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California CW 61A Physical Capacities (CalWORKs)

When a CalWORKs participant reports a physical condition that limits work, the county welfare department sends the CW 61 packet, and the CW 61A is its physical capacities page. The provider rates what the person can do in an 8-hour day, from standing and sitting to lifting and reaching, so the county can assign a suitable work, training or education activity.

Who completes it

The licensed physician or other licensed health care professional completing the CW 61 fills in the whole CW 61A and signs (a designee may sign). The county enters the case details and a description of the participant's assigned CalWORKs activity and hours.

Submitting and payment

How to submit it
Return it to the county welfare department together with the CW 61, which carries the patient's release, the provider's Section 2 statement and the Section 3 certification.
Who pays
The CW 61A sets no fee and does not say who pays for completing it.

Good to know

  • Standing, walking and sitting are each rated as hours at one time and total hours in an 8-hour workday, in two-hour bands.
  • Lifting is graded from 10 to 80+ pounds as never, occasionally (0-2.5 hours), frequently (2.5-5.5 hours) or constantly (5.5+ hours) in an 8-hour day.
  • The CW 61 cover letter explains that the county uses the answers to judge whether the person can complete 32 or 35 weekly hours of activities (one- or two-parent households).
  • The form is marked 'required form, substitute permitted' and asks the provider to address functional issues relevant to the assigned activity, attaching documentation if needed.

Get the official form

Download the current version from the source each time; forms change without notice.

Physical Capacities

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What is the CW 61A used for?

It tells the county how a CalWORKs participant's current physical condition affects work. The provider rates standing, walking, sitting, repetitive hand and foot use, environmental limits, lifting and postural activities, notes treatment or medications that affect work, and lists other limitations and accommodations needed.

Do I need to fill out both the CW 61A and the CW 61B?

Only the ones that apply. The CW 61 cover letter asks the provider to complete Section 2 and the certification, plus the Physical Capacities and/or Mental Capacities forms as appropriate. If the answer to CW 61 question 1 is that there is no medically verifiable condition, only the certification is completed.

Can someone in my office sign the CW 61A?

The signature line reads 'health care provider (or designee) signature', followed by the provider's name, address, phone number and the date. The CW 61 certification likewise allows the provider's authorized representative to sign.