Get California Rs 3 Form

Get California Rs 3 Form

The California RS 3 form is a notification tool used by the Department of Social Services to refer individuals for mandatory services under the Refugee Cash Assistance (RCA) and CalWORKs programs. This form ensures that clients understand their responsibilities and eligibility requirements for receiving cash assistance. To get started on your application process, please fill out the form by clicking the button below.

Structure

The California RS 3 form serves as a crucial document in the process of providing support to individuals and families in need of assistance. This form is specifically designed for clients participating in programs such as the Refugee Cash Assistance (RCA) and CalWORKs, ensuring that they meet all eligibility requirements for cash assistance. It requires essential information, including the registrant's name, social security number, and details about their service provider appointment. The form also includes sections for case identification, reporting obligations, and comments, which help streamline communication between clients, service providers, and county welfare departments. Timely submission of the RS 3 form is vital, as it outlines the responsibilities of the registrant to report to the designated service provider, participate in training and employment activities, and comply with all program requirements. Failure to adhere to these stipulations may result in the loss of benefits, making it imperative for clients to understand and complete the form accurately. The RS 3 form not only facilitates the necessary referrals but also plays a significant role in tracking client progress and ensuring that support services are effectively delivered.

California Rs 3 Preview

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

RCA MANDATORY REFERRAL

CALWORKS MANDATORY REFERRAL

SERVICE PROVIDER

REFERRAL / NOTIFICATION FORM

DISTRIBUTION:

Original Copy:

Client

1st Copy

:

Service Provider

2nd Copy

:

Return to County Welfare Department When Notification is Required

3rd Copy

:

County Welfare Department

ADDRESS OF COUNTY WELFARE DEPARTMENT

TELEPHONE NO.: (

)

----

 

 

 

 

 

COUNTY USE ONLY

 

 

 

1.

CASE NAME

2. AU SIZE

 

 

 

 

 

 

 

 

 

 

 

 

11. YOU ARE REQUIRED TO REPORT TO THE SERVICE PROVIDER

3.

AID CODE/CASE NUMBER

 

 

 

 

 

 

 

 

 

 

 

BEFORE YOU CAN BE ELIGIBLE FOR CASH ASSISTANCE.

 

 

 

 

 

 

A. PLEASE TAKE THIS FORM TO THE FOLLOWING SERVICE

 

 

 

 

 

 

4.

REGISTRANT’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROVIDER AND RETURN TO YOUR WORKER WITH DATED

 

 

 

 

 

 

 

 

ORIGINAL ON OR BEFORE _______________ .

5.

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

B. YOUR APPOINTMENT AT THE SERVICE PROVIDER IS

6.

ALIEN NUMBER

 

 

 

 

 

 

 

 

 

 

 

A -

 

 

 

 

SCHEDULED FOR:

 

 

 

 

 

 

 

 

 

 

 

7.

DATE OF ENTRY AS A REFUGEE, OR DATE GRANTED ASYLUM, OR DATE OF CERTIFICATION AS A

 

DATE:_________________

TIME:_________________

 

TRAFFICKING VICTIM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. INTRACOUNTY OR INTERCOUNTY TRANSFER

 

 

 

 

 

 

 

 

 

FROM:

 

 

 

COUNTY/DISTRICT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

SERVICE PROVIDER ADDRESS

 

 

 

PREVIOUS SERVICE PROVIDER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. SPECIFY PRIMARY LANGUAGE DESIGNATED ON SAWS 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

DATE OF REFERRAL

 

 

 

 

TELEPHONE NO.: (

)

---

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

COMMENTS

 

 

 

 

 

 

 

 

14. I certify that I have informed the applicant/recipient of his or her rights and responsibilities in regard to the RCA/ECA programs. I have explained t h a t h e / s h e m u s t c o m p l y w i t h a l l e l i g i b i l i t y r e q u i r e m e n t s , s u c h a s r e p o r t i n g t o , a n d r e g i s t e r i n g w i t h t h e S e r v i c e P r o v i d e r , and participating and cooperating in training and employment activities, and that, if these requirements are not met, he/she may lose their grant.

