2019 Notice Of Form Change
19-047
NA 791 (9/18) - Notice Of Action
19-046
LIC 9229 (5/19) - Licensing Program Manger (LPM) Checklist For Complaint Review
LIC 9230 (5/19) - Licensing Program Analyst (LPA) Checklist For Complaint Review
19-045
SOC 863 (5/19) - In-Home Supportive Services (IHSS) Applicant Provider Request For General Exception
19-044
SOC 452 (6/19) - Cash Assistance Program For Immigrants (CAPI) Income Eligibility - Adult
19-043
CF SSA 1 (6/19) - Information For Households Applying For CalFresh With The Social Security Administration
CF SSA 1LP (6/19) - Information For Households Applying For CalFresh With The Social Security Administration (20pt Font)
SAR 2 (6/19) - Reporting Changes For Cash Aid And CalFresh
SAR 2LP (6/19) - Reporting Changes For Cash Aid and CalFresh (20pt Font)
19-041
CF 377.1 (6/19) - Notice Of Approval For CalFresh Benefits
CF 377.1LP (6/19) - Notice Of Approval For CalFresh Benefits (20pt Font)
CF 377.1A (6/19) - Notice Of Denial Or Pending Status
CF 377.1ALP (6/19) - Notice Of Denial Or Pending Status (20pt Font)
19-040
SOC 813 (6/19) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination
19-039
CW 2224 (6/19) - CalWORKs Home Visiting Initiative (HVI)
CW 2200 (6/19) - Request For Verification
CW 2200LP (6/19) - Request For Verification (20pt Font)
LIC 610E (3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly
19-038
LIC 622 (5/19) - Centrally Stored Medication And Destruction Record
EFA 14 (4/19) - Emergency Food Assistance Program (EFAP) 2018 Income Guidelines
EFA 15 (4/19) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2018
19-037
CF 31 (6/19) - CalFresh Supplemental Form For Excess Medical Deductions
19-036
CW 2224 (6/19) - CalWORKs Home Visiting Imitative Opt-In Form
19-035
LIC 421 BG (5/19) - Civil Penalty Assessment - BackGround Check
19-034
SAWS 30 (3/19) - Notification Of New Employment
19-033
GEN 727B (5/19) - County Forms Order
19-032
SOC 2243 (4/15) - IHSS Recipients Notice Of New Timesheets - Obsolete
SOC 2243L (10/18) - IHSS Recipients Notice Of New Timesheets - Obsolete
SOC 2244 (1/13) - IHSS Providers Notice Of New Timesheets - Obsolete
19-031
SOC 2298 (1/19) - In-Home Supportive Services (IHSS) Program And Waiver Personal Care Services (WPCS) Program Live-In Self-Certification Form For Federal And State Tax Wage Exclusion
SOC 2299 (1/19) - In-Home Supportive Services (IHSS) Program And Waiver Personal Care Services (WPCS) Program Live-In Self-Certification Cancellation Form For Federal And State Tax Wage Exclusion
SOC 2302 (5/19) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form
19-030
RFA 10 (4/19) - Resource Family Approval Portability Application
19-029
NA 1282 (2/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay
19-028
SOC 804 (5/19) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI)
SOC 813 (5/19) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination
SOC 814 (5/19) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI)
19-027
SOC 2292 (1/19) - In-Home Supportive Services Program Notice To Provider Of Failure To Timely Or Completely Submit The Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Form (SOC 2272)
SOC 2293 (1/19) - In-Home Supportive Services Program Notice To Recipient Of Provider's Failure To Timely Or Completely Submit The Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Form (SOC 2272)
SOC 2255 (3/19) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
19-026
SOC 2243L (10/18) - IHSS Recipients Notice Of New Timesheets - Please Keep For Future Use
19-025
SOC 874L (1/19) - In-Home Supportive Services (IHSS) Program Notice To Applicant Of Health Care Certification Requirement
SOC 875L (10/18) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Health Care Certification Requirement
SOC 876L (10/18) - In-Home Supportive Services (IHSS) Program Notice Of Provisional Approval Health Care Certification Exception Granted
19-024
SOC 862L (10/18) - In-Home Supportive Services (IHSS) Recipient Request For Provider Waiver
