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Purpose
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( ) To release a new policy
( ) To release a new form
( ) To convert existing policy to new writing style only – No concept changes
(X) Revision of existing policy and/or form(s)
What changed?
1. Updated P.O. Box address information for General Relief (GR) mail-in/fax applications designated site.
2. Included reference to BenefitsCal, which is the new statewide self-service portal that replaced Your Benefits Now (YBN).
3. Interactive Interview can be conducted in person or via telephone. A face-to-face interview is not required.
4. GR applicants who disclose that they are not able to work due to a mental health condition and prefer to provide verification from their own mental health care provider will be granted a Temporary Needs Special Assistance (NSA) designation for up to 60 calendar days from the GR application date pending receipt of the medical verification. The GR application will be approved if all other GR requirements are met.
5. GR applicants who disclose that they are not able to work due to a physical health condition and do not have the medical verification available will be granted a Temporary Unemployable designation for up to 60 calendar days pending receipt of the medical verification. The GR application will be approved if all other GR requirements are met.
6. References to the General Relief Opportunities for Work (GROW) Program have been replaced with the Skills and Training to Achieve Readiness for Tomorrow (START) Program.
Note: The GROW term will only be used when referencing California Statewide Automated Welfare System (CalSAWS) pages until the system is fully programmed. All notices and forms that are currently available in CalSAWS will also display the GROW term pending the system change.
7. References to GR Quarterly Reporting (QR-7) have been removed.
8. References to the Leader Replacement System have been replaced with CalSAWS.
9. References to the Electronic Document Management System have been replaced with CalSAWS Imaging Solution (CIS).
Note: Changes are shown highlighted in gray throughout the document.
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Policy
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An applicant can apply for GR benefits in person, online, via U.S. mail, or eFax. The applicant may submit a GR application via:
§ BenefitsCal website at: BenefitsCal.com
§ By Telephone – Intake Call Center (ICC)
§ In person at any GR district office.
§ U.S. mail by completing the GR 20, General Relief Application, and mailing it to:
Department of Public Social Services
P.O. Box 519
Rosemead, CA 91770-9998
Attn: GR APPLICATION
§ eFax by completing the GR 20, General Relief Application, and eFaxing to:
Department of Public Social Services
eFax: (310) 215-8220
ATTN: GR APPLICATION
GR applicants in need of same-day services are encouraged to apply in person at any of the 14 GR district offices.
GR Program Requirements
GR applicants who completed certain GR requirements within the previous 12 months, will be processed through the abbreviated application process described below. These applicants will not be required to complete the standard Intake application process; including completing all Intake forms or START (formerly GROW) Orientation.
All GR applicants who provide all required verification within 30 days after the application date, regardless of how they are submitted, must be processed within 30 days. Applications should not be denied prior to the 30th day, unless the applicant does not meet eligibility criteria (e.g., duplicate aid, minor child/children, excess income/resource, etc.). However, if the application has been denied prior to the 30th day for not making contact and the applicant subsequently makes contact before the 30th day and meets the eligibility requirements, the denial is to be rescinded and the application processed.
If an applicant fails to meet the eligibility requirements, the application will be denied.
Supporting Documents/Verifications
The Eligibility Worker (EW) is to use information provided on the GR application, including documentation/verification provided with the application or during the Intake process to establish eligibility for GR benefits. Additionally, verifications currently on file as part of a prior case record (GR or GR/CalFresh or GR/CalFresh/Medi-Cal combo case) may be used to supplement the current application if completed and/or signed within the last 12 months. This includes any current or expired photo ID saved in the CIS whether it was provided within the last 12 months or prior.
Interactive Interview
Applicants are required to provide verification or documentation to support statements on the applications. Based on the information provided on the application and supporting documentation/verification, an interactive interview will be conducted to determine initial eligibility for aid. This interview may be conducted via telephone; a face-to-face interview is not required. The applicant may be required to provide any missing documentation/verification via BenefitsCal, mail, or at a district office (drop box or document submission window) or to complete an eligibility requirement, such as applying for other potential income (i.e., Unemployment Insurance Benefits) to establish eligibility for GR benefits.
When a GR application is submitted in conjunction with other aid programs (CalFresh and/or Medi-Cal), process the other aid program(s) per existing policy and procedures.
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Definitions
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Term
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Description
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Application
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The form(s) to apply for GR benefits.
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Standard Application Process
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The process of completing all required GR Intake forms and requirements prior to approval of benefits.
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Abbreviated Application Process
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The process of using the previous GR application (forms and verification) to supplement the new application. The GR applicant must have completed some or all of the GR application process within the previous 12 months.
