Right Column
Vietnamese Translations
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- ABCD 239.7A (8/01) - Notice Of Administrative Disqualification California Work Opportunity And Responsibility To Kids (CalWORKs) Program
- ABCD 478A (5/02 - Disqualification Consent Agreement California Work Opportunity And Responsibility To Kids (CalWORKs) Program
- AD 1A (8/02) - Consent To Adoption By Parent(s) (In California)
- AD 1C (3/10) - Parental Consent to Adoption (Outside California)
- AD 20 (3/08) - Refusal To Give Consent To Adoption
- AD 65 (2/02) - Parent's Authorization For Medical And Surgical Care
- AD 67 (2/07) - Information about The Birth Mother
- AD 67A (6/07) - Information About The Birth Father
- AD 100 (7/10) - Authorization For Use And/Or Disclosure Of Health Information Independent Adoption Program
- AD 501 (9/03) - Relinquishment In or Out-of-County (Birth Mother/Presumed Father in California)
- AD 880 (3/99) - Declaration Of Mother (To Be Completed By All Mothers Not Married To The Father Except When A Relinquishment Or Consent Has Been Obtained From The Father)
- AD 885 (3/08) - Mother Or A Presumed Father Of A Child Who Is Not Detained, A Juvenile Court Dependent In Out-of-home Care, Or The Ward Of A Legal Guardian
- AD 885A (3/08) - Mother or a Presumed Father of a Child Who is Detained, a Juvenile court Dependent in Out-of-home Care, or the Ward of a Legal Guardian
- AD 887 (3/08) - Statement Of Understanding - Independent Adoptions Program
- AD 908 (8/08) - Adoptions Information Act Statement
- AD 918 (11/03) - Family Assessment Questionnaire II
- AD 922 (7/99) - Relinquishment Addendum
- AD 926 (10/03) - Statement Of Understanding Independent Adoptions Program – Parent Who Places The Child With The Prospective Adoptive Parent(s)
- AD 4310 (10/99) - Adoption Programs Notice Required By Information Practices Act
- AD 4324 (10/03) - Adoption Questionnaire I This is a large PDF file. Click here if you have problems with it: Tips for Using Adobe PDF Files
- AR 2 (12/12) - Reporting Changes For CalWORKs And CalFresh
- AR 3 (9/12) - Mid-Year Status Report For CalWORKs and CalFresh
- CALIFORNIA WORK OPPORTUNITY AND RESPONSIBILITY TO KIDS HANDBOOK
- CCAP (10/99) - Family Child Care Self-Assessment Guide
- CCAP (10/99) - Family Child Care - Guide to Waivers, Exceptions and Exemptions
- CCP 1 (4/99) - Declaration of Exemption from Trustline Registration and Health and Safety Self-Certification
- CCP 4 (4/99) - Health and Safety Self-Certification (for license exempt providers)
- CCP 6 (8/99) - Health And Safety Checklist
- CCP 7 (2/05) - CalWORKs Stage One Child Care Request Form And Payment Rules
- CCP 2145 (5/04) - CalWORKs Child Care Reimbursement Report
- CF 377.1 (2/13) - Notice Of Approval For CalFresh Benefits
- CL 1 (4/99) - Cal-Learn Registration Program Information Orientation Appointment
- CL 2 (4/99) - Cal-Learn Program Requirements
- CL 3 (4/99) - Cal-Learn Notice Of A Participation Problem
- CL 4 (4/99) - Cal-Learn Notice To Parent/Legal Guardian Of Cal-Learn Participant
- CL 8 (3/99) - Cal-Learn Notice Of Report Card Submittal Schedule
- CL 9 (3/99) - Cal-Learn Notice Of Good Cause Determination
- CL 10 (4/99) - Cal-Learn Notice Of Exemption/Deferral
- CL 11 (4/99) - Cal-Learn Notice Of Incomplete Grades
- CW 2.1 NA (8/04) - Notice And Agreement For Child, Spousal And Medical Support
- CW 2.1Q (7/01) - Support Questionnaire
- CW 4 (6/02) - Immediate Need Payment Request
- CW 5 (7/01) - Veterans Benefits Verification and Referral
- CW 8 (7/01) - Statement of Facts For An Additional Person
- CW 8A (3/00) - Statement Of Facts To Add A Child Under Age 16
- CW 10 (7/01) - Notice of Withdrawn Application
- CW 13 (9/02) - Caretaker Relative Agreement
- CW 23 (3/00) - Senior Parent - Statement Of Facts
- CW 25 (7/01) - Supplemental Statement Of Facts - Minor Parent
- CW 40 (3/00) - CalWORKs - Reduced Income Supplemental Payment Request
- CW 43 (3/00) - CalWORKs Applicant Choice Form Immediate Need Payment/Expedited Grant
- CW 60 (5/01) - Release Of Information - Financial Institution
- CW 61 (7/01) - Authorization to Release Medical Information
- CW 61A (6/01) - Physical Capacities
- CW 61B (6/01) - Mental Capacities
- CW 63 (4/01) - Income And Eligibility Verification Form
