40-128 APPLICANT'S STATEMENT OF FACTS

.1 Filing the Statement of Facts

.11 The applicant, in support of his/her application, shall complete, sign, and file with the county the Statement of Facts (SAWS 2) supporting his/her eligibility for assistance. The statement may be filed with the county at the time of application or at any subsequent time prior to completion of the determination of eligibility. In case of an applicant in "immediate need," see Section 40-129.

.111 A copy of the completed Statement of Facts is to be given to the applicant if he/she so desires or to the guardian, conservator, or other person who completed the original.

.112 Two copies of the Statement of Facts shall be available to applicants and recipients on request, but only one copy of the Statement of Facts shall be required to be completed, signed, and returned to the county welfare department.

.12 Minor Parent Residing with Unaided Senior Parent(s).

.121 The minor parent (see Section 44-133.51) who applies for aid while residing in the same household as his/her unaided senior parent(s) must report the income of his/her parent(s).

In addition to the SAWS 2, the minor parent shall submit a Senior Parent Statement of Facts (SAR 23) to the county welfare department. The minor parent is responsible for obtaining all information necessary to complete the SAR 23 and for obtaining the necessary verification from the senior parent(s). The information and the submitted verification must provide the county welfare department with the facts necessary to make a correct eligibility and grant determination.

.122 Failure to provide a complete SAR 23 (as defined in .121 above) shall result in the denial of aid to the minor parent and child in accordance with Section 40-105.1.

RECEPTION AND APPLICATION

.13 Sponsored Non-Citizens

.131 A sponsored non-citizen who applies for aid shall provide the County Welfare Department (CWD) with a statement of the ability of the sponsor to meet his/her needs. As a part of his/her application for aid on the form SAWS 2, the sponsored non-citizen shall submit a complete Form SAR 22 (Sponsor’s Statement of Facts) to the CWD. The sponsored non-citizen is responsible for ensuring that the SAR 22 is complete.

.132 Failure to provide a complete SAR 22 (as defined in .131 above) shall result in the denial of aid to the sponsored non-citizen.

.14 A change in an aid recipient's status from that of a medically needy person certified for medical assistance to that of a grant recipient requires a new application. A Statement of Facts (SAWS 2) is required before a cash grant is authorized for such person only in circumstances described in Section 40-183.5.

RECEPTION AND APPLICATION

.2 Who May Sign the CalWORKs Statement of Facts

Every effort should be made to obtain the parent's or guardian's signature on the Statement of Facts (SAWS 2) regardless of who signs the application (SAWS 1). However, a relative or the social service agency representative who has responsibility for the care and supervision of the child may sign the SAWS 2 in the following instances:

.21 The child has been relinquished for adoption.

.22 There is no parent or guardian.

.23 The parent has been legally deprived of the child's custody.

.24 The parent cannot be located or is not available to sign. The parent may be deemed unavailable to sign if he/she is physically or mentally incapable of signing. In all situations where the child is living with someone other than the parent, then the parent may be deemed unavailable to sign if (1) his/her whereabouts are unknown, (2) he/she refuses to sign, or (3) he/she refuses to cooperate in providing necessary information.

(See Section 40-131 regarding interview requirement.)

.25 At county option, the placement worker shall have the authority to complete an FC 2 in place of the SAWS 2 under the following circumstances:

.251 The child is relinquished for adoption.

.252 The parent is unavailable to sign, as described in .24 above.

.253 There is no parent or guardian.

.3 Repealed by Manual Letter No. EAS-86-01 (effective 1/17/86).

.4 When the Statement of Facts and other documents are to be completed by a representative of the county on behalf of the applicant or recipient, that representative shall be the person with responsibility for the care and supervision of the applicant or recipient, and another representative of the county shall then countersign and approve any recommendation for authorization of aid payments. (See Section 40-131 regarding interview requirement.)

NOTE: Authority cited: Sections 10553 and 10554, Welfare and Institutions Code. Reference: 45 CFR 205.50(a)(1)(i)(A); 42 USC 602(a)(39); Family Support Action Transmittal 91-15 dated April 23, 1991; and Section 5053 of the Omnibus Budget Reconciliation Act (OBRA) of 1990.

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RECEPTION AND APPLICATION