CalWORKS APPLICATION GUIDELINES

California Work Opportunity and Responsibility to Kids (CalWORKs) is a public assistance cash benefit program for low-income families with minor children.

This brief questionnaire is intended to give VERY broad eligibility guidelines for CalWORKs applicants. If your family is potentially CalWORKs-eligible, you should apply to the Social Services Agency for a determination. If your family appears to be ineligble for CalWORKs, you may still be eligible to other benefit programs, such as Food Stamps and/or Medi-Cal. When in doubt, APPLY!

1. Do you have child(ren) under 18 years of age in the home? YES
 		NO
2. Is anyone pregnant?
IF EITHER QUESTION #1 OR #2 IS ANSWERED "YES", CONTINUE.  OTHERWISE, PERSON MAY NOT BE ELIGIBLE FOR CalWORKKs BUT MAY BE ELIGIBLE FOR OTHER BENEFIT PROGRAMS. 		YES
 NO

3.

Is one of the parent(s) of the minor child(ren) deceased, absent from the home, or receiving disability?

YES
 NO

4.

Are the parents in the home employed full time (over 100 hours per month)?

YES NO

Parent #1

IF AT LEAST ONE PARENT IN THE HOME CHECKED "NO", CONTINUE.

Parent #2

 

5.

What is the total monthly gross earned and unearned income of your family?

$

("Gross" is the amount before taxes are deducted, and includes earnings, child support, unemployment, disability, and any other income.)
IF THE FAMILY HAS EARNINGS, DEDUCT $90 FOR EACH EMPLOYED PERSON. -

$

5.a  Adjusted gross income =

$

        NUMBER OF PERSONS IN THE FAMILY

#
5.b.  Amount allowable from chart

$

 # in Family

 1

2

3

 4

 5

 6

 7

 8

9

10

$ LIMIT

$451

$739

$916

$1089

$1242

$1396

$1534

$1671

$1811

$1966
IF 5.a IS LESS THAN 5.b, CONTINUE.  IF 5.a IS LARGER THAN 5.b, YOUR FAMILY MAY NOT BE  ELIGIBLE FOR CalWORKs BUT MAY BE ELIGIBLE FOR OTHER BENEFIT PROGRAMS.

6.

What is the total amount of liquid assets?
(Cash on hand, checking and savings account, etc.)

$

 

ARE THE LIQUID ASSETS OVER THE CalWORKs $2,000 LIMIT?

YES
 		NO

IF "YES" STOP HERE, UNLESS A MEMBER OF THE FAMILY IS OVER 60 YEARS OLD; THEN THE LIMIT IS $3,000.

You have the right to apply for cash aid regardless of the outcome of this brief questionnaire.
You may apply for benefits at any of the following offices:

Assistance Application Center North County  South County
1919 Senter Road
San Jose, CA 95112
(408) 271-5500 		100 Moffett Blvd.
Mountain View, CA 94043
(650) 988-6100 		379 Tomkins Court
Gilroy, CA 95020
(408) 846-3900