Form CW 60 at a glance
What it is: CW 60 (5/01), Release of Information, Financial Institution, of the California Department of Social Services, is a required form and a substitute is permitted.
Who signs: Sign on the SIGNATURE (OR MARK) OF APPLICANT/RECIPIENT line and enter the DATE.
A filled-in Form CW 60 example: a county asks a bank to release account records
How to fill out Form CW 60, box by box
Name and address of institution
The name and address of institution box is COUNTY USE ONLY: the county enters it.
Release to County and applicant signature
I authorize you to release to the ___ County information on the account(s) in items 1A and 2A 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.
Sign on the SIGNATURE (OR MARK) OF APPLICANT/RECIPIENT line and enter the DATE.
Signature of spouse, joint person and witness
The form also has lines for SIGNATURE (OR MARK) OF SPOUSE, SIGNATURE (OR MARK) OF JOINT PERSON and SIGNATURE OF WITNESS TO MARK(S), each with a DATE.
Type of account, account number, name and address
You and any member of your household for whom you are applying for aid must give the California Department of Social Services 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).
APPLICANT OR RECIPIENT: Complete the information in items 1A and 2A for each account. Accounts include checking, savings, credit union accounts, trust funds, stocks, bonds, certificates, other (specify).
For each account, enter the TYPE OF ACCOUNT, the ACCOUNT NUMBER, the NAME ON ACCOUNT (PRINT) and the SOCIAL SECURITY NUMBER.
Enter the ADDRESS (PRINT) NUMBER, STREET and the CITY, STATE, ZIP CODE.
Account is joint with
Under ACCOUNT IS JOINT WITH (PRINT), enter the SOCIAL SECURITY NUMBER, ADDRESS (PRINT) NUMBER, STREET and CITY, STATE, ZIP CODE.
Balance, deposit and withdrawal amounts
FINANCIAL INSTITUTION: Complete items 1B, 2B and 3, and provide remarks as needed.
Under INFORMATION ITEMS, enter an AMOUNT and a DATE for Balance as of (Date) and an AMOUNT for Present Balance.
Enter the Largest Deposit (other than opening) and the Largest Withdrawal (within past 2 years). If closed within past 2 years, enter the final withdrawal amount.
Financial institution remarks and signature
Under FINANCIAL INSTITUTION REMARKS, mark YES or NO: Does this person have a safety deposit box? Are any funds pledged against a loan? Were any accounts held under a different name and/or number within the past 2 years?
Sign on the SIGNATURE OF PERSON PROVIDING INFORMATION (FINANCIAL INSTITUTION) line and enter the DATE and TELEPHONE NUMBER.
Sources
[1] Form CW 60 (5/01), Release of Information, Financial Institution, California Department of Social Services (the Official source link on this page).