2012 Notice Of Forms Changes

  • 12-102
    PUB 429 (11/12) English and Spanish It's Your Money - Claim It And Save It - Flyer
  • 12-101
    PUB 428 (11/12) English and Spanish It's Your Money Claim It & Save It
  • 12-100
    SOC 833 (3/12) Grievance Procedures For Challenging Reference To The Child Abuse Central Index 
  • 12-099
    SOC 832 (3/12) Notice of Child Abuse Central Index Listing 
  • 12-098
    LIC 9140A  (12/12)  Request To Add Or Remove Instructor
  • 12-097
    LIC 9215 (12/12)  Application For Administrator Re-Certification
  • 12-096
    NA 1271 (12/12) Notice Of Action - Denial Of Home Assessment/Approval
  • 12-095
    CW 8 (7/01) English And Spanish Statement Of Facts For An Additional Person
  • 12-094
    SOC 838 through SOC 840 (10/12) New Forms
  • 12-093
    NA 1250 through SOC 1257 (5/09) New Forms
  • 12-092
    NA 1239 SAR (10/12) Notice Of Action Continuation Page - Semi-Annual Reporting Budget
  • 12-091
    NA 960Y SAR (10/12) Notice Of Action Stop Aid: Report Incomplete
  • 12-090
    NA 960X SAR (10/12) Notice Of Action Stop Aid; Report Not Received
  • 12-089
    SAR 7A (10/12) How To Fill Out Your SAR 7 Semi-Annual Eligibility/Status Report
  • 12-088
    SAR 7 (10/12) Report Month Eligibility/Status Semi-Annual For Cash Aid And CalFresh
  • 12-087
    SAR 2 (10/12) Reporting Changes For Cash Aid And CalFresh
  • 12-086
    TEMP SAR 1 (10/12) New Reporting Requirements For Cash Aid And CalFresh
  • 12-085
    List of Obsolete forms
  • 12-084
    DFA 1239 (9/12) CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
  • 12-083
    PUB 458 (11/11)  Reporting Child Abuse and Neglect - Information About The Law And Training
  • 12-082
    PUB 337 (9/12) Statewide Fingerprint Imaging System Brochure
  • 12-081
    NA 1239 AR (9/12) Notice Of Action - Continuation Page - Annual Reporting Budget
  • 12-080
    TEMP AR 1 (9/12) Important Information - New Reporting Requirements For CalWORKs and CalFresh
  • 12-079
    AR 3 (9/12) Mid-Year Status Report For CalWORKs and CalFresh
  • 12-078
    AR 2 (9/12) Reporting Changes For CalWORKs and CalFresh
  • 12-077
    FS 11 (9/12) English and Spanish - Notice To All CalFresh Recipients - Important - Please Read
  • 12-076
    NA 960Y QR (7/12) English and Spanish - Notice Of Action - Stop Aid; Report Incomplete
  • 12-075
    NA 960X QR (7/12) English and Spanish - Notice Of Action - Stop Aid; Report Not Received
  • 12-074
    SOC 179 (8/12) Transitional Housing Program Plus Foster Care (THP+FC) - Non-Minor Dependent Rate Application
  • 12-073
    PUB 412 (3/11) (Multilingual) State Hearing Information (Print Letter Size)
    PUB 412 (3/11) (Multilingual) State Hearing Information (Print Tabloid Size)
  • 12-072
    GE 1 (7/12) IHSS General Exception Approval -  Applicant Provider
    GE 2 (7/12) IHSS General Exception Denial - Applicant Provider
    GE 3 (7/12) IHSS General Exception Acknowledgement Of Appeal
    GE 4 (7/12) IHSS General Exception Notice Of Late Appeal
    GE 5 (7/12) IHSS General Exception Incomplete Request
    GE 6 (7/12) IHSS General Exception Case Closure - Applicant Provider
  • 12-071
    SOC 877 (11/11) English and Spanish (All Languages) In-Home Supportive Services (IHSS) Program Application For Supplemental Care
  • 12-070
    LIC 9218 (2/05)  Application Checklist - Child Care Center
  • 12-069
