2018 Notice Of Form Change

       
  • 18-094
    M40-107C (6/18) - Time On Aid Between 42th and 46th
    M40-107D (6/18) - Time On Aid To Former CalWORKs Recipients
    M82-832G (6/18) - Eligible/Mandatory/Optional Person Leaving AU
    M82-832H (6/18) - Child Does Not Meet Requirements (SB 380)
  • 18-093
    DFA 377.7F (6/18) - CalFresh Overissuance Notice - Intentional Program Violation (IPV)
    DFA 377.7F LP (6/18) - CalFresh Overissuance Notice - Intentional Program Violation (IPV) - Large Print
  • 18-092
    CF 377.11 (6/18) - CalFresh Time Limit Notice - Failure To Meet The Able-Bodied Adults Without Dependents (ABAWDs) Work Requirement
    CF 377.11A (6/18) - CalFresh Time Limit Notice - Expiration Of Three Consecutive Months For Able-Bodied Adults Without Dependents (ABAWDs)
    CF 377.11B (6/18) - CalFresh Countable Month Letter - Use Of Countable Month For Able-Bodied Adults Without Dependents (ABAWDs
    CF 377.11C (6/18) - CalFresh Informational Notice - CalFresh Time Limit For Able-Bodied Adults without Dependents (ABAWDs)
  • 18-091
    TILP 2 (7/18) - Transitional Independent Living Plan (TILP) Assessment and Referral Form (Optional)
  • 18-090
    SOC 2257 (12/17) - In-Home Supportive Services Program Notice To Provider Of Violation For Exceeding Workweek And/Or Travel Time Limits
    SOC 2257A (12/17) - In-Home Supportive Services Program Notice To Recipient Of Provider’s Violation For Exceeding Workweek And/Or Travel Time Limits
    TILP 1 (7/18) - Transitional Independent Living Plan & Agreement
  • 18-089
    LIC 606 (8/18) - Residential Care Facility For The Elderly Disclosure Worksheet
    DPA 489 (8/18) - Intentional Program Violation (IPV) Online System Request For Adding/Deleting /Modifying A User
  • 18-088
    LIC 200TM (6/18) - Temporary Manager Application For Provisional License
    LIC 215TM (6/18) - Temporary Manager Candidate List Application Information
    LIC 216TM (6/18) - Temporary Manager Appointment Applicant Information
  • 18-087
    RFA 05C (8/18) Resource Family Approval - Written Report (Conversion)
  • 18-086
    CF 377.7B (4/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only
    CF 377.7B LP (2/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only - Large Print
    CF 377.7B1 (10/17) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice
    CF 377.7B1 LP (2/18) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice - Large Print
  • 18-085
    CF 377.7F (10/17) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV)
    CF 377.7F LP (2/18) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV) - Large Print
    CF 377.7F1 (10/17) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV)
    CF 377.7F1 LP (2/18) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV) - Large Print
  • 18-084
    CF 377.7D2 (10/17) - CalFresh Repayment Final Notice - County Administrative Error (AE)
    CF 377.7D2 LP (2/18) - CalFresh Repayment Final Notice - County Administrative Error (AE) - Large Print
    CF 377.7D3 (10/17) - CalFresh Overissuance Notice For Administrative Errors (AE)
    CF 377.7D3 LP (6/18) - CalFresh Overissuance Notice For Administrative Errors (AE) - Large Print  
  • 18-083
    CF 377.2C (3/18) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members
    CF 377.2D (3/18) - CalFresh Notice Of Status Change For Households With Only Elderly And/Or Disabled Members
    CF 377.7G (3/18) - CalFresh Intentional Program Violation (IPV) Notice - Due To Trafficking
  • 18-082
    SOC 860 (7/18) - Cash Assistance Program for Immigrants (CAPI) Sponsor's Statement Of Facts Income And Resources
    SOC 295 (6/18) - Application For In-Home Supportive Services  (14pt Font)
    SOC 295L (6/18) – Application For In-Home Supportive Services  (18pt Font)
  • 18-081
    SOC 2303 (6/18) - In-Home Supportive Services Program Notice To Provider Of Incomplete Paid Sick Leave Request Form (SOC 2302)
    SOC 839A (5/18) - In-Home Supportive Services (IHSS) Cancellation Of Authorized Representative
  • 18-080
    RFA 08 (9/16) Resource Family Approval (RFA) Tuberculosis (TB) Screening Questionnaire
  • 18-079
    HCS 001 (6/18) - Home Care Organization Suboffice Request
    HCS 500 (6/18) - Registered Home Care Aide Training Log
    HCS 9165 (6/18) - Board Of Director Statement
  • 18-078
    GEN 1365 (6/17) - Notice of Language Service
  • 18-077
    SOC 839 (6/18) - In-Home Supportive Services (IHSS) Designation Of Authorized Representative