- CW 71 (3/00) - Statement Of Cash Aid Mother And Unrelated Adult Male (UAM)
- CW 81 (4/10) - Lien Agreement
- CW 82 (3/00) - Important Information About This Agreement
- CW 86 (9/11) - Agreement - Restricted Account - California Work Opportunity And Responsibility To Kids (CalWORKs) Program
- CW 87 (6/02) - Reinforming Letter/Add a Person(s) Program
- CW 88 (6/11) - Diversion Services Agreement CalWORKs Program
- CW 88 Coversheet (6/11) - You May Be Eligible For Diversion Services
- CW 89 (2/03) - Application Withdrawl Request
- CW 103 (11/09) - Multilingual - Transitional Medi-Cal
- CW 2102 (8/00) - The Maximum Family Grant (MFG) Rule for Recipients of Cash Aid
- CW 2166 (9/11) - Multilingual - Work Pays Notice
- CW 2184 (7/11) - CalWORKs 48-Month Time Limit
- CW 2186A (12/12) - CalWORKs Exemption Request Form
- CW 2186B (12/12) - CalWORKs Exemption Determination
- CW 2187 (6/04) - Your CalWORKs 60-Month Time Limit
- CW 2188 (4/02) - Verification Of Aid For The Temporary Assistance For Needy Families (TANF) Program
- CW 2189 (6/11) - Notice of Your CalWORKs Time Limit - 42nd Month On Aid
- CW 2190A (6/11) - CalWORKs 48-Month Time Limit Extender Request Form
- CW 2190B (6/11) - CalWORKs 48-Month Time Limit Extender Determination Denial Form
- CW 2200 (3/09) - Request For Verification Form
- CW 2206 (1/13) - Young Child Exemption Ends December 31, 2012 New Rules For CalWORKs Welfare-To-Work Activities
- DFA 285-A1 (4/09) - Application For Food Stamp Benefits
- DFA 285-A2 (8/06) - Statement Of Facts
- DFA 285-A3 QR (1/13) - CalFresh Benefits Your Rights And Responsibilities
- DFA 285C (4/99) - Food Stamp Supplemental Application For Special Medical Deductions
- DFA 303 (3/05) - Replacement Affidavit/Authorization
- DFA 377.1 (11/01) - Notice of Approval
- DFA 377.1A (3/02) - Notice Of Denial Or Pending Status
- DFA 377.2 (11/03) - Food Stamp Notice of Expiration Of Certification For Change Reporting Household
- DFA 377.4A (7/03) - Food Stamp Notice of Change
- DFA 377.4 QR (1/04) - Food Stamp Notice of Change For Change Reporting Household
- DFA 377.5 (8/06) - Food Stamp Household Change Report
- DFA 377.7A (1/12) - Notice Of Administrative Disqualification
- DFA 377.7A1 (1/12) - Request For Restoration Of CalFresh Benefits After Administrative Disqualification
- DFA 377.7B (6/11) - CalFresh Overissuance Notice For Inadvertent Household Errors (IHE) Only
- DFA 377.7B1 (10/00) - Food Stamp Repayment Notice for Inadvertent Household Errors Only, Final Notice
- DFA 377.7C (5/02) - Food Stamp Repayment Agreement For Inadvertent Household Errors Only
- DFA 377.7D (6/11) - CalFresh Overissuance Notice For Administrative Errors (AE) Only
- DFA 377.7D1 (6/11) - CalFresh Overissuance Notice For Administrative Errors (AE) Only
- DFA 377.7D2 (10/00) - Food Stamp Repayment Notice for Administrative Errors Only, Final Notice
- DFA 377.7D3 (6/11) - CalFresh Overissuance Notice For Administrative Errors (AE) Only
- DFA 377.7E (7/04) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7E1 (5/02) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7F (4/11) - CalFresh Overissuance Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IPV
- DFA 377.7F1 (10/00) - Food Stamp Repayment Notice for an Intentional Program Violation (IPV) Only, Final Notice
- DFA 377.7G (5/02) - Food Stamp Repayment Agreement For An Intentional Program Violation (IPV) Only
- DFA 377.9 (8/01) - Notice Of Back Food Stamp Benefits
- DFA 377.10 (6/04) - Food Stamp Notice Of Disqualification
- DFA 377.11 (9/04) - Food Stamp Notice Of Discontinuance - Failure To Meet The ABAWDs Work Rule
- DFA 377.11A (9/04) - Food Stamp Notice Of Continuance 1st Failure To Meet ABAWD Work Requirement
- DFA 385 (9/11) - Application For Disaster CalFresh
- DFA 386 (10/11) - CalFresh Notice of Missed Interview
- DFA 387 (10/11) - CalFresh Request For Information
- DFA 390 (9/11) - Notice Of Approval/Denial For Disaster CalFresh
- DFA 478 (8/01) - Disqualification Consent Agreement Food Stamp Program
- DFA 1239 (9/12) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
- DPA 19 (12/10) - Authorized Representative
- DPA 315 (7/99) - Withdrawal/Conditional Withdrawals Of Request For Hearing
