Page 11

Note: If your IRT for CalFresh is listed as “N/A”, you are not required to report income changes for CalFresh until your next SAR 7 or recertification, whichever comes first. However, if you have an IRT amount listed for CalWORKs, you must report when your gross income goes over that amount. How to report? If your total income is over the IRT amount listed above, you must report this to the County within 10 days. You can report this information to the County by calling the county or reporting it in writing. By “total monthly income” we mean: [ Any money you get (both earned and unearned). [ The amount before any deductions are taken out. (Examples of deductions are: taxes, Social Security or other retirement contributions, garnishments, etc.) What will happen? [ Your benefits may be lowered or stopped based on income over your IRT. [ Your IRT may change when your income changes or when someone moves in or out of your home. [ The County will let you know in writing each time your IRT changes. [ You also need to report on your SAR 7 all income you get during the Report Month, even if you already reported that money. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES REPORTING CHANGES FOR CASH AID AND CALFRESH CASE NAME: CASE NUMBER: WORKER NUMBER: Penalty for not reporting If you do not report when your income is more than your household’s IRT limit you might get more benefits than you should. You must repay any extra benefits you get. If you do not report on purpose to try to get more benefits, this is fraud, and you may be charged with a crime and/or may no longer get CalFresh for a period of time or life. If you get Cash Aid, you MUST ALSO report the things below within 10 days of when they happen: 1. Anytime someone joins, or is in your household, who has been found by a court of law to be in violation of a condition of probation or parole. 2. Anytime someone joins, or is in your household, who is running from the law (has a warrant out for their arrest). 3. Anytime you have an address change. If you get CalFresh, you MUST ALSO report the following: G If you are an Able Bodied Adult Without Dependents (ABAWD), you must report anytime your work or training hours drop to less than 20 hours a week or 80 hours a month. Voluntarily reporting information You may also voluntarily report changes to the County anytime. Reporting some changes may get you more benefits. For example: G Your income stops or goes down. G Someone with income moves out of your home. G Someone without income moves into your home. G Someone in the house becomes pregnant. G Someone on cash aid has a special need, such as: a pregnancy, a special diet prescribed by a doctor, household emergency, etc. G The birth of a child. G For CalFresh, if someone disabled or age 60 or older has new or higher out of pocket medical costs. Note: Some changes you report voluntarily may result in a decrease in your CalFresh benefits. SAR 2 (3/15) REQUIRED FORM - SUBSTITUTES PERMITTED Because you get nCash Aid nCalFresh, you must report within 10 days when your TOTAL income reaches a certain level. You must report anytime your household’s total monthly income is more than your current Income Reporting Threshold (IRT). Benefit Type CalWORKs CalFresh Family Size Your Current Income Your IRT is