  • 18-076
    SOC 831 (6/18) - IHSS Provider Letter
  • 18-075
    SOC 2313 (4/18) - In-Home Supportive Services (IHSS) Program Exemption From Workweek Limits For Extraordinary Circumstances (Exemption 2) State Administrative Review Request Form
  • 18-074
    SOC 2302 (4/18) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form
  • 18-073
    FC 30 (6/18) - Group Home Extension Request For The Rate Classification Level (RCL) Rate
  • 18-071
    DPA 435 (1/18) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification Hearing)
    DPA 479 (12/17) - Administrative Disqualification Hearing Waiver - CalWORKs/CalFresh
  • 18-070
    CF 30 (2/18) - SAR 7 Reminder Notice
    CF 30 LP (2/18) - SAR 7 Reminder Notice - Large Print
    EFA 7 (2/18) - The Emergency Food Assistance Program (TEFAP) Certification Of Eligibility
  • 18-069
    LIC 184E (3/18) - Notice Of Incomplete Application (NOIA) Changes To Corporate Status
    LIC 610E-S (3/18) - Supplemental Emergency Disaster Plan For Residential Care Facilities For The Elderly
    LIC 9226 (5/18) - Request For Training Approval: Mandated Child Abuse Reporter Training    
    PUB 269 (2/18) - California Child Passenger Safety Law
  • 18-068
    SOC 453 (1/18) - Cash Assistance Program For Immigrants (CAPI) Statement Of Household Expenses And Contributions
    SOC 804 (1/18) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI)
    SOC 814 (1/18) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI)
  • 18-067
    CW 2222 (11/17) - CalWORKs Employment Bureau Request For Policy Interpretation
  • 18-066
    WTW EOA 1 (11/17) - CalWORKs Educational Opportunity and Attainment (EOA) Program Application Form
    WTW EOA 2 (12/17) - CalWORKs Educational Opportunity and Attainment (EOA) Program Approve Form
    WTW EOA 3 (12/17) - Notice of Action CalWORKs Educational Opportunity and Attainment (EOA) Program Deny Form
  • 18-065
    PUB 428 (2/18) - It's Your Money - Get It - The State and Federal Earned Income Tax Credit (EITCs)
    PUB 429 (2/18) - California EITC is Here! Claim Your 2017 State And Federal Credits - You Earned It - It's Your Money
  • 18-064
    HCS 600 (3/18) - Home Care Organization Personnel Report
  • 18-063
    HCS 100 (1/18) - Application For Home Care Aide Registration
  • 18-062
    NA 691 (3/18) - Notice of Denial - Cash Assistance Program For Immigrants (CAPI)
  • 18-061
    SOC 2312A (2/18) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Change In Extraordinary Circumstances Exemption Eligibility
  • 18-060
    SOC 2312 (2/18) - In-Home Supportive Services (IHSS) Program Notice To Provider Of Change In Extraordinary Circumstances Exemption Eligibility
  • 18-059
    SOC 2311 (2/18) - In-Home Supportive Services Program Notice Of Non-Receipt Of Exemption From Workweek Limits Provider Agreement (SOC 2308)
  • 18-058
    SOC 2310A (2/18) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Ineligibility For Exemption From The In-Home Supportive Services Program Workweek Limits For Extraordinary Circumstances
  • 18-057
    SOC 2310 (2/18) - In-Home Supportive Services (IHSS) Program Notice To Provider Of Ineligibility For Exemption From The In-Home Supportive Services Program Workweek Limits For Extraordinary Circumstances
  • 18-056
    SOC 2309A (2/18) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Approval Of Exemption From The In-Home Supportive Services Program Workweek Limits For Extraordinary Circumstances
  • 18-055
    SOC 2309 (2/18) - In-Home Supportive Services (IHSS) Program Notice To Provider Of Approval Of Exemption From The In-Home Supportive Services Program Workweek Limits For Extraordinary Circumstances
  • 18-054
    SOC 2308 (2/18) - In-Home Supportive Services (IHSS) Program Exemption From Workweek Limits For Extraordinary Circumstances Approved Exemption Provider Agreement
  • 18-053
    SOC 2307 (1/18) - In-Home Supportive Services (IHSS) Program Extraordinary Circumstances Secondary Evaluation Worksheet
  • 18-052
    SOC 2306 (1/18) - In-Home Supportive Services (IHSS) Program Exemption From Workweek Limits For Extraordinary Circumstances Referral Justification
  • 18-051
    SOC 860 (4/18) - Sponsor's Statement Of Facts Income And Resources
  • 18-050
    SOC 500A (5/18) - Level Of Care (LOC) Manual Scoring Form
  • 18-049
    SOC 500 (4/18) - Level Of Care (LOC) Digital Scoring Form
  • 18-048