    CW 74 (7/12) Permanent Housing Search Document
  • 12-068
    NA 1242 (4/11) Notice Of Action - Sanctions Budget
  • 12-067
    SOC 881 (6/12) In-Home Supportive Services Program Notice To Provider Of Inactivity
  • 12-066
    M40-107d (6/12) English and Spanish Time On Aid To Former CalWORKs Recpients
  • 12-065
    CF 24 (7/12) CalFresh (CF) Program Request For Policy/Regulation Interpretation
  • 12-064
    SOC 858 (12/11) English and Spanish - IHSS Provider Notification
  • 12-063
    DFA 377.7F (4/11) English and Spanish - CalFresh Overissuance Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IPV
  • 12-062
    DFA 377.7D1 (6/11) English and Spanish - CalFresh Overissuance Notice For Administrative Errors (AE) Only
  • 12-061
    DFA 377.7D (6/11) English and Spanish - CalFresh Overissuance Notice For Administrative Errors (AE) Only
  • 12-060
    DFA 377.7B (6/11) English and Spanish - CalFresh Overissuance Notice For Inadvertent Household Errors (IHE) Only
  • 12-059
    CW 51 (10/11) English and Spanish - Child Support - Good Cause Claim For Noncooperation
  • 12-058
    SOC 2244 (6/11) English and Spanish - IHSS Providers Notice Of New Timesheets
  • 12-057
    SOC 2243 (6/11) English and Spanish - IHSS Recipients Notice of New Timesheets
  • 12-056
    LIC 625 (6/12)  Appraisal/Needs And Services Plan
  • 12-055
    SOC 177 (5/12) Facility Evaluation Report - Transitional Housing Program-Plus-Foster Care Facility
  • 12-054
    SOC 171 (5/12) Transitional Housing Program-Plus-Foster Care (THP-Plus-FC) Application - Approval/Denial/Denial Pending Checklist
  • 12-053
    SOC 170 (5/12)  Application To Become A Transitional Housing Program (THP)-Plus-Foster Care Provider
  • 12-052
    SOC 157A (4/12)  Supervised Independent Living Placement (SILP) Approval And Placement Agreement 
  • 12-051
    SOC 341 (12/06) English and Spanish - Report Of Suspected Dependent Adult/Elder Abuse
  • 12-050
    CF 24 (4/12) CalFresh (CF) Program Request For Policy Regulation Interpretation
  • 12-049
    FS 24 (8/08) English and Spanish Food Stamp Program Request For Regulation Interpretation
  • 12-048
    PUB 387 (5/09) EBT Publication - All Languages
    PUB 390 (5/09) EBT Publication - All Languages
  • 12-047
    GEN 1031 (3/12) Annual County Training Plan - Annual County Training Plan Due Date:  August 1, 2012
  • 12-046
    SOC 2245 (4/12) IHSS Fraud Data Reporting Form
  • 12-045
    SOC 862 (4/12) IHSS Recipient Request For Provider Waiver
  • 12-044
    SOC 857A (4/12) IHSS Program Notice To Recipient Of Provider Ineligibility Acknowledgement Of Receipt Of Invalid Request For Provider Waiver
  • 12-043
    SOC 847 (4/12) Important Information For Prospective Providers About The IHSS Program Provider Enrollment Process
  • 12-042
    SOC 426A (4/12) English and Spanish - IHSS Program Recipient Designation Of Provider
  • 12-041
    SOC 426 (4/12) English and Spanish - IHSS Program Provider Enrollment Form
  • 12-040
    AD 862 (3/12) Relinquishment Of An Indian Child - Out Of State (Alleged Natural Father)
  • 12-039
    DPA 19 (12/10)  Authorized Representative
  • 12-038
    PUB 325 (3/12)  Your Right To Make Decisions About Medical Treatment
  • 12-037
    SOC 157B (3/12) SILP Inspection:  Checklist Of Facility Health And Safety Standards
  • 12-036
    SOC 157A (3/12)  Supervised Independent Living Placement (SILP) Approval And Placement Agreement
