Forms

  • NA 991 - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
  • NA 992 - RCA Application Approval
  • 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 - Services Report:  Employment Services (Schedule C) **(Not to be used for county reporting)
  • RS 51 - Caseload Movement Report (Schedule B) **(Not to be used for county reporting)
  • RS 52 - Claim for Reimbursement (see ACIN I-42-09 for reporting details)
  • 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.

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