    RFA 09B (4/18) - Notice Of Action To Individual Regarding Resource Family Approval Criminal Record Exemption Decision
  • 18-047
    RFA 05 (5/18) - Resource Family Approval - Written Report
  • 18-046
    AAP 4 (4/18) - Eligibility Certification Adoption Assistance Program
    18-045
    FC 8 (12/17) - Federal Eligibility Certification - Adoption Assistance Program
  • 18-044
    AD 927 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Places The Indian Child With The Prospective Adoptive Parent(s)     
  • 18-043
    AD 926 (1/18) - Statement Of Understanding Independent Adoptions Program – Parent Who Places The Child With The Prospective Adoptive Parent(s)
  • 18-042
    AD 900B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father Of An INDIAN Child
  • 18-041
    AD 900A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The INDIAN Child To The Petitioner(s)
  • 18-040
    AD 900 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The INDIAN Child To The Petitioner(s)
  • 18-039
    AD 887B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father
  • 18-038
    AD 887A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The Child To The Petitioner(s)
  • 18-037
    AD 887 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The Child To The Petitioner(s)
  • 18-036
    AAP 3 (12/17) - Reassessment Information - Adoption Assistance Program
  • 18-035
    AAP 6 (1/18) - Adoption Assistance Program Negotiated Benefit Amount and Approval
  • 18-034
    SOC 2305 (1/18) - In-Home Supportive Services (IHSS) Program Request For Exemption From Workweek Limits For Extraordinary Circumstances (Exemption 2)
  • 18-033
    TEMP 2315 (1/18) - Notice to Recipient
  • 18-032
    TEMP 2314 (1/18) - Provider Notice
  • 18-031
    RFA 07 (2/18) - Resource Family Approval (RFA) Health Questionnaire
  • 18-030
    PUB 400 (8/17) - Safely Surrendered Baby Campaign Brochure
  • 18-029
    PUB 400 (8/17) - Safely Surrendered Baby Campaign Brochure (Black & White)
  • 18-028
    PUB 400C-1 (6/17) - Safely Surrendered Baby Law - Know Your Rights Poster
  • 18-027
    SOC 157B (7/17) - SILP Inspection: Checklist Of Facility Health And Safety Standards
  • 18-026
    SOC 157C (7/17) - Standardized SILP Readiness Assessment Tool
  • 18-025
    SOC 163 (7/17) - Voluntary Re-Entry Agreement For Extended Foster Care
  • 18-024
    SOC 162 (7/17) - Mutual Agreement for Extended Foster Care
  • 18-023
    RFA 09I (9/17) - Order To Individual Of Immediate Exclusion From Resource Family Homes And Department Licensed Facilities
  • 18-022
    RFA 09E (9/17) - Order To Individual of Exclusion From Resource Family Homes And Department Licensed Facilities
  • 18-021
    RFA 09B (1/18) - Notice Of Action To Individual Regarding Resource Family Approval Criminal Record Exemption Decision
  • 18-020
    RFA 09 (1/18) - Notice Of Action Regarding Resource Family Approval
  • 18-019
    AAP 8 (12/17) Adoption Assistance Program Nonrecurring Adoption Expenses Agreement
  • 18-018
    AAP 7 (12/17) Adoption Assistance Program Statement Of Acknowledgment
  • 18-017
    AAP 5 (12/17) Adoption Assistance Program Independent Adoptions Program
  • 18-016
    AAP 2 (12/17) Payment Instructions Adoption Assistance Program
  • 18-015
    OCAP A (8/17) - Exhibit A Scope of Work
  • 18-014
    RFA 05A (8/17) - Resource Family Approval Certificate
  • 18-013
    SOC 500A (12/17) - Level Of Care (LOC) Manual Scoring Form
  • 18-012
    SOC 500 (12/17) - Level Of Care (LOC) Digital Scoring Form
  • 18-011
    SOC 157A (8/17) - Supervised Independent Living Placement Approval And Placement Agreement
  • 18-010
    TILP 1 (8/17) - Transitional Independent Living Plan & Agreement
  • 18-009
    FCR 16 (10/17) - Group Home/Short Term Residential Therapeutic Program (STRTP) Shelter Costs Declaration And Survey
  • 18-008
    FC 30 (11/17) - Group Home Extension Request
  • 18-007
    RFA 811 (8/17) - Confidential Names
  • 18-006
    RFA 809 (9/17) - Resource Family Visit Record
  • 18-005
    RFA 809C (9/17) - Resource Family Visit – Corrective Action Plan
  • 18-004
     LIC 00 (8/17) - Conversion to Resource Family: Release of Information
  • 18-003
    RFA 9099C (9/17) - Complaint Investigation Report - Continued
  • 18-002 
    SOC 501 (12/17) - Levels Of Care (LOC) Rate Determination Matrix
  • 18-001
    SOC 2267 (1/16) - In-Home Supportive Services Program Notice To Recipient Denial Of Exception To Exceed Weekly Hours