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STATE OF CALIFORNIA - HEALTH AND HUMAN …

state of california - health and human services agency welfare-to-work plan rights and responsibilities california department of social services

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYWELFARE-TO-WORK PLANRIGHTS AND RESPONSIBILITIESCALIFORNIA DEPARTMENT OF SOCIAL SERVICESPARTICIPANT NAMECASE NAMECASE NUMBER NUMBERThis is an overview of the rights and responsibilities ofparticipants in Welfare-to-Work activities under theCalifornia Work Opportunity and Responsibility to Kids(CalWORKs) Program. Your Welfare-to-Work Plan tellshow you and the county will work together so that you canget and keep a job. Your plan includes this form, theActivity Assignment, and the Welfare-to-Work Welfare-to-Work Handbook tells you about Welfare-to-Work activities, services, and rules. The ActivityAssignment tells you the Welfare-to-Work activity that youwill be participating in. The county must do certain things to help you while youare in Welfare-to-Work. The county must explain Welfare-to-Work to you and answer any RIGHTSAs a Welfare-to-Work participant, you have the following rights which will help you take part in have the right to the following:Employment Services Receive direction and support from the county to help you improve your ability to get a job. This can possiblyinclude on-the-job training and job skills training or education. Receive a referral to places that offer personal counseling, mental health, substance abuse, or domestic abuseservices, at no cost to you, if you need them to help you Services Receive payment for child care, transportation, and work and training-related expenses if you need them toparticipate in or attend any Welfare-to-Work appointment or activity. These are called supportive services. If youneed them, but do not get them, you may have good cause for not participating. Receive details of your supportive service arrangements in writing. Receive advance payment, if you need it to avoid using your own money, for approved supportive Plan Ask for a change or reassignment to another activity within 30 days from the beginning of your first training oreducation assignment under your initial Welfare-to-Work plan. Change your mind about the activities assigned in your Welfare-to-Work plan. If you change your mind, you musttell your Welfare-to-Work worker within three (3) working days after signing your Welfare-to-Work plan ActivityAssignment form (WTW 2). Automatically get a neutral third party to assess your employment and or training needs if you disagree with theassessment or you and the county cannot agree on a plan to meet your assessed employment needs. Ask for a different provider if you object to the religious character of any provider to which you have been assigned. Not to participate in any religious activity offered by a service provider. Participation in such an activity is Problems with your Welfare-to-Work Plan Not participate if the services you and the county agree you need are not provided. Not participate if the county decides you have any other good reason. Explain the reason if you fail to do what Welfare-to-Work requires. Have a second chance to cooperate and participate in Welfare-to-Work through the compliance process. Ask for legal advice at anytime regarding your participation in Welfare-to-Work from your local legal aid or welfarerights office by calling ( ) _______________________ .Employment Problems Leave a job or not accept a job if the county decides you have a good Protest any county action you do not agree with by filing a formal grievance with the county or asking for a Statehearing by calling 1-800-952-5253, or for the hearing or speech impaired who use TDD, call county must help you arrange and pay for child care,transportation, and work and training costs. If necessary, thecounty can make advance payments to you for thesesupportive plan and any changes to it will apply to you and thecounty as long as you participate in Welfare-to-Work. But, thecounty may have to change or stop all or part of this plan if: 1)there are changes in law or regulations; 2) the county cannotget or pay for services from the provider; or 3) you stopreceiving cash aid under the CalWORKs program. Thecounty will inform you of any changes in 1 (12/05) REQUIRED FORM - SUBSTITUTE PERMITTEDPHONE NUMBERYOUR RESPONSIBILITIESAs a Welfare-to-Work participant, you also have the following responsibilities to make sure Welfare-to-Work works for must: Accept a job if you get an offer, unless you have a good reason not to. If working, keep the job and not lower your earnings. Sign activity assignments which tell how you and the county will work together while you participate. Participate as described in your Welfare-to-Work plan unless you have a good reason. Choose and arrange for supportive services. The county will help you. Sign up for subsidized child care if you will need it. The county will tell you how. Ask your Welfare-to-Work worker if you have any questions about Welfare-to-Work. Tell your Welfare-to-Work worker of changes that may affect your participation. Tell your Welfare-to-Work worker right away of changes in your need for supportive services. This includeschanges in child care providers. If you do not tell the county in advance, the county may not be able to pay for theservices that change. Pay Welfare-to-Work back for any supportive services payments you got, but you did not need or you were noteligible to get. Call or go to the county when they ask you to. Give proof of satisfactory progress in your assigned activity, if required by your county. Read (or have read or explained to you) the Welfare-to-Work Handbook and ask questions about any part of thehandbook you do not Welfare-to-Work Handbook gives you more information on your rights and responsibilities. If you have any questions, besure to check the Welfare-to-Work Handbook or call your Welfare-to-Work worker at the number shown understand that the purpose of Welfare-to-Work is to help me prepare for work and find a have read (or had read or explained to me) and understand this Rights and Responsibilities form. I have received a Welfare-to-Work Handbook. I know that I have certain rights and responsibilities as a participant in Welfare-to-Work. I know that I must meet all my responsibilities as a Welfare-to-Work participant. If I fail to meet my responsibilities without good reason, I know that there are certain penalties and that my cash aid may be 1 (12/05) REQUIRED FORM - SUBSTITUTE PERMITTEDPARTICIPANT S SIGNATURE:WELFARE-TO-WORK WORKER S SIGNATURE:DATE:DATE:PHONE:

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