SOC 865L (10/18) - IHSS Request For Applicant Provider Reference
SOC 873L (1/19) - In-Home Supportive Services (IHSS) Program Health Care Certification Form
19-023
SOC 857L (10/18) - IHSS Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver
SOC 859AL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes Ineligibility - Subsequent Conviction
SOC 859BL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction
19-022
SOC 855AL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes (Elder Or Dependent Adult Abuse/Child Abuse & Fraud Against A Government Health Care Or Supportive Services Program)
SOC 855BL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies)
SOC 856L (1/19) - To Request Appeal Of Provider Enrollment Denial
19-021
SOC 332L (1/19) - In-Home Supportive Services (Recipient/Employer Responsibility Checklist)
SOC 854L (10/18) - In-Home Supportive Services Program Notice To Recipient Of Provider Eligibility
SOC 855L (10/18) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process
19-020
LIC 215TM (11/18) - Temporary Manager Candidate List Application Information
LIC 216TM (11/18) - Temporary Manager Appointment Applicant Information
19-019
LIC 610E ( 3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly
WTW 51 (2/19) - Welfare To Work Noncompliance Checklist Tool
19-018
LIC 610E-S ( 3/18) Supplemental Emergency Disaster Plan For Residential Care Facilities For The Elderly - Obsolete
19-017
AAP 8 (9/18) - Adoption Assistance Program Nonrecurring Adoption Expenses Agreement
19-016
HCS 402 (2/19) - Home Care Organization Dishonesty Bond
HCS 9183 (1/19) - Home Care Organization Association Request
HCS 9184 (1/19) - Home Care Organization Disassociation Request
19-015
HCS 100 (1/19) - Application For Home Care Aide Registration
HCS 101 (1/19) - Home Care Aide Registration Renewal
HCS 105 (3/19) - Home Care Aide Registry Request For Name/Address Change
19-014
LIC 9102 (8/06) - Advisory Notes - Obsolete
19-013
LIC 9102TA (2/19) - Advisory Notes - Technical Assistance
LIC 9102TV (2/19) - Advisory Notes - Technical Violation
19-012
EBT 2259 (12/18) - Report Of Electronic Theft Of Cash Aid
EBT 2259A (12/18) - EBT Scamming Acknowledgement
19-011
AAP 4 (2/19) - Eligibility Certification Adoption Assistance Program
19-010
FC 8 (2/19) - Federal Eligibility Certification For Adoption Assistance Program
19-009
SOC 2324 (1/19) - In-Home Supportive Services (IHSS) Program County Or Public Authority (PA) Request To Remove Criminal Offender Record Information (CORI) From The Case Management, Information And Payrolling System (CMIPS)
19-008
SOC 2273 (11/18) - In-Home Supportive Services Program Request For State Administrative Review Of Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits
SOC 2282 (9/18) - In-Home Supportive Services Program Notice To Provider Upholding Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits
SOC 2283 (9/18) - In-Home Supportive Services Program Notice To Recipient Upholding Provider’s Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits
19-007
SOC 2323 (12/18) - In-Home Supportive Services Program – Provider Requirements For Minor Recipients Living With Their Parents
19-006
CW 2223 (9/18) - Demographic Questionnaire For CalWORKs, Refugee Cash Assistance (RCA), Entrance Cash Assistance (ECA), Trafficking And Crime Victims Assistance Program (TCVAP) And CalFresh Programs
19-005
LIC 613C (1/19) - Personal Rights Of Residents In Publicly Operated Residential Care Facilities For The Elderly
LIC 613C-2 (1/19) - Personal Rights Of Residents In Privately Operated Residential Care Facilities For The Elderly
19-004
M44-350K (12/18) - EBT Replacement Denial
M44-350L (12/18) - Notice Of Overpayment
19-003
WI 10072A (12/18) - EBT Replacement Approval
WI 10072B (12/18) - EBT Replacement Review
19-002
Temp WI 10072 (8/13)- Has been obsoleted. Use form WI 10072A (12/18).
Temp WI 10072A (8/13) - Has been obsoleted. Use form WI 10072B (12/18).