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Forms translated into HMONG
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For Hmong forms beginning with the following letters click below:
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
- 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
- CW 8 (7/01) - Statement of Facts For An Additional Person
- CW 8A (3/00) - Statement Of Facts To Add A Child Under 16
- CW 2200 (3/09) - Request For Verification Form
- DFA 285-A1 (4/09) - Application For Food Stamp Benefits
- DFA 285-A2 (8/06) - Statement Of Facts
- DFA 285-A3 QR (5/06) - Food Stamp 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 377.4 QR (1/04) - Food Stamp Notice Of Change For Change Reporting Household
- DFA 377.4A (7/03) - Food Stamp Notice of Change
- 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 (AE) 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 Discontinuance
- 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 353 (4/00) - Notice Of Aid To Families With Dependent Children (AFDC) And/Or Food Stamp Administrative Disqualification Hearing
- DPA 421 (7/99) - Notification Of Open Record And Waiver Of time
- DPA 435 (2/02) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification Hearing)
- EFA 7A ENG/HMONG (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 11 ENG/Hmong (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/Hmong (11/10) - Notice To All Food Stamp Recipients - Important - Please Read
- FS 17 ENG/HM (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
- GEN 1179 (9/12) - Complaint of Discrimination
- LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home
- LIC 627 (9/08) - Consent For Emergency Medical Treatment - Child Care Centers Or Family Child Care Homes
- LIC 627A (9/08) - Consent To A Medical Examination
- LIC 627B (9/08) - Consent For Emergency Medical Treatment - Children's Residential Facilities
- LIC 700 (8/08) - Identification And Emergency Information Child Care Centers/Family Child Care Homes
- LIC 701 (8/08) - Physician's Report - Child Care Centers
- LIC 995 (9/08) - Child Care Center - Notification Of Parents' Rights
- LIC 995A (8/08) - Family Child Care Home - Notification Of Parents' Rights
- LIC 995B (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Removal/Exclusion)
- LIC 995C (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Reinstatement)
- LIC 995D (5/03) - Family Child Care Home Explanation Of Removal/Exclusions And Reinstatement
- LIC 995E (10/09) - Caregiver Background Check Process
- LIC 995F (10/09) - Caregiver Background Check Information
- LIC 9040 (10/05) - Child Care Facility Roster
- 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 9212 (10/05) - Consumer Awareness Information - Family Child Care
- NA Back 9 - Your Hearing Rights (revised 2011)
- NA 960X QR (7/12) - Notice Of Action - Stop Aid; Report Not Received
- NA 960X SAR (10/12) - Notice Of Action - Stop Aid;Report Not Received
- NA 960Y QR (7/12) - Notice Of Action - Stop Aid; Report Incomplete
- NA 960Y SAR (10/12) - Notice Of Action - Stop Aid;Report Incomplete
- NA 1215 (6/00) - Food Stamps Notice of Change
- NA 1216 (4/00) - Food Stamp Notice of Change
- NA 1239 AR (10/12) - Notice Of Action - Continuation Page - Annual Reporting Budget
- NA 1240 (8/08) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account
- 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
- 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 109 (3/10) - Welfare Fraud & Abuse Poster (11 x 17 size)
- PUB 275 (4/07) - Family Planning...Making the Commitment for a Healthy Future
- 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 367 (1/04) - Reach For Your Dreams With Cal-Learn
- PUB 387 (2/06) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp benefits
- PUB 388 (5/09) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits
- 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
- PUB 456 (3/11) - Important Information For Relatives Pamphlet (Requires 8 1/2" x 14" paper printed landscape)
- 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 Quarterly 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 72 (12/06) - Sponsor's Quarterly Income And Resources Report
- QR 377.1 (4/04)- Food Stamp Notice Of Approval
- 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
- 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/34-County Medical Services Program (CMSP)
- SAWS 2A QR (9/11) - Rights, Responsibilities And Other Important Information For The Cash Aid and CalFresh Programs, and/or Medi-Cal/State-Run County Medical Services Program (CMSP)
- 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 2214 (7/08) - Additional Information about EBT
- TEMP 2215 (7/02) - Electronic Benefit Transfer (EBT) Important Information
- TEMP NA 1232 (8/08) - Food Stamp Notice of Action - EBT Account
- TEMP NA 1238 (7/04) - Required Form - Substitute Permitted
- TEMP NA 1239 (3/04) - Food Stamp Notice of Approval/Termination Transitional Benefits
- TEMP QR 1 (8/03) - New Reporting Requirements For CalWORKs And Food Stamp Recipients