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Interactive Interview
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An interview conducted in person or via telephone to collect information necessary to determine eligibility for benefit programs.
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“Intake Packet” – Intake Forms
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A set of forms that may include a paper application, mandatory, situational, or informational forms.
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BenefitsCal
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The statewide self-service portal website that replaced the YBN portal. Applicants can apply for, view, and renew benefits for health coverage, food, and cash assistance. The BenefitsCal portal also allows applicants to upload supporting verification/ documents online.
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Extended Suspend Period
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Individuals (except those whose benefits are discontinued for time limits or duplicate filings) are provided an Extended Suspend period through the third Thursday of the month following discontinuance where they can resolve certain noncompliance issues and reinstate aid by rescinding the case. If the noncompliance issue(s) are not resolved during this period, the case remains discontinued.
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Rescission
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To reverse a discontinuance and reinstate benefits. A discontinued case should be rescinded on the date the participant resolves all outstanding noncompliance issues before the end of the Extend Suspend period. Benefits are reinstated as of the first of the discontinued month if all issues are resolved prior to the end of the Extended Suspend period.
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CIS
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The new system that replaced the Electronic Document Management System. CIS may also be referenced to as Hyland or Perceptive Experience.
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START Program (formerly known as the GROW Program)
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A mandatory welfare-to-work program for employable GR participants that provides education and training opportunities, supportive services, and case management to help them obtain jobs and achieve self-sufficiency. While participating in the START Program, participants will be assigned activities to help them achieve their employment goals. The START Program helps with transportation costs and job-related expenses such as supplies and uniforms.
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START Orientation
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Provides the participants with an overview of the START Program, its services, participation requirements, and benefits of employment. Orientation can be completed by viewing the video on the START webpage or by listening to a pre-recorded session on the START Orientation Phone Line at (866)488-8482, Monday through Friday from 8:00 a.m. through 5:00 p.m. However, completing the Orientation activity is not mandatory.
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Requirements
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The information below is needed to determine initial GR eligibility. The EW must verify each of the following requirements prior to approving GR benefits. Verification that is not submitted at the time of application can be provided up to 30 days after the date of application in any of the following ways: in person, by telephone, uploaded via BenefitsCal, U.S. mail or eFax.
Note: GR applications must be made available in the applicant’s preferred language and if unavailable, the English version is to be provided along with the GEN 1365, Notice of Language Services, and verbal translation of the application must be provided. In those instances where the application or supplemental forms are not available in the applicant’s preferred language, staff must assist the applicant in their preferred spoken language using available methods (i.e., interpreter services, or certified bilingual staff) per existing policy and procedures. Document all actions taken in the CalSAWS Journal, including if interpretive services were provided and/or accepted.
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Requirement
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Limit/Condition
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Application
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All applicants must complete an application for aid through one of the following methods:
a. In person – At any of the 14 GR district offices.
b. Online – Via the BenefitsCal website.
c. By Telephone – ICC
d. U.S. mail/eFax – Via U.S. mail or eFax submitted to the address or fax number provided.
Note: All application methods require an interactive interview to collect information necessary to determine eligibility for benefit programs.
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Identification (ID)
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Individuals applying for GR must provide a form of photo ID at the time of application. However, they are not required to provide a photo ID in person.
If the GR applicant/participant has no photo ID and no scanned permanent identification is available in CIS, the PA 594 Request for Photo Identification form is provided to the applicant, and they are advised of their responsibility to provide photo ID within 60 days.
If a photo ID is already on file, the applicant is not required to provide it again.
Eligibility staff must assist GR applicants in obtaining ID documents, when necessary, by issuing transportation funds and/or completing the following form(s):
a. PA 230, Request for Verification/Certification of Evidence, to request verification of the applicant’s birth certificate when aid is being approved based on an interim ID;
Ø An ABCDM 228, Applicants Authorization for Release of Information, must be completed and signed by the applicant.
b. DL 933, No Fee Identification Card Eligibility Verification, given only to homeless applicants;
c. DL 937, Reduced Fee Identification Card Eligibility Verification, given to applicants to obtain an ID at a reduced fee.
Note: Refer to 40-111 Identification, for additional information on ID requirements.
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Naturalized Citizenship or Immigration Status
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Applicants must declare their citizenship or immigration status. If proof of naturalized citizenship or immigration status is already on file, the applicant is not required to provide it again, unless the verification has expired, or the citizenship/immigration status has changed.
Eligibility staff must assist GR applicants in obtaining naturalized citizenship or immigration verification through the Systematic Alien Verification Entitlement (SAVE) system. When the results of the SAVE are inconsistent with the information provided by the non-citizen, the G845, SAVE, United States Citizenship and Immigration Services (USCIS) Document Verification Request, form is completed and submitted to USCIS.