WORKER’S SIGNATURE

WORKER’S NUMBER

DATE

 

SERVICE PROVIDER USE ONLY

 

 

 

 

15. Individual reported to Service Provider as required.

 

 

16. SERVICE PROVIDER EMBOSSING STAMP

AUTHORIZED SIGNATURE

 

DATE

 

 

 

 

When the above named registrant has completed participation in the training program or been placed in employment, please complete the 1st and 2nd copies and return the 2nd copy to the county welfare department addressed above.

17. Reason for notification to the county welfare department:

Client has completed participation in training.

Other (Explain in COMMENTS section)

(see attached RS 3A)

 

Client has been placed in employment on ______________________

 

(see attached RS 3A)

DATE

18. COMMENTS

19.SERVICE PROVIDER AUTHORIZED SIGNATURE

RS 3 (10/03)

DATE

SERVICE PROVIDER REFERRAL FORM

Instructions

County Use Only

1.Case Name --- Enter the refugee’s name: last name, first name, and middle initial.

2.AU Size --- Enter number of persons in the Assistance Unit

3.Aid Code/Case Number --- Enter the two-digit aid identification code for the appropriate public assistance program/Enter the refugee’s case number as assigned by your CWD.

4.Registrant’s Name --- Enter the name of person in the AU who is being referred on a mandatory basis, and required to register with the Service Provider.

5.Social Security Number --- Enter the registrant’s social security number.

6.Alien Number --- Enter the registrant’s alien number.

7.Date of Entry to U.S. or Date Granted Asylum --- Enter the date shown on the registrant’s I-94 form or I-551 form or other appropriate documentation.

8.Intracounty or Intercounty Transfer --- Enter the county (or district, if Los Angeles), and the Service Provider name and address that the registrant is transferring from.

9.Specify primary language designated on SAWS 1.

10.Date of Referral --- Enter the date on which the registrant is referred to the Service Provider.

11a. Check this box and enter the date that the registrant is to return the validated original RS 3 form to the Worker.

11b. If you make an appointment for the registrant to report to the Service Provider, check this box and enter the date and time of the appointment.

12.Service Provider Address --- Enter the address and telephone number of the Service Provider the registrant is being referred to. Enter the Service Provider’s full address including, number, street, city and zip code.

13.Comments --- Self-explanatory.

14.Worker Name and Worker Number --- Enter the name of worker assigned to the case, and the number that your county uses to identify the worker.

Service Provider Use Only

15.Authorized Signature --- This is to be signed by the person authorized to certify that the registrant has reported to the Service Provider for registration.

16.Service Provider Embossing Stamp --- Enter the official certification stamp.

17.Check the appropriate box to indicate why notification is being made.

18.Comments --- Self-explanatory.

19.Service Provider Authorized Signature --- This is to be signed and dated by the person authorized to complete this form.

Document Data

Fact Name Description
Purpose The California Rs 3 form is used for mandatory referrals to service providers for individuals receiving cash assistance through programs like RCA and CalWORKs.
Governing Law This form is governed by the California Welfare and Institutions Code, specifically under regulations pertaining to public assistance programs.
Distribution The form has several copies: the original goes to the client, the first copy is for the service provider, the second copy is returned to the County Welfare Department, and the third copy is kept by the County Welfare Department.
Required Information Essential details include the case name, aid code, registrant's name, social security number, and the service provider's address, among others.
Appointment Scheduling Clients must report to the service provider and provide a dated original of the Rs 3 form to their worker before becoming eligible for cash assistance.
Completion Notification Service providers must notify the County Welfare Department when a client completes training or is placed in employment, using the appropriate sections of the form.

How to Use California Rs 3

Filling out the California Rs 3 form is an important step in ensuring that individuals receive the necessary support and services. After completing the form, it will need to be submitted to the appropriate county welfare department, where it will be processed. Follow these steps carefully to ensure accuracy and compliance.

