November 28, 2011


CalWORKs Program Guide Letter # 256






All County Information Notices (ACINs) I-09-09, I-17-96, I-56-95, I-46-94; All County Letters (ACLs) No. 96-21, 96-01, 95-26; and Public Law 103-31 Section 7, May 20, 1993; and additional guidance received from CDSS.



Effective Date

Upon Receipt




The purpose of this letter is to reiterate and provide additional clarification and updates related to the National Voter Registration Act (NVRA).



The NVRA requires public assistance offices to provide the following services to clients at initial application, redetermination, and reported changes of address. Offices shall:


   Include a Voter Registration Interest/Declination form (16-64 HHSA) and CA Voter Registration Form in all applications and RRR packets, and provide both of these forms to clients each time they report a change of address.

   Provide the same level of assistance in completing NVRA forms as is normally provided for every other service or application of benefits.

   Accept and forward completed CA Voter Registration Forms to the appropriate County Registrar of Voters (ROV) within 10 days.However, if the Voter Registration Form is received within 5 days before the last day to register to vote in an election, the form must be forwarded to ROV within 5 days.

   Inform applicants/recipients that receipt of benefits is not linked in any way to the individualís decision to register or not register to vote; and

   Retain the Voter Registration Interest/Declination forms for a minimum of 24 months even if the individual does not complete the form, declines to register to vote, or wishes to register later.




Summary of Updates

The following CPG chapters have been updated on the CPG online at


CPG Chapter



CPG Section Update



Application Process

Updated NVRA Requirements, by adding:

         Inclusion of CA Voter Registration Form in all application and RRR packets,

         Submission timeframes to ROV,

         Revised retention timeframes, and

         Requirement for offices to identify an NVRA Liaison


Redetermination of CalWORKs Eligibility

Added CA Voter Registration Form as a required form for all application and RRR packets




         Issuance of CA Voter Registration Form as requirement upon reported address change, and

         Reminder that form is required regardless of client transaction type

44-250 E

Mandatory Reporting and County Initiated Mid-Quarter Changes





CalFresh staff shall also comply with NVRA requirements.


Medi-Cal Program Impact

Medi-Cal staff shall also comply with NVRA requirements.


NVRA Liaisons


Offices shall establish an NVRA Liaison to be responsible for NVRA compliance and communication with the Strategic Planning & Operational Support (SPOS) NVRA Coordinator and the ROV. ††††


Election Information

Information regarding elections and registration deadlines will be provided by the SPOS NVRA Coordinator to all Managers and NVRA Liaisons.



ACCESS staff shall follow these instructions and adhere to ACCESS NVRA protocol.



Forms Impact

The Voter Registration Interest/Declination Form (16-64 HHSA) and CA Voter Registration Form must be included in all application and redetermination packets and provided to clients when they report a change of address.


The Voter Registration Interest/Declination form (16-64 HHSA) has been updated and can be found and ordered from the Xerox Print Center.†† Offices shall immediately recycle all existing supplies and start using the new version.


CA Voter Registration Forms shall be ordered directly from the ROVís designated liaison to HHSA.


Imaging Impact

The Voter Registration Interest/Declination Form (16-64 HHSA) shall continue to be imaged and retained for at least 24 months for all cases, regardless of whether or not the client chooses to complete the form.


Automation Impact



Quality Assurance Impact

QA will cite the appropriate error when the requirements in this material have not been followed.


Assistant Deputy Director



Assistant Deputy Director

Self-Sufficiency Programs

Strategic Planning & Operational Support



Manager Contact

CalWORKs Program