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Social Security Number (SSN)
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Applicants must provide a SSN at the time of application or during the application process. A copy or the Social Security card is not mandatory.
Note: Victims of human trafficking, domestic violence, and other serious crimes that apply for the "T" or "U" Visa under Senate Bill 1569 are not required to have a SSN as part of the eligibility criteria for GR benefits. The "T" and "U" Visa are granted for a term of four years and the noncitizen is eligible to apply for a Legal Permanent Residence (green card) and a SSN.
Exemptions to the SSN requirement apply for some Violence Against Women Act applicants.
Refer to 40-113 Social Security Number Requirement for additional information.
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Authorization for Reimbursement of Interim Assistance Initial Claim or Post- Eligibility Case, SSP 14
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Applicants are required to complete a SSP 14, Authorization for Reimbursement of Interim Assistance Initial Claim or Post- Eligibility Case, form.
GR applicants must agree to repay all GR benefits paid to them upon approval of Social Security Income (SSI) benefits by completing the SSP 14, Authorization for Reimbursement of Interim Assistance Initial Claim or Post Eligibility Case.
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Income
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Applicants must provide proof of all income received, if any.
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Property
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Applicants must provide proof of all types of personal and real property owned.
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Residency
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Applicants must be residents of Los Angeles (L.A.) County and must meet the following residency criteria:
a. Be a U.S. citizen or a documented immigrant entitled to reside in the U.S. permanently; and
b. Be a resident of the County for at least 15 calendar days and intend to remain permanently or indefinitely. However, for GR applicants who intend to reside in L.A. County, but have not been a resident of L.A. County for at least 15 calendar days at the time they submit their application will have their benefits prorated from the day the 15-day residency requirement is met. For those applicants who apply before their 15-day residency requirement is met, the Beginning Date of Aid will be set to the date the 15-day residency requirement is met if all other eligibility requirements are satisfied.
Note: Refer to 42-400 Residence, for additional information on Residency requirements.
Applicants who have been in L.A. County for less than 15 days and do not want to stay in L.A. County may be provided assistance to return home, if requirements are met.
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Employability Status
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Employable – An employability status given to an applicant who is able to work. They must comply with the requirement of the START Program.
Unemployable - An employability status given to an applicant who is unable to work due to a physical health condition, documented by medical verification. Such documentation may be provided by their treating doctor.
NSA – An employability status given to an applicant who is unable to work due to a mental health condition, documented by medical verification. Such proof may be provided by their treating doctor, or through an evaluation by a remote or co-located Department of Mental Health (DMH) clinician.
Administratively Unemployable – An employability status given to an applicant who for reasons other than a physical or mental health incapacity is prevented from finding, accepting, or continuing employment.
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Mandatory Substance Use Disorder Recovery Program (MSUDRP)
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Applicants may be required to undergo screening for substance use disorder when there is a reasonable suspicion of dependence on illegal drugs or alcohol. Those who are screened and professionally evaluated to be in need of treatment must participate in MSUDRP as a condition of receiving benefits.
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Mandatory Forms
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Forms required for a new (never applied for GR benefits before) GR application or when the previous GR application was processed more than 12 months from the date of the new application. These include the following:
a. GR Application:
o BenefitsCal.com (In district office or online)
§ SAWS 2 Plus
Note: The applicant can add CalFresh when applying for GR via BenefitsCal.
o Telephone - ICC
§ SAWS 2 Plus (Telephonic Signature)
o Mail/Fax
§ GR 20, General Relief Application
o District Office (In person via Receptionist)
§ SAWS 1 and SAWS 2 Plus (For any combination of programs that includes GR)
b. GR Rights and Responsibilities:
o GR 21
c. NVRA VPF, Voter Preference Form (1/13);
d. MV-1, State of California County of L.A. Voter Registration;
e. SSP 14, Authorization for Reimbursement of Interim Assistance Initial Claim or Post Eligibility Case; and
f. Form 5076, GR Intake Screening Form.