- DPA 353 (4/00) - Notice Of Aid To Families With Dependent Children (AFDC) And/Or Food Stamp Administrative Disqualification Hearing
- DPA 435 (2/02) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification hearing)
- EFA 7A ENG/VN (3/11) - Emergency Food Assistance Program (EFAP) Certification Of Eligibility
- EFA 14 (5/12) - Emergency Food Assistance Program (EFAP) 2012 Income Guidelines
- EFA 15 (5/12) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2012 Income Guidelines
- FS 5 (8/94) - Notice To All Food Stamp Recipients
- FS 11 ENG/Vietnamese (9/12) - Notice To All CalFresh Recipient - Important - Please Read
- FS 11B (4/09) - Notice To All Food Stamp Recipients - Important Please Read - Things You Need To Know
- FS 11C ENG/Vietnamese (11/10) - Notice To All Food Stamp Recipients - Important - Please Read
- FS 17 (9/99) - Notice To All Food Stamp Recipients - Important Information For Legal Immigrants
- FS 22 QR (12/06) - Applying For Food Stamp Benefits
- FS 23 QR (3/05) - Food Stamp Benefits How To Report Household Changes
- FS 26 (12/09) - Food Stamp Program Qualifying Drug Felon Addendum
- FS 27 (12/09) - Non-Assistance Food Stamps (NAFS) Household Recertification Form
- FS 28 Coversheet (10/08) - Food Stamp Program Restricted Account Coversheet - Important To Know
- FS 28A (10/08) - Food Stamp Program Restricted Account Agreement Part A
- FS 28B (10/08) - Food Stamp Program Restricted Account Agreement Part B
- FS 29 (10/11) - CalFresh Recertification Appointment Letter
- KG 2 (1/11) - Statement Of Facts Supporting Eligibility For Kinship Guardianship Assistance Payment (Kin-GAP) Program
- LIC 200A (6/08) - Application for a Child Care Center License
- LIC 215 (7/04) - Applicant Information
- LIC 279 (2/09) - Application For A Family Child Care Home License
- LIC 283 (4/10) - Foster Family Home Application
- LIC 503 (3/99) - Health Screening Report - Facility Personnel
- LIC 508 (3/11) - Criminal Record Statement
- LIC 508D (3/11) - Out-Of-State Disclosure And Criminal Record Statement
- LIC 610B (6/02) - Emergency Plan For Foster Family Homes
- LIC 613A (8/08) - Personal Rights - Child Care Centers
- LIC 613B (1/03) - Personal Rights - Children's Residential Facilities
- LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home
- LIC 702 (8/08) - Child's Preadmission Health History - Parent's Report
- LIC 9058 (8/05) - Applicant/Licensee Rights
- LIC 9108 (3/05) - Statement Acknowledging Requirement To Report Suspected Child Abuse
- LIC 9150 (8/08) - Parent Notification - Additional Children in Care
- LIC 9151 (3/05) - Property Owner/Landlord Notification Family Child Care Home
- LIC 9224 (8/08) - Acknowledgement Of Receipt Of Licensing Reports
- LIC 9225 (4/10) - Pre-Placement Questionnaire
- M16_105 (7/02) - EBT Dormant Account
- M16-120A (6/11) - EBT Dormant Account
- M16_120B (6/11) - EBT Account Account: Suspend
- M16_120C (7/02) - EBT Dormant Account - Reactivate
- M16_215 (7/02) - EBT Availability
- M16_325A (7/02) - EBT Exemption Request
- M16_325B (7/02) - EBT Incomplete Document
- M16_325C (7/02) - EBT Exemption Deny
- M16-325E (8/08) - Direct Deposit Cancellation
- M16_505A (7/02) - Designated Alternate Cardholder
- M16_505B (7/02) - Designated Alternate Cardholder - Need Additional Facts
- M16_505D (7/02) - Designated Cardholder - Deny
- M16-701 (8/08) - EBT Adjustment Advice
- M16-705 (8/08) - EBT Adjustment Denial
- M20_353C (6/98) - Fraud, Penalty Applied to AU
- M20_353D (6/98) - Fraud, Penalty Applied to AU
- M20_353F (6/98) - Fraud, Penalty Stops - Change
- M40_105 (10/95) - Failed to Provide SSN/Cooperate - Change
- M40_105A (10/95) - Failed to Provide SSN/Partial Approval
- M40_105B (7/98) - Change: Required Documentation Received, Immunization
- M40_105C (7/98) - Change: Required Documentation NOT Received, Immunization
- M40_105D (7/98) - Change: Required Documentation Received, School Attendance
- M40_105E (7/98) - Change: Documentation Not Received, School Attendance
- M40_105I (3/00) - Deny: SFIS Requirements, Failure to Cooperate
- M40_105J (3/00) - Deny: SFIS Requirements, Refusal to Cooperate
- M40_107 (6/11) - Addendum 1 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption
- M40_107 (6/11) - Addendum 2 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption
