CalWORKs Program Allocation Adjustment
2014-15
Instructions: Please review the following information below to determine which sections of the form are needed.
Please Note: If you adjusted your budget on the 2014-15 CalWORKs Budget Plan on the Student Services Automated Reporting for Community Colleges (SSARCC) website or if you submitted the same Allocation Adjustment request earlier, please do not submit the same request on this form. It is only necessary to submit the portion of the form you are requesting a transfer, or additional funds. If you are not requesting any type of adjustment to your budget, please do not submit this document.
Section 1: Declaration of Unused Funds: By completing this section, the district/college will be returning State CalWORKs funds (Prop 98) and TANF funds. The district/college certifies that the initial allocated funds will not be used and are returning the funds from one or more of the following areas CalWORKs State Program (Prop 98), Work Study, (Prop 98), Child Care (Prop 98), or CalWORKs Federal TANF funds. The district gives the Chancellor’s Office authorization to redistribute these funds to another district/college. District/Colleges may return unused funds at any time during the year. However, if funds are returned in an excess of 5% of their prior year’s total allocation (including all adjustments) on June 30 or after the close of the fiscal year the programs are subject to a penalty that will reduce future year allocations. Additionally, district/colleges with a history of returning funds may be ineligible for additional reallocated funds in future year.
Section 2: Request to transfer State CalWORKs Funds to Another Program Area: By completing this section, the district/college is requesting a transfer of State CalWORKs funds to another program area. The district/college must explain how the transfer of funds will be used.
Transferring Child Care Funds: If CalWORKs State Child Care Funds are being transferred to another program area, the district/college must certify that all child care needs are met and by whom.
Transferring Work-Study Funds: Requires awrittenjustification, the justifications must include explaining how the student’s requirement for work-study is being met, why there is no need for additional the allocated funds, how many students are currently in work-study position (s) and how the funds being transferred will be spent.
Section 3: Request for Additional CalWORKs Program, Child Care or TANF Funds: By completing this section, the college is requesting additional CalWORKs State Program funds, CalWORKs State Child Care funds, and/or CalWORKs Federal TANF funds. The district must declare how the additional funds will be used.
Section 4: Request for Additional Work Study Funds: By completing thissection, the college is requesting additional CalWORKs State Program Work-Study funds. Work-study funds require that employers provide a minimum of 25% of the student’s salary. The college must declare the employer portion of the student salary.
The employer portion of the student’s salary may not be included in the dollar for dollar match if it is from Federal Work study and/or an off campus employer.
Section 5: Certification: By completing any of the sections of this form and submitting them to theChancellor’s Office. The college/district is certifying that funds requested are to be used for the sole purpose stated on the request. Chancellor’s Office staff will review and approve requests, based on State priorities for reallocation and availability of funds, such as no less than $4,900,000 of State Community College CalWORKs dollars is spent on work-study; also required are signatures of the CalWORKs Director/Coordinator, CalWORKs Director/Coordinator’s Supervisor, CalWORKs District Contact, District Business Manager, and the District Chancellor are required. After review and approval of any of the sections may cause funds to be adjusted and redistributed to other CalWORKs college programs. The funds will be allocated to the districts/colleges via the apportionment process. The Chancellor’s Office does not guarantee the availability of funds for reallocation district/college must explain how the additional funds will be used and identify the matching funds that will be provided.
District:__College:
Section 1: Declaration of Unused Funds: By completing this section, the college or district declares that it has unused 2014-15funds for CalWORKs State Program funds, CalWORKs Work Study funds, CalWORKs Child Care funds and/or CalWORKs Federal TANF funds. Colleges that report an excess of 5% of unused funds after the end of the fiscal year will face a penalty. In addition, colleges with a history of returning funds will likely become ineligible from requesting additional reallocated funds in the future year
NOTE: Unused funds may be declared at any time during the year and should always be returned prior to June 30th so they can be reallocated.
(Do not include any funds being requested to be transferred.)
Unused CalWORKs State Program Funds$ / The district/college reports the following unused CalWORKs State Program funds for
2014-15 and requests to have these funds deducted from the district/college’s 2014-15 CalWORKs State Program funds allocation.
Unused CalWORKs State Program Work Study Funds
$ / The district/college reports the following unused CalWORKs State Program Work Study Funds for 2014-15 and requests to have these funds deducted from the district/college’s 2014-15 CalWORKs State Program Work Study funds allocation.
Unused CalWORKs State Child Care Funds
(check the box) The district/college declares all CalWORKs student’s child care needs are being fully met either by the district/college and/or another agency.
$ / The district/college reports the following unused CalWORKs State Child Care funds for 2014-15 and requests to have these funds deducted from the district/college’s 2014-15 CalWORKs State Child Care funds allocation.
Please explain how the child care needs are being met.
Unused CalWORKs Federal TANF Funds
$ / The district/college reports the following unused CalWORKs Federal TANF funds for
2014-15 and requests to have these funds deducted from the district/college’s 2014-15 CalWORKs Federal TANF funds allocation.