The following forms are required with every abbreviated application regardless of whether they were collected on a prior application:
a. GR Application;
b. GR 21;
c. SSP 14; and
d. Form 5076
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Situational Forms
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Forms that are required based on the applicant’s personal and living situation. These are the most commonly used forms:
ID/SSN:
a. PA 594, Request for Photo Identification
b. PA 230, Request for Verification/Certification of Evidence
c. DL 933, No Fee Identification Card Eligibility Verification
d. DL 937, Reduced Fee Identification Card Eligibility Verification
e. MC 194, Social Security Administration Referral Notice
f. PA 4013, Non-Work Social Security Number Referral Letter
Housing:
a. PA 1815, Important Notice - Regarding a Mailing Address
b. PA 908, Rent Higher than Your GR Grant
c. PA 6146, GR Housing Subsidy & Case Management Project (GRHSCMP) Pre-Screening Referral form
Employability:
a. ABP 1461, GROW Orientation Appointment Notice
b. ABP 4029, Mental Health Screening Form
c. PA 2012, Referral for Mental Health Services
d. ABP 1676-1, Physical Health Assessment for General Relief
e. ABP 1676-2, Authorization for Use and Disclosure of Protected Health Information
f. ABP 1676-3 GRMH, Mental Health Assessment for GR
g. ABP 1676-4 GRMH, Authorization for Use and Disclosure of Protected Health Information
h. ABP 597, Determination of Administratively Unemployable Status
Miscellaneous:
a. CW 5, Veterans Benefits Verification and Referral
b. PA 1675, Direct Deposit Authorization Sign-Up Form
c. CSF 170, Text Message Notification Agreement
d. ABCDM 228, Applicants Authorization for Release of Information
e. GR 6, Unemployment Insurance Benefit Referral Form
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Informational Forms
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Forms provided to the applicant and discussed with the applicant by the EW:
a. PA1675-2, Direct Deposit Overview
b. ABP 392, Information Sheet - General Relief
c. PA 2457, Civil Rights Information Notice
d. PA 1914, Domestic Violence Information Brochure
e. PA 6044, Department of Motor Vehicles (DMV) Reduced Fee for California ID Cards
f. PUB 388, California Electronic Benefits Transfer (EBT) Card
g. PUB 275, Family Planning - Making the Commitment for a Healthy Future
h. PA 2126, Do You Live in or Plan to Live in Public or Section 8 Housing?
i. Pub 430, Mental Health Assessment and Use of the Third-Party Verification Brochure
j. CW 2223, Demographic Questionnaire for CalWORKs, Refugee Cash Assistance, Entrance Cash Assistance, Trafficking and Crime Victims Assistance Program and CalFresh Programs
Note: The abbreviated application will require all informational forms be provided and explained to the applicant.
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Verification Documents
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The following is a list of information necessary to determine eligibility and acceptable types of verification documents to submit with a GR application, as applicable. The documents may be uploaded and submitted with the GR application through BenefitsCal, U.S. mail, eFax, or provided to the EW during the interactive interview or at any time within 30 days after the application date. Additionally, eligibility staff are available to assist applicants with completing any required forms.
District staff must inform GR applicants of the option to use the computers, printers, and scanners in the district lobby to upload verification forms. Staff must also advise the public that they can submit their verifications forms at the Document Submission Service Reception Window in the district office.
Note: Staff must assist the applicant in their preferred spoken language using available methods (i.e., interpreter services, certified bilingual staff) per existing policy and procedures. Document all actions taken in the CalSAWS Journal, including if interpretive services were provided and/or accepted.
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Category
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Acceptable Verification Documents
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Applicant and Household Members Identification Verification
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a. Photo ID card, or driver license (current or expired from any State);
b. Cards issued by United States Citizenship and Immigration Service with a photograph such as the I-94, I-151, or I-551;
c. Photo ID issued by DMV, an employer, or any recognized agency, with applicant’s/participant’s signature and a number, such as license number, employee number, or SSN; or
d. U.S. Passport.
Note: Refer to 40-111 Identification, for more information on proof of identity.
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Income Verification
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a. Pay stubs;
b. Employer statement(s);
c. Unemployment Insurance Benefits (UIB)/Disability Insurance Benefits (DIB) award letters;
d. Social Security and/or Veterans Administration (VA) benefits award letters;
e. Statement of support or contribution(s) received; and/or
f. PA 167, Monthly Earnings Report.
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Personal/Real Property and/or Resource Verification (if applicable)
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a. Automobile registration(s);
b. Checking and/or savings account statement(s);
c. Stock/Bond value statement(s);
d. Real property deed(s);
e. Student financial aid award letter(s);
f. Life insurance/life estate policy(ies), (cash surrender value);
g. Burial Funds/Insurance;
h. Interment space/crypt/niche; and/or
i. Oil/mineral rights.
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Qualified Noncitizen Immigration Verification
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Qualified noncitizens must provide acceptable documentation, which must indicate their immigration status or contain enough information to confirm their presence and residency in the U.S. is lawful either permanently or for an indefinite period of time.
Note: Refer to 42-404 Immigrant Eligibility Chart, for more information on acceptable verification documents.
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