Research, Automation, and Data Division

Report Form and Instructions

This webpage contains downloadable Excel automated report forms that allow county offices and designated agencies to electronically transmit their statistical data via email.

Contact the report email address to request an older automated form version for revisions.

CalFresh Programs

Automated Form Letters and Notices Contact Information

CF 18: CalFresh Churn Monthly Report

admCF18@dss.ca.gov

CF 296: CalFresh Monthly Caseload Movement Statistical Report

admCF296@dss.ca.gov

DFA 256: Food Stamp Program Participation and Benefit Issuance Report

admDFA256@dss.ca.gov

CF 358F: CalFresh Participants by Race/Ethnicity (Federal Only and Combined Households)

CF 358S: CalFresh Participants by Race/Ethnicity (State Only)

  • CF358FS Automated Form (Updated 08/30/22)
  • Effective July 2021 and July 2022 report month
  • Automated form combines the CF 358F and CF 358S reports

admCF358FS@dss.ca.gov

STAT 47: Non-Assistance CalFresh Work Registrants, Able-Bodied Adults without Dependents (ABAWD), and Employment and Training (E&T) Program Quarterly Statistical Report

admSTAT47@dss.ca.gov

WINS 2: Work Incentive Nutritional Supplement (WINS) Monthly Caseload Report

admWINS2@dss.ca.gov

CalWORKs Programs

Automated Form Letters and Notices Contact Information

Cal-OAR: CalWORKs Outcomes and Accountability Review

admCalOAR19@dss.ca.gov

CA237CW: Cash Grant Caseload Movement Report

CA253CW: Report on Reasons for Discontinuances of Cash Grant

CA255CW: Report on Reasons for Denials and Other Non-Approvals of Applications for Cash Grant

DSSDB@dss.ca.gov

CA237HA: Homeless Assistance Program Monthly Statistical Report

admCA237HA@dss.ca.gov

CCB18: Emergency Child Care Bridge Program for Foster Children (Bridge Program)

admCCB18@dss.ca.gov

CW115: Child Care Monthly Report (CalWORKs Families)

CW115A: Child Care Monthly Report (Two-Parent Families)

admCW115@dss.ca.gov

FSP14: Family Stabilization Program

admFSP14@dss.ca.gov

HSP14: Housing Support Program (HSP)

HVP19: Home Visiting Program (HVP)

admHVP19@dss.ca.gov

STAT45: Teen Parent Cal-Learn Program

admSTAT45@dss.ca.gov

TEMP2220: Children Aged 5-17 in Families Receiving CalWORKs Exceeding Poverty Level during October

admTEMP2220@dss.ca.gov

WTW25: Welfare-to-Work (All Other Families)

WTW25A: Welfare-to-Work (Two-Parent Families)

admWTW25@dss.ca.gov

admWTW25A@dss.ca.gov

Child Welfare Programs

Automated Form Letters and Notices Contact Information

AD202B: Intercountry Adoption Program

admAD202B@dss.ca.gov

AD42I: Independent Adoption Program (Individual Case)

admReportAD42I@dss.ca.gov

AD56D: Independent Adoption Program and Adoption Set-Asides

admAD56D@dss.ca.gov

CA237EA: Title IV-A Emergency Assistance Program (EA)

admCA237EA@dss.ca.gov

CA237FC: Aid to Families with Dependent Children (AFDC) Foster Care (FC)

admCA237FC@dss.ca.gov

FC-AAP-KG-AAC84: Supplement to the Rate Requests for Dual Agency AFDC-FC, AAP, Kin-Gap, and ARC Children

admFCAAP84@dss.ca.gov

LIC181: Licensing of Facilities for Children

admLIC181@dss.ca.gov

RFA181: Resource Family Approval (RFA)

admRFA181@dss.ca.gov

SOC405X: Outcomes for Nonminor Dependents Exiting Foster Care (Child Welfare)

SOC405XP: Outcomes for Nonminor Dependents Exiting Foster Care (Probation)

admSOC405X@dss.ca.gov

admSOC405XP@dss.ca.gov

Disability and Adult Programs

Automated Form Letters and Notices Contact Information

CA1037: Cash Assistance Program for Immigrants

admCA1037@dss.ca.gov

GR237: General Relief and Interim Assistance to Applicants for SSI/SSP Monthly Caseload and Expenditure Report

admGR237@dss.ca.gov

SOC242: Adult Protective Services and County Services Block Grant Monthly Report

admSOC242@dss.ca.gov

SOC808: Quarterly Report of Overpayments and Collections for the Cash Assistance Program for Immigrants (CAPI)

admSOC808@dss.ca.gov

Fraud Programs

Automated Form Letters and Notices Contact Information

CA812: Quarterly Report of Overpayments and Collections (CalWORKs)

admCA812@dss.ca.gov

DPA482: Income and Eligibility Verification System (IEVS) Management Report

admDPA482@dss.ca.gov

DSS466: Fraud Investigations Activity Report

admDSS466@dss.ca.gov

Immigration Programs

Automated Form Letters and Notices Contact Information
FY 22-23 IS-AIR: Affirmative Immigration Remedies Application Assistance Quarterly Report
  • Report Instructions

raddISAIR@dss.ca.gov

FY 22-23 IS-DACA: Deferred Action for Childhood Arrivals Application Assistance Quarterly Report

  • Report Instructions

admISDACA@dss.ca.gov

FY 22-23 IS-EO: Education and Outreach Quarterly Report

  • Report Instructions

admISEO@dss.ca.gov

FY 22-23 IS-EOW: Education and Outreach Workshop/ Online Events Quarterly Report

  • Report Instructions

raddISEOW@dss.ca.gov

FY 22-23 IS-LC: Legal Consultation Quarterly Report
  • Report Instructions

admISLC@dss.ca.gov

FY 22-23 IS-LTTA: Legal Training and Technical Assistance Quarterly Report
  • Report Instructions

admISLTTA@dss.ca.gov

FY 22-23 IS-NAT: Naturalization Application Assistance Quarterly Report
  • Report Instructions

admISNAT@dss.ca.gov

Multiple Programs

Automated Form Letters and Notices Contact Information

ABCD350: Annual Recipient Report on CalWORKs, Foster Care, Social Services, Non-Assistance CalFresh, CalWORKs Welfare-to-Work, Refugee Cash Assistance, and the Cash Assistance Program for Immigrants Ethnic Origin and Primary Language Report

admABCD350@dss.ca.gov