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Definitions
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Term
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Description
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I-864, Affidavit of Support (New)
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Refers to the United States Citizenship and Immigration Services (USCIS) Form I-864, Affidavit of Support, Under Section 213A of the Immigration and Nationality Act (INA), which is completed and signed by the sponsor.
Under Section 213A of the INA, the new Affidavit is a legally enforceable contract between the sponsor and the Federal Government, for the benefit of the sponsored immigrant and of any federal, State, or local government agency or entity that provides the sponsored immigrant with any means-tested public benefit.
Note: The new Affidavit is required for all applications for immigrant visas or for adjustment of status filed on or after December 19, 1997.
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I-134, Affidavit of Support (Obsolete)
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Refers to USCIS Form I-134, Affidavit of Support, that was signed before the formulation and implementation of the new version of the Affidavit, Form I-864.
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Conditional CAPI
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A continuation of CAPI benefits, pending Social Security Administration (SSA) determination of Supplemental Security Income/State Supplementary Payment (SSI/SSP) eligibility, for CAPI participants who become naturalized United States (U.S.) citizens.
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Extended CAPI
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Refers to the most recent eligibility component of CAPI, in which the earliest possible payment date was October 1, 1999. A non-citizen is potentially eligible for extended CAPI if he/she entered the U.S. on or after August 22, 1996, and meets one of the following criteria:
1. Does not have a sponsor;
2. Has a sponsor who is NOT deceased or disabled; or
3. Has a sponsor and is NOT a victim of abuse by the sponsor or the sponsor’s spouse.
Note: The Sponsor-Deeming rule is applicable for ten years from the date the sponsor signed the Affidavit of Support.
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Household
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A personal place of residence in which the individual(s) share common living quarters and functions as a single economic unit.
Note: The members of a household do not need to be related by blood or marriage but must live together in a single dwelling and function as an economic unit. A person who is temporarily absent from a household is still a member of the household.
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Immigrant/ Non-Citizen
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An individual who is not a U.S. citizen.
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In-Kind Support and Maintenance (ISM)
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Unearned income received in the form of food, clothing or shelter that is given to a CAPI applicant/participant for free or the applicant/participant receives for free because someone else pays for it. ISM can be received from someone living in the same household or from outside the household.
Note: Shelter expenses include room, rent, mortgage payments, property taxes, heating fuel, gas, electricity, water, sewer and garbage services. Mobile home space rental is not a shelter expense.
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Living Arrangements
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Where you live, if you live alone or with someone else, or if you live in an institution, such as a nursing home. Your living arrangement also depends on who pays for your food and shelter.
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Naturalized Citizen
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A person, born a foreign citizen or national, who has lawfully become a citizen of the U.S. under the U.S. Constitution and laws.
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Qualified Alien
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An immigrant who is:
a. Lawful Permanent Resident;
b. Granted Cuban/Haitian entrant status;
c. A refugee;
d. An asylee;
e. Deportation/removal is being withheld;
f. Paroled into the U.S. for a period of at least one year;
g. A conditional entrant admitted to the U.S.; or
h. A battered person, child of a battered spouse, or parent of a battered child with a petition pending.
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Sponsor
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A person who has executed an Affidavit of Support agreeing to support an immigrant as a condition of the immigrant’s admission for permanent residence in the U.S.
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Sponsor Deeming Rule
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Considering the income and resources of the sponsor in determining the immigrant’s eligibility for a government benefit program, such as CAPI.
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Sponsored Immigrant
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A person on whose behalf a sponsor has executed an Affidavit of Support.
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SSI/SSP
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Refers to the federal (SSI) and State (SSP) funded program that provides cash assistance to aged, blind, and disabled residents of California.
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Suspension
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A stoppage of CAPI benefits that is always effective the first day of a month when an individual no longer meets all eligibility requirements.
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Termination
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Occurs when benefits have been suspended for 12 consecutive months and cannot be reinstated without filing a new application.
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Requirements
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A CAPI participant who is 18 years old or over and mentally/physically competent must:
1. Complete, sign, and submit a SOC 804, Statement of Facts for Determining Continuing Eligibility for the Cash Assistance Program for Immigrants (CAPI), and all forms that were mailed out in the CAPI redetermination packet, as applicable;
Note: Forms must not be signed prior to the redetermination due date.
2. Provide all documentation and verification requested by the worker to verify information stated on the CAPI redetermination packet to the worker’s satisfaction;
3. Pursue and file for any other cash benefits for which they may be eligible for, such as the Title II Social Security, Veterans’ benefits, Worker’s unemployment or compensation benefits, disability insurance benefits, or any other private pensions;
Note: When a CAPI worker requires a CAPI participant to apply for SSI/SSP, the participant must do so within 30 days, regardless of any previous SSA determinations, unless the SSA determination was made within the last six months (refer to 49-030 Ineligibility for SSI/SSP).
4. Give consent to have a necessary evaluation be made to establish eligibility;
5. Within ten days report any changes in U.S. citizenship, immigration status, income, property, household composition, address, or other facts that affect CAPI eligibility or payment amounts; and
6. Complete SOC 453, Cash Assistance Program for Immigrants (CAPI) Statement of Household Expenses and Contributions, if they are being charged with ISM. This occurs when they are living in the household of another and receive a CAPI payment that is based on the reduced needs payment standard or is being charged with ISM as unearned income (refer to 49-050 Living Arrangements and Benefits Categories).
