member of your household for whom you are applying for aid must give us a Social Security Number(s) (SSN). The SSN(s) is used to determine your eligibility, and failure to cooperate may result in denial or discontinuance of aid. Authority: 45 Code of Federal Regulations Section 205.52, and Welfare and Institutions Code Section 11286(a).

Enter name and address of institution

COUNTY USE ONLY

WORKER NAME

CASE NAME

CASE NUMBER

DATE

I authorize you to release to ___________________________County information on the account(s) below and other information required for

the purpose of determining my eligibility for public assistance. I understand I have the right to stop this authorization at any time, but that failure to cooperate may affect my eligibility. This authorization is valid for 60 days from date signed.

SIGNATURE (OR MARK) OF APPLICANT/RECIPIENT

DATE

SIGNATURE (OR MARK) OF SPOUSE

DATE

SIGNATURE (OR MARK) OF JOINT PERSON

DATE

SIGNATURE OF WITNESS TO MARK(S)

DATE

APPLICANT OR RECIPIENT:

 

FINANCIAL INSTITUTION:

 

 

 

Complete the information below for each account. Accounts include checking,

 

 

 

 

 

 

 

savings, credit union accounts, trust funds, stocks, bonds, certificates, other

Complete items 1B

, 2B and 3 , and provide remarks as needed.

(specify).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICANT/RECIPIENT: COMPLETE THIS SECTION

 

INFORMATION ITEMS

AMOUNT

DATE

 

1A

TYPE OF ACCOUNT

ACCOUNT NUMBER

1B

 

 

 

 

 

 

 

 

Balance as of

(Date):

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

NAME ON ACCOUNT (PRINT)

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

Present Balance

 

 

$

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (PRINT) NUMBER, STREET

CITY, STATE, ZIP CODE

 

 

 

 

 

 

 

 

 

 

Largest Deposit (other than opening)

$

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT IS JOINT WITH (PRINT)

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

Largest Withdrawal (within past 2 years)

$

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (PRINT) NUMBER, STREET

CITY, STATE, ZIP CODE

If closed within past 2 years, final

 

 

 

 

 

 

 

 

 

 

 

 

withdrawal amount.

$

 

 

 

 

 

 

 

 

 

 

 

2A TYPE OF ACCOUNT

ACCOUNT NUMBER

2B

Balance as of (Date):

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME ON ACCOUNT (PRINT)

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

Present Balance

 

 

$

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (PRINT) NUMBER, STREET

CITY, STATE, ZIP CODE

 

 

 

 

 

 

 

 

 

 

Largest Deposit (other than opening)

$

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT IS JOINT WITH (PRINT)

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

Largest Withdrawal (within past 2 years)

$

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (PRINT) NUMBER, STREET

CITY, STATE, ZIP CODE

If closed within past 2 years, final

 

 

 

 

 

 

$

 

 

 

 

 

withdrawal amount.

 

 

3

FINANCIAL INSTITUTION REMARKS:

 

FINANCIAL INSTITUTION COMPLETE:

 

 

 

 

 

 

 

 

 

 

■

■

 

 

 

 

Does this person have a safety deposit box?

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are any funds pledged against a loan?

■

■

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were any accounts held under a different name

■

■

 

 

 

 

and/or number within the past 2 years?

YES

NO

 

 

 

 

 

 

 

 

 

SIGNATURE OF PERSON PROVIDING INFORMATION (FINANCIAL INSTITUTION)

DATE

 

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CW 60 (5/01) REQUIRED FORM - SUBSTITUTE PERMITTED

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Filling out this document will require focus on details. Ensure that each and every field is filled out properly.

1. The cw60 involves specific information to be inserted. Ensure that the next blanks are completed:

Filling in part 1 in ca financial institution cdss online

2. After the previous array of fields is finished, you have to insert the required details in ACCOUNT IS JOINT WITH PRINT, SOCIAL SECURITY NUMBER, ADDRESS PRINT NUMBER STREET, CITY STATE ZIP CODE, TYPE OF ACCOUNT, ACCOUNT NUMBER, NAME ON ACCOUNT PRINT, SOCIAL SECURITY NUMBER, ADDRESS PRINT NUMBER STREET, CITY STATE ZIP CODE, ACCOUNT IS JOINT WITH PRINT, SOCIAL SECURITY NUMBER, ADDRESS PRINT NUMBER STREET, CITY STATE ZIP CODE, and Largest Withdrawal within past so you can move forward further.

Filling in segment 2 in ca financial institution cdss online

As to SOCIAL SECURITY NUMBER and CITY STATE ZIP CODE, be certain you get them right here. The two of these are the most significant ones in this file.

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