- M40_107A (11/02) - Other: CalWORKs 60-Month Time Limit, Time on Aid (no previous NOA issued)
- M40_107B (6/11) - Time On Aid at Redetermination
- M40_107C (6/11) - Time On Aid Between 42th and 46th
- M40-107D (6/12) - Time On Aid To Former CalWORKs Recipients
- M40_107E (4/04) - Change: CalWORKs 60-Month Time Limit, 60th month On Aid
- M40_107F (6/11) - Extended Beyond 48 Months of Aid
- M40_107F1 (6/11) - Other: CalWORKs 60-Month Time Limit, Extended Beyond 60th month On Aid
- M40_107F2 (6/11) - Extender Ended
- M40_107G (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid
- M40_107H (11/02) - Change: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only
- M40_107I (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only
- M40_107J (11/02) - Partial Approval: CalWORKs 60-Month Time Limit, Time-Out Adult
- M40_107J1 (6/11) - Approval After 48 Months on Aid
- M40_107k (6/11) - Increase Grant due to TOA Adjustment
- M40_118A (8/96) - Application Processing Deny
- M40_129D5 (10/95) - Immediate Need: Failed to Prove SSN App - Deny
- M40_157A1 (5/91) - Incomplete Citizen/Alien Documentation: Approval
- M40_171A (11/96) - Failure to Cooperate - Deny
- M40_171B (1/97) - Refusal to Cooperate - Denial
- M40_171C (6/98) - Approve: Application Processing, Basic Approval
- M40_171D (4/99) - Approve: Application Processing, Basic Approval
- M40_171M (7/87) - Denial: Application Processing, Not a California Resident
- M40_181D (5/91) - Denial: Application Processing, Not a California Resident
- M40_181E (7/98) - Denial: Application Processing, Not a California Resident
- M41_401A (12/86) - Denial: Deprivation, No Deprivation
- M41_440F (6/98) - Deny: Deprivation, CalWORKs-U, 100 Hours Work Rule
- M41_450A (1/98) - Deprivation: Uniformed services - Deny
- M42_101B (5/87) - Age and School Requirements (Change)
- M42_101C (5/87) - Age and School Requirements (Discontinue)
- M42-207A (7/98) - Deny: Property, $2,000 Property Limit
- M42_221K (4/99) - Suspend: Property, Transfer w/out Fair Consideration
- M42_221L (4/00) - Suspend: Income, Transfer w/out Fair Consideration
- M43_119E (1/98) - Sponsored Non-Citizen: Some needs Met - Change
- M43_119G (1/98) - Sponsored Non-Citizen: Missing CA 72 - Change
- M43_119I (7/98) - Change: Sponsored Alien, Deemed & Family Property
- M43_119J (7/98) - Change: Sponsored Alien, Deemed Property
- M43_119K (7/98) - Deny: Sponsored Alien, Deemed Property & Family Property
- M43_119L (7/98) - Deny: Sponsored Alien, Deemed Property
- M43_119M (1/98) - Sponsored non-Citizen: Deemed Income-Change
- M44_113A (6/98) - Change: Income, Change in Income
- M44_113G1 (6/98) - Change: Income, Change in Income
- M44 113H (11/12) - Change In Income
- M44_133D (6/98) - Change: Income, Change in Income
- M44_133Q (6/98) - Change: Income, Change in Income
- M44_133S (10/02) - Minor Parent Financial Eligibility (Change)
- M44_133S1 (10/02) - Financial Eligibility (Change)
- M44_133T (10/02) - Minor Parent Financial Eligibility (Denial)
- M44_133V (10/02) - Minor Parent Financial Eligibility (Suspend)
- M44_207J (6/98) - Deny: Income, Financial Eligibility Test
- M44_207K1 (10/02) - Minor Parent Financial Eligibility (Discontinue)
- M44_207K2 (10/02) - Financial Eligibility (Discontinue)
- M44_207L (6/98) - Suspend: Income, Financial Eligibility Test
- M44-211D (7/10) - Temporary Shelter and/or Permanent Housing, Deny
- M44_211L (7/01) - Change: Special Needs - Pregnancy
- M44_305 (9/97) - Minor Parent Change of Payee
- M44_307A (11/02) - Voucher Vendor Payment
- M44 307C (7/98) - Voucher/Vendor Payment, Change
- M44_314 (11/00) - Increase in MAP
- M44_314A (11/00) - Other: Aid Payments
- M44_314B (11/00) - Change: Aid Payments
- M44_314C (9/97) - Change: Aid Payments
- M44_315B (9/98) - Change: Aid Payment Levels, ICT between Reg-2
- M44 315C (4/09) - Notice of Action - Four Percent Grant Reduction
- M44 316 (8/04) - No Change/Mid Quarter Reporting
- M44_340 (4/00) - Approval: Underpayments, Underpayment Adjustment
- M44_340A (7/05) - Approval: Underpayments, Underpayment Adjustment
- M44 340C (8/12) - Underpayment Adjustment
- M44_350A (11/11) - Overpayment Adjustment
- M44_350E (11/11) - Excess Property O/P and Adjustment (W/O Good Faith)
- M44_350F (11/11) - Excess Property O/P (W/O Good Faith)