  1. Case Name: Enter the refugee’s name, including last name, first name, and middle initial.
  2. AU Size: Indicate the number of persons in the Assistance Unit.
  3. Aid Code/Case Number: Provide the two-digit aid identification code and the refugee’s case number assigned by the county welfare department.
  4. Registrant’s Name: Enter the name of the individual in the Assistance Unit who is being referred.
  5. Social Security Number: Fill in the registrant’s social security number.
  6. Alien Number: Input the registrant’s alien number.
  7. Date of Entry to U.S. or Date Granted Asylum: Enter the date as shown on the registrant’s I-94 form or I-551 form.
  8. Intracounty or Intercounty Transfer: Specify the county or district from which the registrant is transferring.
  9. Primary Language: Indicate the primary language designated on SAWS 1.
  10. Date of Referral: Enter the date on which the registrant is referred to the Service Provider.
  11. Mandatory Reporting: Check the box and enter the date the registrant must return the validated original RS 3 form to the worker.
  12. Appointment Details: If applicable, check the box and provide the date and time of the appointment with the Service Provider.
  13. Service Provider Address: Enter the full address and telephone number of the Service Provider.
  14. Comments: Use this section for any additional notes or information.
  15. Worker Name and Number: Enter the name and identification number of the worker assigned to the case.
  16. Authorized Signature: This should be signed by the person who certifies that the registrant has reported to the Service Provider.
  17. Service Provider Embossing Stamp: Include the official certification stamp.
  18. Reason for Notification: Check the appropriate box for the reason for notifying the county welfare department.
  19. Additional Comments: Provide any further comments if necessary.
  20. Service Provider Authorized Signature: The authorized person must sign and date this section.

Key Facts about California Rs 3

What is the California RS 3 form?

The California RS 3 form is a mandatory referral notification form used within the California Department of Social Services. It is primarily designed for individuals receiving cash assistance through programs like RCA (Refugee Cash Assistance) and CalWORKs. This form ensures that clients are referred to service providers for necessary training and employment activities.

Who needs to fill out the RS 3 form?

The RS 3 form must be filled out for individuals in the Assistance Unit (AU) who are required to register with a service provider. This typically includes refugees and other eligible individuals receiving cash assistance. The caseworker is responsible for completing the form and providing it to the client.

What information is required on the RS 3 form?

Essential information includes the case name, AU size, aid code or case number, registrant’s name, social security number, alien number, date of entry to the U.S., and the service provider's address. Additional details such as the primary language and appointment date may also be necessary.

How should the RS 3 form be submitted?

The original RS 3 form must be submitted to the designated service provider. The client should return the dated original to their caseworker by the specified deadline. Copies of the form are distributed to the client and the service provider for their records.

What happens if a client does not report to the service provider?

If a client fails to report to the service provider as required, they may risk losing their cash assistance grant. Compliance with all eligibility requirements is crucial for continued support.

What is the role of the service provider regarding the RS 3 form?

The service provider is responsible for certifying that the client has reported for registration. They must complete the form upon the client's participation in training or placement in employment and return the necessary copies to the county welfare department.

What should clients do if they have questions about the RS 3 form?

Clients should reach out to their assigned caseworker for clarification or assistance regarding the RS 3 form. The caseworker can provide guidance on completing the form and understanding the referral process.

Is there a deadline for submitting the RS 3 form?

Yes, the RS 3 form must be returned to the caseworker by a specified date, which is indicated on the form. It is important for clients to adhere to this timeline to maintain their eligibility for cash assistance.

What should be done if there are errors on the RS 3 form?

If errors are identified on the RS 3 form, clients or caseworkers should correct them promptly. It is essential to ensure that all information is accurate to avoid complications in the referral process.

Where can clients find more information about the RS 3 form?

Clients can find additional information about the RS 3 form by visiting the California Department of Social Services website or by contacting their local county welfare department for specific guidance and resources.

