DPSS ePolicy

All GR applicants/participants are informed about their rights and mandatory reporting responsibilities at intake and during the GR RE. All GR applicants (including their spouse or domestic partner or Authorized Representative) are required to read, sign, and submit the GR 21, General Relief Rights and Responsibilities at intake prior to the approval of their GR application. The GR 21 is included in the GR RE packet as an informational notice to remind GR participants of their rights and responsibilities but is not required to be signed or returned during the GR annual RE period.

Additionally, the GR Approval Notice of Action (NOA), QR 3-LA, General Relief Mid-Quarter Status Report (10/2012), and GR 22, General Relief Annual Renewal form, inform and remind the applicant/participant of the mandatory reporting responsibilities.

Applicants’/Participants’ Reporting Responsibilities

GR applicants/participants are presumed to know and reasonably understand the provisions for eligibility, as well as their mandatory reporting responsibilities unless evidence to the contrary is presented. Furthermore, applicants/participants are presumed to know of changes in income, needs, resources, and other circumstances affecting their situation unless evidence to the contrary is presented.

Good Cause may exist only when the applicants/participants cannot reasonably be expected to fulfill their mandatory reporting responsibilities due to factors outside of their control.

GR applicants/participants are not eligible for GR if they refuse/fail to:

1. Provide or disclose information which is pertinent to establishing initial or continued eligibility;
2. Complete the appropriate GR application and/or annual RE forms;
3. Report any changes that affect initial or continued eligibility; or
4. Consent to an investigation made in order to establish initial or continued eligibility.

Refer to 40-107 Abbreviated General Relief Application Process and 40-116 General Relief Renewal policies for details on reporting responsibilities at intake and during the GR RE.

Reporting requirements for an applicant/participant with a Needs Special Assistance designation may be temporarily deferred until the co-located Department of Mental Health staff or another designated person has assisted the applicant/participant in reporting information.

Refer to 41-100 Needs Special Assistance for additional details.

Mid-Period Mandatory Reporting

GR participants are required to report all mandatory mid-period changes within five calendar days from the date the change became known to the household (HH), as indicated below:

1. New earned income, including self-employment, of $203 or more;
2. New unearned income of $25 or more;
3. Increased earned or unearned income of $25 or more;
4. Someone moves in or out of the HH;
5. New property/resources;
6. Change of address;
7. United States Citizenship and Immigration Services (USCIS) makes a determination on the participant’s application for a T or U Visa;
8. Fleeing to avoid prosecution or custody/conviction of a felony; and
9. In violation of parole/probation.

Refer to 40-122 Periodic Reporting policy for details regarding the information reported on the SAR 7, Eligibility Status Report, for GR/CalFresh combo cases.

County Responsibilities

The County has a responsibility to:

1. Inform applicants/participants of their rights and responsibilities when applying for or receiving GR, and to remind them during the annual RE.
2. Assist the applicants/participants in exploring all possible alternative sources of income.
3. Advise the applicants/participants about their ongoing obligation to immediately report any change in circumstances or information that could affect continued eligibility.

Per County Code of Ordinance Chapter 2.102 Sections 2.102.050 and 2.102.150, each individual applying for or receiving GR benefits must sign a written declaration under penalty of perjury at the time of the GR application and once annually thereafter stating their address, income/source of income, property/resources, HH composition, responsible relative’s name, their address and income. Any individual who fails or refuses to provide the required information at the time of application or once every 12 months will not be eligible for GR benefits.

Per County Code of Ordinance Chapter 2.102 Section 2.102.100, any individual who fails or refuses to apply for any potentially available income is not eligible for GR benefits.

BenefitsCal

A website for individuals to apply for, view, and renew benefits for health coverage, food, and cash assistance. The BenefitsCal portal also allows applicants/participants to upload supporting verifications/documents online.

Questionable Information

Information provided on the application, or any other report which is inconsistent with statements made by the applicant/participant, and/or inconsistent with the information received by the Department from another source.

Participants are required to report mandatory mid-period changes that may impact their GR eligibility or monthly grant determination to the County within five calendar days of the date the change becomes known to them. Any late reporting may result in an overpayment.

Refer to 44-309 General Relief Overpayments for additional details.

The QR 3-LA may be used by participants to report mandatory and/or voluntary mid-period changes in writing. However, participants are not mandated to use this form and may report mandatory mid-period changes in writing in a manner other than on the QR 3-LA or verbally (either in person or by phone).

Note: Mandatory mid-period changes must be reported for GR but not for CalFresh. However, if the participant with a GR/CalFresh combo case reports a change mandatory for GR, it will be reviewed for CalFresh also.

Reporting Responsibilities Met

An applicant/participant meets their reporting responsibilities when making an accurate and complete report of all facts that have an impact on their GR eligibility or monthly grant determination within five calendar days of learning of the change.

Reporting Responsibilities Not Met

An applicant/participant fails to meet their reporting responsibilities after they have been informed of their responsibilities; and knowingly fails to report facts that impact their GR eligibility or monthly grant determination.

Income

Any new earned income of $203 or more, and any new unearned income of $25 or more must be reported within five calendar days. Any increase in earned or unearned income of $25 or more must also be reported within five calendar days.