- M44_350G (11/11) - Excess Property O/P Adjustment (With Good Faith)
- M44_350H (11/11) - Excess Property O/P (With Good Faith)
- M44 350I (11/11) - Notice of Overpayment
- M44 350J (3/12) Overpayment To Be Stopped Effective February 1, 2012
- M44 352A (11/11) - Notice of Overpayment and Demand
- M44 352C (11/11) - Overpayment Recovery
- M44 352D (11/11) - Overpayment Recovery
- M44 352G (11/11) - Demand Overpayment
- M44 352H (11/11) - Overpayment Adjustment
- M44_401A (6/98) - Approve: Hardship Supplement RISP - MFG
- M44_401B (6/98) - Deny: Hardship Supplement RISP - MFG
- M81_215A (6/98) - Deny: Aid Payments, Diversion payment provided
- M81_215B (6/98) - Deny: Aid Payments, Diversion services provided
- M81_215D (6/98) - Change: Aid Payments, Diversion Repayment Stops
- M81_215E (6/11) - Time Limit Diversion
- M81_215F (6/11) - Time Limit Diversion
- M82 506 (6/98) - Change: Assignment of Support Rights, Failure to Cooperate
- M82 506A (6/98) - Partial Approval: Assignment of Support Rights, Failure to Cooperate
- M82 510A (6/98) - Change: Support Process/Assignment, Cooperate
- M82 820A (1/00) - Deny: AU Composition - No Eligible Person
- M82 832A (2/99) - Change: Aid Payments, Fleeing Felons
- M82 832B (2/99) - Partial Approval: Application Processing, Fleeing Felons
- M82 832C (1/99) - Partial Approval: Application Processing, Drug Felons
- M82 832D (1/99) - Change: Aid Payments, Drug Felons
- M82 832E (12/99) - Change: Aid Payments, Eligible Person Leaving AU
- M82 836A (8/91) - Denial: Au Composition, Unborn not Eligible for Aid
- M89_110 (1/98) - Exempt: Change
- M89_110A (1/98) - Non-Exempt Change
- M89_110B (1/98) - Exemption: Deny
- M89_201 (11/96) - Minor Parent exemption: Deny
- MT42_101.2A (8/04) - Fry vs Saenz Lawsuit 18 year old - (Rescind Discontinuance)
- MT42_101.2B (8/04) - Fry vs Saenz Lawsuit 18 year old - Change
- MT42_101.2C (8/04) - Fry vs Saenz Lawsuit 18 year old - Change
- MT42 101.2D (11/04) - Fry v. Saenz Lawsuit, Age Requirement, Change
- MT42 101.2E (11/04) - Fry v. Saenz Lawsuit, Age Requirement, Discontinue
- NA Back 9 - Your Hearing Rights (revised 2011)
- NA 200 (9/11) - Notice Of Action - Multipurpose
- NA 210 (1/02) - Discontinue, Suspend Financial Eligibility
- NA 211 (1/00) - Notice of Action
- NA 213 (1/02) - Deny - Financial Eligibility
- NA 214 (1/02) - Discontinue, Suspend Transfer of Property
- NA 271 (9/11) - Notice of Action - Continuation Page - Family Income Computations - Cash Aid
- NA 274E (6/11) - Notice Of Action - Overpayment Computations (for 1/1/98 to 6/30/11)
- NA 274F (6/11) - Notice Of Action - Overpayment Amount Owed (For Overpayments Occurring on or after 7/1/2011)
- NA 275 (4/99) - Continuation Page - Overpayment Adjustment Computation - Cash Aid
- NA 290 (1/02) - Multipurpose Required Form - Substitute Permitted
- NA 281 (6/11) - Notice Of Action - Underpayment Amount Owed (For Underpayment Occurring On Or After 1/1/98 thru 6/30/11)
- NA 281A (6/11) - Notice Of Action Underpayment Amount Owed (For Underpayments Occurring On Or After 7/1/2011)
- NA 300 (9/11) - Notice of Action - Continuation Page - Recipient - Financial Eligibility Test
- NA 530 (4/11) - Notice Of Action 48-Month Time Limit
- NA 531 (9/11) - Notice of Action 48 Month Time Limit (Continued) Adult Reached CalWORKs 48-Month Time Limit
- NA 532 (4/11) - Notice Of Action 48-Month Time Limit (Continued) Adult Reached CalWORKs 48-Month Time Limit - Discontinue
- NA 690 (3/03) – IHSS Notice of Action
- NA 693 (4/99) - Notice Of Approval Cash Assistance Program For Immigrants (Capi)
- NA 801 (11/99) - Notice of Action
- NA 802 (11/99) - Notice of Action
- NA 803 (11/99) - Notice of Action (Continued)
- NA 816 (5/08) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan
- NA 817 (5/08) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan
- NA 818 (10/06) - Notice Of Action - Taking You Out Of Welfare To Work
- NA 820 (1/01) - Notice Of Action - Transportation Approval
- NA 821 (1/01) - Notice Of Action - Transportation Approval/Denial
- NA 822 (1/01) - Notice Of Action - Transportation Change
- NA 823 (8/00) - Notice Of Action - Ancillary Expenses Approval/Denial
- NA 824 (4/99) - Notice Of Action
- NA 825 (8/00) - Notice Of Action - Payment Adjust Transportation
- NA 827 (7/99) - Notice Of Action - Recoupment Unused Advance Payment
- NA 828 (7/99) - Notice Of Action - Transportation And Ancillary Exp Overpayment
- NA 832 (4/99) - Notice of Action - CCP Approval
- NA 833 (6/99) - Notice of Action - CCP Change
- NA 834 (6/99) - Notice of Action - CCP Denial
- NA 835 (7/99) - Notice of Action - CCP Discontinuance
- NA 840 (5/08) - Notice Of Action - Welfare To Work Plan
- NA 840A (10/03) - Notice Of Action - Determination Of Good Cause/No Good Cause
- NA 841 (10/06) - Notice Of Action - Welfare-To-Work Plan
- NA 843 (6/99) - Notice of Action - Ineligible
- NA 844 (8/99) - Notice of Action - Adequate Progress
- NA 845 (5/08) - Notice Of Action - Sanction And Removal Of The Other Parent's Needs
- NA 960XQR (7/12) - Notice Of Action - Stop Aid; Report Not Received
- NA 960X SAR (10/12) - Notice Of Action - Stop Aid;Report Not Received
- NA 960YQR (7/12) - Notice Of Action - Stop Aid; Report Incomplete
- NA 960Y SAR (10/12) - Notice Of Action - Stop Aid;Report Incomplete
- NA 991 (10/03) - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
- NA 992 (05/03) - Refugee Cash Assistance (RCA) Application Approval
- NA 995 (2/00) - Food Stamp Notice Of Denial/Disqualification For The California Food Assistance Program
- NA 1205 (1/00) - Notice of Action
- NA 1208 (2/00) - Notice Of Action - Basic Approval
- NA 1209 (2/02) - Notice of Action - Change In The Amount Of Kin-Gap Payment
- NA 1211 (2/00)- Notice Of Action - Denial
- NA 1212 (2/00) - Notice Of Action - Discontinue Property
- NA 1213 (2/00) - Notice Of Action - Discontinue Restricted Account
- NA 1214 (2/00) - Notice Of Action - Change Under/Overpayment
- NA 1215 (6/00) - Food Stamps Notice of Change
- NA 1216 (4/00) - Food Stamp Notice Of Change
- NA 1230 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Approval
- NA 1231 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Partial Waiver Approval
- NA 1232 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Denial
- NA 1239 (9/11) - Notice of Action Continued Quarterly Reporting Budget
- NA 1239 AR (10/12) - Notice Of Action - Continuation Page - Annual Reporting Budget
- NA 1239 SAR (10/12) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget
- NA 1240 (5/05) - Food Stamp Overissuance & Dormant EBT Account
- NA 1242 (4/11) - Notice Of Action - Sanctions Budget
- NA 1263 (8/11) - Notice of Action - Overissuance Budget Worksheet
- NA 1267 (4/11) - CalFresh Informing Notice Of Receiving Intercounty Transfer
- NA 1268 (4/11) - CalFresh Informing Notice Of Sending Intercounty Transfer
- NA 1269 (11/11) - Notice of Action - Approve Non-Minor Dependent
- NA 1270 (11/11) - Notice of Action - Discontinue Non-Minor Dependent
- PUB 13 (6/11) - Your Rights Pamphlet (Requires 8 1/2" x 14" paper printed landscape)
- PUB 13 (6/11) - Your Rights Pamphlet (Large print 8 1/2" x 11")
- PUB 56 (12/06) - The In-Home Supportive Services Program
- PUB 104 (12/06) - In-Home Supportive Services Individual Provider Benefits and Services Information
- PUB 109 (3/10) - Welfare Fraud & Abuse Poster (11 x 17 size)
- PUB 129 (1/04) - Child Abuse Reporting And You - What happens When A Report Is Made?
- PUB 244 (12/03) - Establishing Paternity For You and Your Child
- PUB 275 (4/07) - Family Planning...Making the Commitment for a Healthy Future
- PUB 367 (1/04) - Reach For Your Dreams With Cal-Learn
- PUB 370 (10/05) - Public Benefits For Asylees In California
- PUB 373 (Print 8 1/2 X 11) (5/07) - Important Food Stamp Information For Noncitizens
- PUB 373 (Print 11 X 17) (5/07) - Important Food Stamp Information For Noncitizens
- PUB 387 (2/06) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp benefits This is a large PDF file. Please save it to your computer before opening and printing. For help with these files click here: Tips for Using Adobe PDF Files
- PUB 388 (5/09) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits. This is a large PDF file. Please save it to your computer before opening and printing. For help with these files click here: Tips for Using Adobe PDF Files
- PUB 389 (5/09) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase . (This Publication Is Designed To Be Folded For Use As A Wallet Card.)