Common mistakes

Filling out the California RS 3 form can be a straightforward task, but many individuals encounter common pitfalls that can lead to complications. One frequent mistake is failing to provide the correct case name. This section requires the full name of the refugee, including the last name, first name, and middle initial. Omitting any part of this information can result in delays or miscommunication with the county welfare department.

Another common error is related to the aid code or case number. Applicants often either enter an incorrect code or leave this section blank. Each public assistance program has a specific two-digit aid identification code. Ensuring that this code is accurate is crucial for processing the application efficiently. Missing or incorrect information in this area can lead to significant delays in eligibility determination.

In addition to these issues, many people neglect to include the social security number of the registrant. This information is vital for verifying the identity of the individual being referred. Without it, the county welfare department may struggle to locate the correct records, which can further complicate the assistance process. It is essential to double-check that this number is both accurate and complete.

Another mistake often made involves the service provider address. Applicants sometimes provide incomplete or incorrect addresses, which can hinder the referral process. The form requires the full address, including street number, city, and zip code. Ensuring this information is precise will help in avoiding any unnecessary delays in receiving assistance.

Lastly, individuals frequently overlook the importance of the comments section. This area allows for additional notes or explanations that may be pertinent to the case. Failing to utilize this section can lead to misunderstandings or a lack of clarity regarding the registrant's situation. Providing thorough and clear comments can facilitate smoother communication between the service provider and the county welfare department.

Documents used along the form

The California Rs 3 form is an important document used in the state's welfare system. It is often accompanied by several other forms and documents that help streamline the process for clients. Below is a list of other forms that are frequently used alongside the Rs 3 form, along with a brief description of each.

  • RS 3A Form: This form provides additional information regarding the client's participation in training or employment. It is used to notify the county welfare department when a client has completed training or secured a job.
  • SAWS 1 Form: This form is used to collect demographic information about the client, including their primary language. It helps service providers understand the needs of their clients better.
  • CalWORKs Application: This application is necessary for individuals seeking cash assistance through the California Work Opportunity and Responsibility to Kids (CalWORKs) program. It gathers essential information about the applicant's situation.
  • Verification of Employment Form: This document is used to verify a client’s employment status. It may be required to assess eligibility for various assistance programs.
  • Notice of Action: This notice informs clients about decisions made regarding their benefits. It explains approvals, denials, or changes to their assistance status.
  • Client Rights and Responsibilities Form: This form outlines the rights and responsibilities of clients participating in welfare programs. It ensures that clients understand what is expected of them.
  • Referral Form for Supportive Services: This document is used to refer clients to additional supportive services, such as counseling or job training, that can assist them in achieving self-sufficiency.
  • Income Verification Form: This form is used to report a client’s income, which is crucial for determining eligibility for assistance programs.
  • Emergency Assistance Application: This application is used for clients seeking immediate financial assistance due to unforeseen circumstances, such as homelessness or medical emergencies.
  • Service Provider Agreement: This agreement outlines the relationship between the client and the service provider. It details the services to be provided and the expectations for both parties.

Each of these documents plays a vital role in the welfare process, ensuring that clients receive the support they need while complying with program requirements. Proper completion and submission of these forms can help facilitate a smoother experience for all involved.

Similar forms

The California RS 3 form serves as a crucial document for individuals receiving assistance through various social services. Similar forms exist to facilitate communication between clients and service providers. Below are four documents that share similarities with the RS 3 form:

  • California CalWORKs Referral Form: Like the RS 3 form, this document mandates that recipients of cash assistance report to designated service providers. It outlines the responsibilities of the clients and ensures they are aware of their eligibility requirements.
  • California Food Assistance Program (CFAP) Referral Form: This form also requires clients to engage with service providers to maintain their eligibility for benefits. It includes information on the client’s responsibilities and appointments, similar to the RS 3 form.
  • Welfare-to-Work (WTW) Participation Form: This document tracks the participation of clients in employment and training programs. Much like the RS 3 form, it emphasizes the importance of compliance with program requirements to avoid losing benefits.
  • California Refugee Cash Assistance (RCA) Notification Form: This form is specifically designed for refugees and requires them to report to service providers. It parallels the RS 3 in its focus on eligibility and compliance, ensuring that clients understand their obligations.