Refer to 44-101 Income policy for additional details.

Potentially Available Income

The applicant/participant is responsible for providing information necessary for an income determination and for taking all necessary actions to obtain potentially available income. Income is considered available if the applicant/participant only has to apply for, claim, or accept the income in order to obtain it. Examples of available income include:

1. A relative’s offer of a contribution;
2. Unemployment Insurance Benefits (UIB)/Disability Insurance Benefits (DIB); and
3. Supplemental Security Income/State Supplemental Program (SSI/SSP) or Retirement Survivors Disability and Health Insurance benefits, including benefits available by appealing SSI/SSP discontinuances and denials.

Note: The entire HH is ineligible for GR, if any member of that HH refuses to accept or apply for available income.

As a condition of receiving GR benefits, the applicant/participant must give the County permission to contact:

1. Any agency from whom the applicant/participant may be entitled to receive income;
2. Applicant’s/participant’s past and potential employers; or
3. Any person who may be able to support the applicant/participant.

HH Changes

When the applicant/participant reports a change in the GR HH (e.g., marriage, newborn), they are required to provide the Social Security Number, photo Identification, citizenship status, income, and resources (if applicable) of the new person.

Refer to 44-203 Household Composition and Living Arrangement policy for details.

Citizenship/Immigration Status

All GR applicants/participants must provide acceptable verification of their immigration status:

1. At the time of application; and
2. Anytime a change is reported in the individual’s immigration status.

Refer to 42-404 Immigration Eligibility Chart policy and 42-411 Noncitizen Victims of Human Trafficking, Domestic Violence, and Other Serious Crimes for additional details.

Address

If the applicant/participant reports a new address and/or rent amount, the applicant’s/participant’s verbal or written statement is sufficient. They are only required to provide verification of the amount of rent paid if the reported amount is “questionable,” or if the rent amount is higher than the GR monthly grant amount.

Refer to 44-203 Household Composition and Living Arrangement policy for details.

Property

GR applicants/participants must report all property owned or acquired within five calendar days. The value of all available property is used to determine initial and ongoing eligibility. Verifications must be provided to determine conditional or partial ownership, or unavailability of property.

Refer to 42-200 Property policy for additional details.

Responsible Relatives

All GR applicants/participants are required to provide, to the best of their knowledge, the name, address, and relationship of each responsible relative. Refusal or failure to provide this information will result in denial or discontinuance of aid.

Refer to 43-100 Responsible Relatives for General Relief for additional information.

NOA

If any mandatory changes affect the HH’s GR benefits, a Discontinuance or Change NOA that includes an adverse action will be mailed ten calendar days prior to the effective date of change.

Refer to 44-401 Initiating Hearings and Notices of Action for additional details.

 All mandatory reports affect eligibility and may result in a discontinuance or reduction of GR benefits. The discontinuance or benefits reduction will be effective the first of the next month following the 10-day NOA rules.

Citizenship/Immigration Status

1. United States (U.S.) Passport;
2. N-550, Certification of Naturalization;
3. I-551 Permanent Resident Card (formerly known as I-151 Alien Registration Card);
4. I-94 or I-94A Arrival/Departure Form;
5. Foreign Passport with Temporary I-551;
6. I-766 Employment Authorization Document;
7. I-797 or I-797C, Notice of Action;
8. Written notice or letter from USCIS confirming I-914, Petition for T Nonimmigrant Status was received, approved or in the appeals process;
9. Written notice or letter from USCIS confirming the I-918, Petition of U Immigrant Status and/or I-918 Supplemental A, Petition for Qualifying Member of U-1 Recipient (if applicable) was received, approved, or is in the appeals process; or
10. Statements from persons in official capacities (e.g., law enforcement officials or victims’ advocates) who assisted the victim with the T/U Visa application.

Refer to 42-404 Immigration Eligibility Chart and 42-411 Noncitizen Victims of Human Trafficking, Domestic Violence, and Other Serious Crimes policies for additional information.

Income Verification

1. Paycheck stubs;
2. W-2, Wage and Tax Statement;
3. 1099 form;
4. Award Letters;
5. PA 167, Monthly Earnings Report (for self-employment income);
6. GEN 111, Employer Statement Form; or
7. Written statement from employer.
   • Note: If the employer cannot be contacted by telephone or mail, a GEN 853, Sworn Statement, can be completed by the applicant/participant as the last resource for obtaining employment verification

Refer to 44-101 Income policy for additional verifications.

Property/Resources

Personal Property

1. The most recent bank account statement;
2. A current statement from the bank, credit union or savings and loan; or
3. A passbook of the account updated by the institution;

Insurance Policy

1. The Cash Surrender Value using the insurance policy; or
2. A replacement of the insurance policy or statement from the insurance company, if the applicant/participant does not have the actual policy.

Motor Vehicle

1. A Department of Motor Vehicles (DMV) registration; or
2. A duplicate form obtained from the DMV, if the applicant/participant does not have the vehicle registration.

Ownership and Value of Real Property

The most recent tax statement.

Refer to 42-200 Property policy for additional details.

Applicants/participants have the following options to provide the required verification(s):

1. By U.S. mail or fax;
2. In person to the district office; or
3. Upload via BenefitsCal;