- PUB 390 (2/06) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Buy Food
- PUB 412 (4/04) - State Hearing Information
- QR 2 (6/04) - Reporting Changes For Your Cash Aid Assistance Unit And Food Stamp Household
- QR 3 (7/06) - Mid-Quarter Status Report For Cash Aid And Food Stamps
- QR 7 (12/08) - Eligibility/Status Report - Quarterly For Cash Aid and Food Stamps
- QR 7 Addendum (12/08) - Instructions And Penalties Eligibility/Status Report For Cash Aid and Food Stamps
- QR 7A (8/09) - How To Fill Out Your QR 7 Quarterly Eligibility/Status Report
- QR 22 (12/06) - Sponsored Noncitizens Applying For Or Receiving Cash Aid And/Or Food Stamps
- QR 25A (5/04) - Payee Agreement For Minor Parent
- QR 72 (12/06) - Sponsor's Quarterly Income And Resources Report
- QR 73 (6/04) - Senior Parent Quarterly Income Report
- QR 377.1 (4/04) - Food Stamp Notice Of Approval For Quarterly Reporting Household
- QR 377.2 (5/08) - Food Stamp Notice Of Expiration Of Certification
- QR 377.4 (1/04) - Food Stamp Notice Of Change For Quarterly Reporting Household
- QR 377.5 (2/04) - Food Stamp Mid-Quarter Status Report
- QR 2103 (11/11) - Reminder For Teens Turning 18 Years Old
- RCA 43 (5/03) - Refugee Cash Assistance (RCA) Notice Of A Participation Problem
- RCA 44 (5/03) - Refugee Cash Assistance (RCA) Notice Of No Good Cause Determination And Compliance Plan Appointment
- RS 3 (5/03) - Service Provider Referral/Notification Form
- RS 36 (10/03) - Employment And Training Requirements For Refugee Cash Assistance(RCA)
- SAR 2 (10/12) - Reporting Changes For Cash Aid And CalFresh
- SAWS 1 (12/06) - Application For Cash Aid, Food Stamps, And/Or Medi-Cal/State CMSP
- SAWS 2 (7/07) - Statement Of Facts For Cash Aid, Food Stamps, and Medi-Cal State Run County Medical Services Program (CMSP) . This is a large PDF file. Click here if you have problems with it: Tips for Using Adobe PDF Files
- SAWS 2A QR (9/11) - Rights, Responsibilities and Other Important Information For the Cash Aid and CalFresh Programs, and/or Medi-Cal/34-County Medical Services Program (CMSP)
- Script on Learning Disabilities Screening (9/02)
- SOC 155 (5/99) - Voluntary Placement Agreement - Placement Request
- SOC 161 (9/11) - Six-Month Certification Of Extended Foster Care Participation
- SOC 162 (10/11) - Mutual Agreement for Extended Foster Care
- SOC 163 (11/11) - Voluntary Re-Entry Agreement For Extended Foster Care
- SOC 295 (2/00) - Application For Social Services
- SOC 310 (1/03) - Statement Of Facts For In-Home Supportive Services
- SOC 404 (10/11) - In-Home Supportive Services Program Direct Deposit Enrollment/Change/Cancellation Form
- SOC 445 (6/99) - Medi-Cal Recovery For The Personal Care Services Program
- SOC 451 (8/02) - Cash Assistance Program For Immigrants Supplemental Application Form
- SOC 453 (11/02) - Cash Assistance Program For Immigrants (CAPI) Statement Of Household Expenses And Contributions
- SOC 804 (11/99) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI)
- SOC 809 (7/03) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Statement
- SOC 814 (11/02) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI)
- SOC 818 (12/10) - Relative Or Non-Relative Extended Family Member Caregiver Assessment
- SOC 829 (9/12) - In Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form
- SOC 860 (12/09) - Sponsor's Statement Of Facts Income And Resources
- SSP 4A (1/99) - Application And Verification For Special Circumstances Program
- SSP 14 (9/10) - Authorization For Reimbursement Of Interim Assistance Initial Claim Or Posteligibility Case
- SSP 18 (10/10) - Notice Of Action And Right To Request A State Hearing On Interim Assistance
- TEMP 2102 (9/99) - The Maximum Family Grant (MFG) Rule For Recipients Of Cash Aid
- TEMP 2131 (5/99) - Addendum To Food Stamp Application
- TEMP 2171 (9/99) - California Self-Initiated Program (SIP) Review Request Form
- TEMP 2172 (9/99) - Notice Of Action
- TEMP 2173 (3/00) - New Cash Aid And Food Stamp Rules - Fingerprint Imaging And Photo Imaging
- TEMP 2174 (6/99) - Notice Of Action
- TEMP 2174 A (6/99) - Notice Of Action
- TEMP 2175 (7/99) - Notice Of Action
- TEMP 2177 (11/99) - CFAP Work Rule
- TEMP 2181 (4/00) - Notice Of Action
- TEMP 2193 (Eng/VN) (5/06) - Notice To All Food Stamp Recipients
- TEMP 2193A (Eng/VN) (5/06) - Notice To All Food Stamp Recipients
- TEMP 2198 (11/01) - Important Food Stamp Information For Noncitizens
- TEMP 2200 (2/02) - CalWORKs Welfare-To-Work Activities Review Request Form
- TEMP 2201 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Request For A Designated Alternate Card Holder/Authorized Representative
- TEMP 2202 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Service Request
- TEMP 2203 (7/02) - Request For Cash Aid Electronic Benefit Transfer - EBT Exemption
- TEMP 2206 (4/02) - Notice Of Action
- TEMP 2207 (5/02) - Notice Of Action
- TEMP 2208 (4/02) - Notice Of Action
- TEMP 2209 (4/02) - Notice Of Action
- TEMP 2211 (4/02) - Notice Of Action
- TEMP 2212 (5/02) - Notice Of Action
- TEMP 2214 (7/08) - Additional Information About Electronic Benefit Transfer (EBT)
- TEMP 2215 (7/02) - Electronic Benefit Transfer (EBT) Important Information
- TEMP 2223 (3/05) - Notice To All Quarterly Reporting (QR) Households Not Receiving Cash Aid
- TEMP 2224 (9/05) - Application for Food Stamp Benefits for Evacuees of Hurricane Katrina
- TEMP 2229 (3/07) ENG/VN - Important Notice - KinGAP Informing Notice
- TEMP 2253 (4/11) - You Are Required To Participate In Welfare-To-Work
- TEMP 2254 (4/11) - The State Law Has Changed The Cal-Learn Program New Rules For Pregnant And Parenting Teens
- TEMP AR 1 (2/13) - New Reporting Requirements For CalWORKs and CalFresh
- TEMP CA 600 (4/99) - Annual Review For Cash Aid And Food Stamps
- TEMP CW 2186A (7/11) - CalWORKs Time Limit and Welare-To-Work Participation Exemption Request Form
- TEMP M40-107A (9/11) - CalWORKs 48-Month Time Limit Time on Aid (Unticking Months Due To Temporary Exemptions)
- TEMP M40-107E (4/11) - Change CalWORKs Time Limit 48th Month On Aid
- TEMP M40-107G (4/11) - Discontinue CalWORKs Time Limit/Income Exceeds
- TEMP M40-107H (4/11) - Change CalWORKs Time Limt 40th Month On Aid-MFG Child
- TEMP M40-107I (4/11) - Discontinue CalWORKs Time Limit 48th Month On aid, No Eligible Child
- TEMP M40-107J (4/11) - Partial Approval CalWORKs Time Limit Timed-Out Adult
- TEMP NA 303B (4/00) - Continuation Page - Underpayment Amount Owed
- TEMP NA 1225 (9/01) - Underpayment Computation
- TEMP NA 1228 (6/01) - Notice Of Action
- TEMP NA 1229 (6/01) - Notice Of Action
- TEMP NA 1230 (1/02) - Retroactive Approval - Child Citizen Act Of 2000
- TEMP NA 1231 (5/02) - Continuation Page - Underpayment computation Pre 1/1/98- Required Form- No Substitute Permitted
- TEMP NA 1232 (8/08) - Food Stamp Notice of Action - EBT Account
- TEMP NA 1234 (1/03) - No Adjustment To WtW Time Limit On Learning Disabilities
- TEMP NA 1235 (9/02) - Adjustment To WtW Time Limit Based On Learning Disabilities
- TEMP NA 1236 (8/03) - Retroactive Eligibility - Deny (MBSAC)
- TEMP NA 1237 (8/03) - Retroactive Eligibility (MBSAC)
- TEMP NA 1238 (7/04) - Required Form - Substitute Permitted
- TEMP NA 1239 (3/04) - Food Stamp Notice of Approval/Termination Transitional Benefits
- TEMP NA 1262 (4/09) - Notice Of Action - CalWORKs Four Percent Grant Cut
- TEMP SAR 1 (10/12) - Important Information - Please Read New Reporting Requirements For Cash Aid and CalFresh
- TEMP QR 1 (8/03) - New Reporting Requirements For CalWORKs And Food Stamp Recipients
- Welfare to Work Handbook
- WTW 1 (12/05) - Welfare to Work Plan Rights and Responsibilities
- WTW 2 (12/12) - Welfare to Work Plan Activity Assignment
- WTW 4 (8/04) - Notice to Other Parent
- WTW 5 (5/99) - Welfare To Work Program Notice
- WTW 8 (6/04) - Student Financial Aid Statement Welfare to Work Supportive Services
- WTW 9 (7/99) - Welfare To Work Appraisal Appointment Letter
- WTW 10 (7/99) - Request For Welfare To Work Third-Party Assessment
- WTW 11 (7/99)- Welfare to Work/Cal-Learn Supportive Service Overpayment/Underpayment Notice
- WTW 12 (7/99) - Welfare to Work/Cal-Learn Supportive Service Repayment Agreement
- WTW 13 (7/99) - Welfare to Work/Cal-Learn Supportive Service Overpayment Final Notice
- WTW 15 (9/11) - Simplified CalFresh Program Unpaid Work Experience (WEX) And Unpaid Community Service Hours Worksheet
- WTW 16 (12/05) - Grant-Based On-The-Job Training Participation: Voluntary Consent Form
- WTW 17 (12/05) - Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
- WTW 26 (8/03) - Good Cause Determination Guidelines
- WTW 27 (10/03) - Request For Good Cause Determination
- WTW 29 (9/03) - Plan To Stop A Welfare To Work Sanction
- WTW 31 (10/06) - Request To Stop A Welfare To Work Sanction
- WTW 32 (10/03) - Welfare To Work Compliance Plan
- WTW 34 (4/04) - Welfare To Work Family Reunification Plan
- WTW 37 (7/09) - Permission To Release Domestic Abuse Information When Moving To Another County