2013 Notice Of Forms Changes

  • 13-153
    CF 10 (12/13) Dependent Care Cost Affidavit
  • 13-152
    LIC 184D (12/13) Notification Of Incomplete Application (NOIA) Child Care Centers - 30-Day NOIA
  • 13-151
    LIC 184C (12/13) Notification Of Incomplete Application (NOIA) Child Care Centers - Pre-30-Day NOIA
  • 13-150
    LIC 184B (12/13) Notification Of Incomplete Application - Family Child Care Home
  • 13-149
    KG 2A (3/01)  Rights, Responsibilities and Other Important Information for Kin-GAP Program -- Obsolete
  • 13-148
    WTW 39 (12/13) Assembly Bill (AB) 74 County Welfare Department (CWD) Expanded Subsidized Employment (ESE) Plan
  • 13-147
    AR 2 (11/13), AR 2 SAR (11/13), SAR 2 (11/13)
  • 13-146
    EBT 2259 (11/13) Report Of Electronic Theft Of Cash Aid And Instructions
  • 13-145
    PUB 429 (11/13) English and Spanish - 2013 Earned Income Tax Credit It's Your Money You Earned It - Now Claim It And Save It
  • 13-144
    PUB 428 (11/13) English and Spanish - It's Your Money Claim It & Save It File For Your 2013 Earned Income Tax Credit
  • 13-142
    AD 551A (11/13) Notification Of Procedure In Lieu Of Signing Relinquishment, Waiver or Denial
  • 13-141
    TEMP 42-769 (8/11) School Bonus
  • 13-140
    FS 12 (5/05) ENG/SP Notice To All Food Stamp Households With Elderly And/Or Disabled Members
  • 13-139
    SAWS 1 (8/13) English and Spanish - Initial Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
  • 13-138
    FS 22  QR (10/13) Applying For Food Stamp Benefits
  • 13-137
    SAWS 2A QR (9/11) English and Spanish - Rights, Responsibilities And Other Important Information
  • 13-136
    NA 960Y SAR (9/13) Notice Of Action - Stop Aid; Report Incomplete
  • 13-135
    NA 960X SAR (9/13) Notice Of Action - Stop Aid; Report Not Received
  • 13-134
    CF 377.2A (10/13) CalFresh Notice Of Expiration Of Certification For Households In Which All Adults Are Elderly or Disabled
  • 13-133
    CF 377.2 (10/13) CalFresh Notice Of Expiration Of Certification
  • 13-132
    AD 590B (9/13) Waiver Of Right To Further Notice Of Adoption Planning (Biological/Presumed Father In Or Out Of California) Indian Child
  • 13-131
    SAWS 2 PLUS (9/13) English and Spanish - Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
  • 13-130E
    M44-350K (8/13) EBT Replacement Denial
    M44-350L (8/13) Notice Of Overpayment
    TEMP WI 10072 (8/13) EBT Replacement Approval
    TEMP WI 10072A (8/13) EBT Replacement Review
  • 13-130
    M44-350L (8/13) Notice Of Overpayment
    M44-350M (8/13) EBT Replacement Denial
    TEMP WI 10072 (8/13) EBT Replacement Approval
    TEMP WI 10072A (8/13) EBT Replacement Review
  • 13-129
    CF 11A (9/13) English and Spanish  Notice To All CalFresh Recipients
  • 13-128
    CF 11 (9/13) English and Spanish  Notice To All CalFresh Recipients
  • 13-127
    DFA 285-A1 (2/13) English and Spanish - CalFresh Benefits
  • 13-126
    CW 2212 (9/13) The Rules For Your CalWORKs Case Have Changed Annual Reporting To Semi-Annual Reporting
  • 13-125
    CW 2211 (9/13) Your CalWORKs Reporting Rules Have Changed Semi-Annual Reporting To Annual  Reporting
  • 13-124
    TEMP SAR 1 (9/13) Important Please Read New Reporting Requirements For Cash Aid And CalFresh
  • 13-123
    SAR 7A (9/13) How To Fill Out Your SAR 7 Eligibility Status Report For Cash Aid And CalFresh (formerly known as Food Stamp) Benefits
  • 13-122
    SAR 7 (8/13) SAR 7 Eligibility Status Report
  • 13-121
    SAR 2 (9/13) Reporting Changes For Cash Aid And CalFresh
  • 13-120
    AR 2 SAR (9/13) Reporting Changes For CalWORKs And CalFresh
  • 13-119
    AD 929A (7/13) - Waiver Of Right To Revoke Relinquishment Agency Adoption Program
  • 13-118
    AD 508 (7/13) - Rescission Request/Rescission Of Relinquishment
  • 13-117
    WTW 39 (9/13) Assembly Bill (AB) 74 County Welfare Department (CWD) Expanded Subsidized Employment (ESE) Plan
  • 13-116
    AD 512 (7/13) - Psychosocial And Medical History Of Child
  • 13-115
    WTW 17 (9/13) Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
  • 13-114
    WTW 15 (9/13) Simplified CalFresh Program Unpaid Work Expereicne (WEX) And Unpaid Community Service Hours Worksheet
  • 13-113
    WTW 5 (9/13) Welfare-To-Work Program Notice
  • 13-112
    TEMP 2215 (7/02) English and Spanish - Electronic Benefit Transfer (EBT) Important Information
  • 13-111
    Messages in ACL 13-80
  • 13-110
    CF 215 (8/13) CalFresh Notification of Inter-County Transfer
  • 13-109
    FS 22 QR (12/06) English and Spanish - Applying For Food Stamp Benefits
  • 13-108
    PUB 339 (7/13) Foster Care Ombudsman Brochure
  • 13-107
    SOC 412 (8/02) English and Spanish - IHSS Employee's Claim For Workers' Compensation Benefits
  • 13-105
    CF 285 (9/13) Application For CalFresh Benefits
  • 13-104
    CF 388 (8/13) CalFresh Notice Of Restoration Approval
  • 13-103
    CF 377.6 (8/13) Information/Verification Needed
  • 13-102
    CF 286 SAR (8/13) CalFresh Budget Worksheet/Semi-Annual Reporting Households
  • 13-101
    CF 23 CR (9/13) CalFresh Benefits How To Report Housdhold Changes
  • 13-100
    TEMP 2259 (12/12) English and Spanish - Report Of Electronic Theft Of Cash Aid
  • 13-099
    AD 90 (6/13) Supporting Information For Issuance Of California Department Of Social Services Acknowledgement And Confirmation Of Receipt Of Child Freeing Documents
  • 13-098
    EBT 2259 (8/13) