California Department of Social Services - State Hearings Division
Notes from the Training Bureau - April 22, 2003

This ACIN introduces a CW89 Application Withdrawal Request form. This new form was developed for applicants who wish to withdraw an application for CalWORKs, food stamps or Medi-Cal.

This CW89 is a recommended form. It includes language that the applicant may reapply at any time and that by withdrawing an application, the applicant will have no appeal rights.

The ACIN advises counties that if they choose to develop their own withdrawal of application form, such form should make sure that the form uses language that clearly states that the applicant will not be able to file for a hearing and that the applicant may reapply at any time.

When an applicant asks to withdraw an aid application, counties may ask applicants to sign the CW89 form or other withdrawal form, but the applicant is not required to do so.

While this ACIN states that when an applicant signs the withdrawal form, he/she gives up appeal rights, an applicant who signs the CW89 or other withdrawal form may request a state hearing if he/she contends that the withdrawal was not voluntary or not in accord with regulations. MPP §40-171.23 addresses withdrawals in CalWORKs, MPP §63-300.36 addresses withdrawals in food stamps, and Title 22, CCR §50155 refers to withdrawals in Medi-Cal.