Forms

  • NA 991 - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
  • NA 992 - RCA Application Approval
  • Refugee Cash Assistance (RCA) and Refugee Services (RS) forms:
  • RCA 43 - Refugee Cash Assistance (RCA) Notice Of A Participation Problem
  • RCA 44 - Refugee Cash Assistance (RCA) Notice Of No Good Cause Determination And Compliance Plan Appointment
  • RS 1 - Refugee Settlement Program Services Application And Assessment Information
  • RS 3 - Service Provider Referral/Notification Form
  • RS 3A - Client Tracking
  • RS 18 - Refugee Services - Information Transmittal
  • RS 36 - Employment And Training Requirements For Refugee Cash Assistance (RCA)
  • RS 50: Exhibit C - Services Report: Employment Services (Schedule C) **(Not to be used for county reporting), Instructions (Exhibit C-1) and Narrative form (Schedule A)
    • Due to the RS 50 form not being ADA accessible, please email RPB Reports for a mailed copy.
  • RS 51: Exhibit C-2 - Caseload Movement Report (Schedule B) **(Not to be used for county reporting)
    • Due to the RS 51 form not being ADA accessible, please email RPB Reports for a mailed copy.
  • RS 52 - Claim for Reimbursement


Additional CDSS Forms and Translations

Please contact your county analyst for the latest reporting forms or if you have any questions regarding these forms. For the County Operations & Performance Unit staff responsible for your county, either call (916) 654-4356 or email. Some documents are in Adobe Portable Document Format (PDF). Please see Tips for Using Adobe PDF Files for details.