The following are required forms for redeterminations:
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Requirement
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Limit/Condition
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CAPI 103,
CAPI Referral for SSI
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The CAPI participant must take this referral to SSA to file an SSI/SSP application. Failure to obtain/provide the SSA Notice may result in the suspension/termination of the CAPI benefits (refer to 49-060 Benefits Suspensions and Terminations).
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PA 2126,
Do You Live or Plan to Live in Public or Section 8 Housing
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If the CAPI participant lives in or plans to live in public or Section 8 Housing, the Eligibility Worker (EW) will provide the Housing Authority of the City of Los Angeles and the Housing Authority of the County of Los Angeles with information necessary to determine eligibility for these housing programs, upon the participant’s request.
Note: The information shared may be, but is not limited to the monthly grant amount received, who is living in the household, and any other information necessary to determine eligibility for housing.
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PA 2457,
Civil Rights Information
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An informational sheet that explains participant’s civil rights and provides information about steps that can be taken if he/she believes their civil rights are being violated. Additionally, the reverse side of the form provides instructions for filing for a State Hearing via DPSS Appeals and State Hearings Section.
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PUB 13,
Your Rights Under California Welfare Programs
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Informs the participant of her/his rights and responsibilities relating to eligibility for public assistance, including CAPI.
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SOC 453, Cash Assistance Program for Immigrants (CAPI) Statement of Household Expenses and Contributions
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Must be given to all CAPI participants. The head of the household where the participant is living must co-sign (or complete and sign his/her own statement anytime the application alleges sharing in the household expenses (refer to 49-035 Income). Must be completed for any participant who is being charged with ISM from within the household.
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SOC 455, Cash Assistance Program for Immigrants State Interim Assistance Reimbursement
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Required for any CAPI participant who received General Relief (GR) benefit as interim assistance pending approval of their CAPI application. A CAPI participant must sign the SOC 455, authorizing reimbursement of any GR interim assistance received.
Note: SOC 455 can be signed by an Authorized Representative (AR).
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SOC 804,
Statement of Facts for Determining Continuing Eligibility for CAPI
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The CAPI redetermination form wherein a CAPI participant or their designated AR must:
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Document their property, income, living arrangements, and other information to be used by the CAPI worker in redetermining CAPI eligibility; and
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Date and sign under penalty of perjury.
Note: In a couple case, each eligible member must complete the SOC 804 and all other required forms, separately.
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SOC 809,
Indigence Exception Statement
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Must be completed by a CAPI participant only if applying for an indigence exception to the sponsor deeming rule. This does not apply to a non-sponsored applicant (refer to 49-037: Sponsor Deeming).
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SOC 813,
Indigence Exception Determination
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Required only when a sponsored CAPI participant applies for an indigence exception to the sponsor deeming rule. This form is completed by the worker to evaluate whether the participant qualifies for an indigence exception (refer to 49-037 Sponsor Deeming).
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SOC 860,
Sponsor’s Statement of Income and Resources
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The SOC 860 should be used along with existing CAPI forms whenever a sponsor’s income and resource information are needed to determine initial or continuing eligibility. When there are multiple sponsors, a separate form should be provided for each sponsor. A sponsored participant is responsible for ensuring completion by each of their sponsors.
Note: The SOC 860 is not required for indigence exception cases (refer to 49-037: Sponsor Deeming).
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SSP 14,
Authorization for Reimbursement of Interim Assistance Initial Claim or Posteligibility Case
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Required for any CAPI participant determined by the worker to be a qualified alien (refer to 49-020: Immigration Status – Qualified Alien). A CAPI participant must sign, acknowledging that when the SSI/SSP is approved, they agree to have any interim assistance deducted from the first SSI/SSP check (refer to 49-065: Interim Assistance Reimbursement).
Note: SSP 14 cannot be signed by an AR.
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Verification Documents
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A CAPI participant must provide the following verifications to their CAPI worker, in addition to completing the applicable forms included in the CAPI redetermination packet, when completing their CAPI redetermination:
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Type
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Acceptable Documents
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Participant Verification
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Documentation verifying statements made on SOC 804 (pay stubs, bank statements, tax records, rent receipts, proof of property ownership, etc.).
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Sponsor Verification
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Documentation verifying statements made on SOC 860 (pay stubs, bank statements, tax records, rent receipts, proof of property ownership, etc.) (refer to 49-037 Sponsor Deeming).
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Immigration Document
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Evidence of current immigration status (refer to 49-020 Immigration Status – Qualified Alien and 49-020_1 Immigration Status - PRUCOL).
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Identity Document
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Photographic documentation (e.g., a driver’s license or State Identification card) that identifies the participant (refer to 49-010 Eligibility for CAPI).
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Proof of Age
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Evidence of date of birth (e.g., birth certificate) especially for a participant claiming eligibility for CAPI based on having attained the age of 64 (refer to 49-025 Age and Disability).
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Proof of SSI Ineligibility
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A formal or informal SSA denial of SSI/SSP benefits based solely on immigration status of a qualified alien CAPI participant and dated within the past six months (refer to 49-030 Ineligibility for SSI/SSP).
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