District:__College:
Section 2: Request to transfer State CalWORKs Funds to another program area: These funds require matching funds from the district/college. Check the box below to indicate the program area and amount of transfer
- Check the appropriate box and include the amount to be transferred FROM (More than one box may be checked)
CalWORKs State Program Funds Decreased by Amount: $
CalWORKs Work Study Funds Decreased by Amount: $
CalWORKsChild Care Funds Decreased by Amount: $
- Check the appropriate box and include the amount to be transferred TO: (More than one box may be checked)
CalWORKs State Program Funds Increased by Amount: $
CalWORKs Work Study FundsIncreased by Amount: $
CalWORKs Child Care Funds Increased by Amount: $
List the amount per program component to be funded with the reallocated funds:
Program Component
/ Amount /Purpose: please provide detail.
Coordination / $Child Care / $
Work Study / $
Job Development/Placement / $
Total / $
(Check the box) transferring work-study funds justification attached.
(Check the box)The college certifies child care needs are being met by the district/college and/or another agency.
District:__College:______
Section 3: Request for additional CalWORKs State Program Funds, CalWORKs State Child Care Funds, or CalWORKs Federal TANF Funds.
Please complete this section if the district/college needs additional CalWORKs State Program funds, CalWORKs State Child Care funds, or CalWORKs Federal TANF funds. The program further certifies that it has the necessary funds available to meet the match requirements for use of CalWORKs State Program Funds. Programs will be required to report matching funds in their year-end expenditure reports.
CalWORKs State Program Funds - Requested Amount: $
If CalWORKs State Program funds are not available to fully meet the request, the district/college certifies that it will accept CalWORKs Federal TANF funds (to partially or wholly fund the request). Yes NO
If funds are allocated to a district/college, they must be used for the expressed purpose for which they were requested.The district will provide a $1 for $1 match for the additional CalWORKs State Program funds requested.
Amount per program component to be funded with these additional funds:
Program Component
/ Amount /Object Code
/Purpose: please provide detail.
CoordinationJob Development/Placement / $
Total / $
CalWORKs State Child Care Funds - Requested Amount: $__
Please explain the changes that occurred that require a request for additional child care funds:
Description of activities to be funded with these additional funds:
Child care funded functions
/ Object Code / CalWORKs State Child Care Funds AmountChild Care Tracking Costs (Maximum of 15% of total Expenditures) / $
On Campus Child Care / $
Off-Campus Child Care / $
Total / $
CalWORKs Federal TANF Funds - Requested Amount: $
Amount per program component to be funded with these additional funds:
Program Component
/ Amount /Object Code
/Purpose: please provide detail.
Coordination / $Job Development/Placement / $
Child Care / $
Total / $
District:__College:______
Section 4: Request for additional Work- Study Funds -Requested Amount:$
Please note the CalWORKs State Program Work Study funds may only be used for eligible CalWORKs student salaries and benefits. Funds distributed to the campus may be CalWORKs Prop 98 funds or CalWORKs Federal TANF funds whichever the Chancellor’s Office has available for redistribution. The district must provide a $1 for $1 match for the additional CalWORKs State Prop 98 funds. Work study funds require that there be an additional employer and they provide a minimum of 25% of the student’s salary. The district/college must declare the employer portion of the student salary and the employer portion of the salary may or may not be used as match towards the $1.00 for $1.00 required match.
Salary / Benefits (Workers Comp Only)Colum 1
Student Salary
Funding Source
(in dollars paid by funding source) / Colum 2
Employer’s Portion of Student’s Salary / Colum 3Campus Portion
$1 for $1 Match / Colum 4
WORKERS COMP Only Funding Source
(in dollars by funding source) / Colum 5
Employer’s Portion of Workers Comp / Colum 6
Campus Portion
$1 for $1 Match
CalWORKs Work Study Funds / $ / * / CalWORKs Work Study Funds / $ / *
District/College Funds / $ / $ / District/College Funds / $ / $
Federal Work Study Funds / $ / * / Federal Work Study Funds / $ / *
County Contract Funds / $ / County Contract Funds / $
Other – Off campus employer / $ / * / Other – Off Campus employer / $ / *
Other Direct Services Match (e.g. BOG, PELL. SEOG) / * / $ / Other Direct Services Match (e.g. BOG, PELL, SEOG) / * / $
Total / Total
*Please note: The funding sources with an asterisks are not an allowable funding match source. Please see CalWORKs handbook page 37 & 38 for allowable matches.
If CalWORKs State Program funds are not available to meet a request, the district/college certifies that it will accept CalWORKs Federal TANF funds (to partially or wholly fund the request). Yes NO
District:__College:
Section 5: Certification
We hereby certify the aforementioned CalWORKs Program Allocation Adjustment form is accurate and understand that the above information may result in an adjustment to district/college’s 2014-15 CalWORKs allocation.The college/district is certifying that funds requested are to be used for the sole purpose stated on the request.
Please note: There is no need to submit any portion if there are no allocation adjustments being requested.
Typed Name of College CalWORKs Director/Coordinator / Signature / Phone / Email / DateTyped Name of Supervisor of the CalWORKs Director/Coordinator / Signature / Phone / Email / Date
Typed Name of CalWORKs District Contact / Signature / Phone / Email / Date
Typed Name of District Business Manager / Signature / Phone / Email / Date
Typed Name of District Chancellor / Signature / Phone / Email / Date
Questions regarding this form may be directed to Cristina Mora at (916) 445-1643 or via email at .
NOTE: PLEASE SUBMIT ONLY THE SECTIONS OF THE REPORT THAT YOU COMPLETE.
Scan and email completed and signed copies of this document to the Chancellor’s Office ()byApril 14, 2015.
1