Dos and Don'ts

Filling out the California RS 3 form can be a straightforward process if you keep a few important things in mind. Here’s a list of what you should and shouldn’t do to ensure your form is completed correctly.

  • Do double-check all personal information before submission. Accurate details are crucial.
  • Do ensure you have the correct dates and times for any appointments related to the service provider.
  • Do include all required signatures and stamps to validate the form.
  • Do report to the service provider as instructed. This is essential for maintaining eligibility.
  • Do keep a copy of the completed form for your records.
  • Don’t leave any sections blank. Every part of the form must be filled out.
  • Don’t forget to include your social security number and alien number, as these are critical for processing.
  • Don’t submit the form without verifying that all information is accurate and up to date.
  • Don’t ignore any instructions provided on the form regarding deadlines or required actions.
  • Don’t overlook the importance of the comments section; use it to clarify any special circumstances.

By following these guidelines, you can navigate the process of filling out the California RS 3 form with confidence and ease. Remember, attention to detail is key to ensuring your application is processed smoothly.

Misconceptions

Understanding the California Rs 3 form is essential for those navigating the state's welfare system. However, several misconceptions often cloud its purpose and use. Here are eight common misunderstandings:

  • The Rs 3 form is optional. Many believe that completing the Rs 3 form is not mandatory. In reality, it is a required document for individuals seeking cash assistance through programs like RCA and CalWORKs.
  • Only refugees need to fill out the Rs 3 form. While the form is primarily used for refugees, it can also apply to other eligible individuals under specific welfare programs.
  • Submitting the form guarantees assistance. Completing the Rs 3 form does not automatically ensure that cash assistance will be granted. Eligibility requirements must still be met.
  • Once submitted, the Rs 3 form is never reviewed again. This is incorrect. The form may be revisited during eligibility checks and could affect ongoing assistance.
  • There are no deadlines associated with the Rs 3 form. In fact, the form must be returned to the case worker by a specified date. Missing this deadline can lead to delays or denial of assistance.
  • Only one copy of the Rs 3 form is needed. Individuals must provide multiple copies of the form: one for themselves, one for the service provider, and one for the county welfare department.
  • Filling out the Rs 3 form is straightforward and doesn't require help. While the form may seem simple, many find it beneficial to seek assistance from a case worker or service provider to ensure accuracy.
  • Information on the Rs 3 form is confidential. While personal information is protected, the form is shared with relevant agencies involved in the welfare process, which may lead to misunderstandings about privacy.

Addressing these misconceptions can help individuals navigate the welfare system more effectively and ensure they meet all necessary requirements for assistance.

Key takeaways

When filling out and using the California RS 3 form, it is essential to understand its purpose and requirements. Here are some key takeaways:

  • Purpose of the Form: The RS 3 form is used for mandatory referrals to service providers for individuals seeking cash assistance under California's public assistance programs.
  • Distribution of Copies: The form has multiple copies. The original goes to the client, the first copy to the service provider, and the second copy is returned to the County Welfare Department.
  • Accurate Information: Ensure that all personal details, such as the registrant’s name and social security number, are entered accurately to avoid delays in processing.
  • Appointment Scheduling: If an appointment is made with the service provider, it is crucial to include the date and time on the form to ensure compliance.
  • Language Considerations: Specify the primary language of the registrant as designated on the SAWS 1 form to facilitate effective communication.
  • Certification of Rights: The worker must certify that the applicant has been informed of their rights and responsibilities regarding the RCA/ECA programs.
  • Service Provider Responsibilities: After the registrant completes their training or is placed in employment, the service provider must return the appropriate copies to the County Welfare Department.
  • Comments Section: Use the comments section to provide any additional information or explanations relevant to the referral.

Understanding these aspects will help ensure that the RS 3 form is filled out correctly and used effectively within the public assistance framework in California.