$__________
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 during your annual
redetermination/recertification (RD/RC) all
income the RD/RC form asks about, even if you
already reported that money.
Penalty for not reporting
If you do not report when your income is more than your
household’s IRT limit you may get more benefits than you
should. You must repay any extra benefits you get based
on income you do not report. If you do not report on
purpose to try to get more benefits, this is fraud, and you
may be charged with a crime.
If you get CalWORKs, you MUST ALSO report the
things below within 10 days of when they happen:
1. Anytime someone moves into or out of your
household.
2. Anytime someone joins, or is in your household,
who has a con
viction for a drug related felony
that was not reported before
.
3. Anytime someone joins, or is in your household,
who is in violation of a condition of probation or
parole.
4. Anytime someone joins, or is in your household,
who is running from the law.
5. Anytime you have an address change.
If you get CalFresh, you MUST ALSO report the
things below within 10 days of when they happen:
1. All mandatory reports required for CalWORKs,
other than IRT (see 1-5 above).
2. You have a change in the source of income
including starting, stopping or changing jobs;
3. Earned income changes by more than $100.
4. Unearned income changes by more than $50
(except for CalWORKs or General Assistance).
5. Rent or utility costs change (only if you move).
6. Any change in the amount of any court-ordered
child support.
7. If you are an Able Bodied Adult Without
Dependents (ABAWD), you must report any time
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:
● Someone in the house becomes pregnant.
● Someone on cash aid has a special need, such
as: a pregnancy, a special diet prescribed by a
doctor, household emergency, etc.
● For CalFresh, if someone disabled or age 60 or
older has new or higher out of pocket medical
costs.
AR 2 (11/13) REPORTING CHANGES FOR CALWORKS AND CALFRESH - REQUIRED FORM - SUBSTITUTES PERMITTED