  • 12-035
    AD 924 (2/12) English and Spanish - Independent Adoption Placement Agreement
  • 12-034
    NA 832 (3/10) English and Spanish - Notice Of Action Child Care Services
  • 12-033
    NA 533 (5/11) English and Spanish - Notice Of Action CalWORKs "Child-Only" Time On Aid Grant Cut
    NA 534 (5/11) English and Spanish - Notice Of Action CalWORKs "Child-Only" Time On Aid Grant Cut (Continued)
  • 12-032
    FC 2 NM (2/12)  Statement Of Facts Supporting Eligibility For AFDC-Extended Foster Care (EFC)
  • 12-031
    LIC 9163B (7/11) Request For Live Scan Service - Long Term Care Ombudsman
  • 12-030
    QR 2103 (11/11) English and Spanish Reminder For Teens Turning 18 Years Old
  • 12-029
    NA 1270 (11/11) English and Spanish Notice Of Action - Discontinue Non-Minor Dependent
  • 12-028
    NA 1269 (11/11) English and Spanish Notice Of Action - Approve Non-Minor Dependent
  • 12-027
    SOC 154A (12/11) Placement Agency -  Foster Family  Agency Agreement - Child Placed by Agency in Foster Family Agency
  • 12-026
    SOC 870 (1/12) IHSS Notice To Provider Of Provider Eligibility Acknowledgement of Receipt Of Waiver
  • 12-025
    KG 3 (12/11)  Kin-GAP Mutual Agreement For Nonminor Former Dependents
  • 12-024
    DFA 377.7A1 (1/12) Request For Restoration Of CalFresh Benefits After Administrative Disqualification
  • 12-023
    DFA 377.7A (1/12) Notice Of Adminstrative Disqualification
  • 12-022
    SOC 856 (1/12) To Request Appeal Of Provider Enrollment Denial
  • 12-021
    AD 880 (12/11) Declaration Of Mother
  • 12-020
    AD 924 (4/08) English and Spanish Independent Adoption Placement Agreement
  • 12-019
    AD 4320 (11/11) Adoption Assistance Program (AAP) Agreement
  • 12-018
    AAP 7 (10/10) Adoption Assistance Program Statement Of Acknowledgement
  • 12-017
    AAP 8 (11/11) Adoption Assistance Program Nonrecurring Adoption Expenses Agreement
  • 12-016
    AAP 6 (11/11) Adoption Assistance Program Negotiated Benefit Amount And Approval
  • 12-015
    AAP 4 (11/11) Eligibility Certification Adoption Assistance Program 
  • 12-014
    SOC 157B (12/11)  SILP Inspection:  Checklist Of Facility Health And Safety Standards 
  • 12-013
    SOC 157A (1/12)  Supervised Independent Living Plan (SILP) Approval And Placement Agreement
  • 12-012
    SOC 156A (1/12)  Agency - Foster Parents Placement Agreement Nonminor Dependent Placed By Agency in Foster Home
  • 12-011
    SOC 156 (12/11)  Agency - Foster Parents Agreement - Child Placed By Agency In Foster Home
  • 12-010
    SOC 154B (1/12)  Agency - Group Home Agreement Nonminor Dependent Placed By Agency in Group Home
  • 12-009
    SOC 153 (1/12) Placement Agency - Foster Family Agency Agreement
  • 12-008
    SOC 152 (1/12)  Placement Agency - THP Plus Foster Care Provider Agreement
  • 12-007
    LIC 422A (10/11) Civil Penalty Ledger
  • 12-006
    FC 8 (10/11)  Federal Eligibility Certification For Adoption Assistance Program
  • 12-005
    LIC 403A (9/11) Balance Sheet Supplemental Schedule
  • 12-004
    LIC 9223 (1/12) Child Care Advocate Program
  • 12-003
    SOC 818 NMD (1/12)  Relative or Non-Relative Extended Family Member Caregiver
  • 12-002
    SOC 817 NMD (1/12)  Checklist of Health and Safety Standards for Approval of Family Caregiver Home
  • 12-001  
    SOC 815 (1/12) Approval Of Family Caregiver Home