May 23, 2012


CalWORKs Program Guide Letter No. 267






Effective Date

Upon Receipt




All County Information Notice (ACIN) No. I-49-94, I-56-95, I-17-96, I-09-09, I-01-12, All County Letter (ACL) No. 95-26, 96-21, 96-01, Medi-Cal All County Welfare Directors Letter (ACWDL) No. 94-85, 95-36, 95-78, 96-01, and Public Law 103-31 Section 7, May 20, 1993




The purpose of this letter is to notify staff of updates to the CalWORKs Program Guide due to the issuance of the National Voter Registration Act (NVRA) – Requirements for Public Assistance Offices chapter of the HHSA Eligibility Desk Guide (EDG).




Under federal law, the NVRA requires states to provide voter registration opportunities at initial application, redetermination, and changes of address at all offices that provide public assistance, regardless of the type of client transaction (in-person, by mail, through the internet/email, or over the telephone).


All applicants and continuing clients must be given both a CA Voter Registration Form (also known as a Voter Registration Card or VRC) and a NVRA Voter Preference Form (16-64 HHSA) at the time of application, redetermination, and changes of address, regardless of whether they indicate they want to register to vote or not. 


A failure to comply with the NVRA may subject the county and state to a civil action by the US Department of Justice or a private party.



Summary of Updates

The following program updates have been made to the CPG online:


CPG Section


Program Updates

40-100 E.





Application Process

·         Removes NVRA-related program material previously issued

·         Directs staff to utilize the included links to the National Voter Registration Act (NVRA) chapter in the HHSA Eligibility Desk Guide (EDG).

40-100 M.


Redetermination of CalWORKs Eligibility

42-400 A.



44-250 E.

Mandatory Reporting and County Initiated Mid-Quarter Changes



Other Program Impact

CalFresh and Medi-Cal eligibility staff shall also comply with NVRA requirements as outlined in the HHSA Eligibility Desk Guide.



ACCESS staff shall comply with NVRA requirements as outlined in the HHSA Eligibility Desk Guide and adhere to ACCESS NVRA Protocol.


Automation Impact



Forms Impact

Both the CA Voter Registration Form (VRC) and the NVRA Voter Preference Form (16-64 HHSA) must be included in Lobby Welcome Packets for CalWORKs in-office applications and in CalWORKs Renewal/Redetermination/Recertification (RRR) packets.


Both NVRA required forms must also be provided to CalWORKs clients whenever they report an address change.


NVRA Preference Form (16-64 HHSA)

The NVRA Voter Preference Form (16-64 HHSA) was updated in November 2011 to allow clients and agency staff to complete the form more easily without requiring a client signature. 


This updated 16-64 HHSA form is currently available in the following languages:  English, Spanish, Vietnamese, Chinese, and Tagalog.  A PDF fill-in enabled version of the 16-64 HHSA is also available.


All translations of the 16-64 HHSA can be ordered from the Xerox Print Center.  Offices shall review their shelf stock to ensure that outdated versions of the 16-64 HHSA are no longer in use. 


CA Voter Registration Form (VRC)

CA Voter Registration Forms shall be ordered directly from the San Diego County Registrar of Voters’ (ROV) designated liaison to HHSA. 



Imaging Impact

The NVRA Voter Preference Form (16-64 HHSA) shall be imaged and retained for at least 24 months for each CalWORKs application, redetermination, or change of address even if the client declines to register to vote, wishes to register later, or does not return a 16-64 HHSA form.


CA Voter Registration Forms (VRCs) shall not be imaged.  Completed VRCs shall be forwarded to the County of San Diego Registrar of Voters within the specified timeframe.    



Operational Impact

NVRA Liaisons at each office shall continue to monitor their site for ongoing compliance with NVRA requirements. 



QC / QA Impact

Quality Assurance will cite the appropriate error when the regulations cited in the material have not been followed.



Senior Program Manager Approval


Senior Program Manager

Self-Sufficiency Programs

Strategic Planning & Operational Support


Manager Contact

CalWORKs Program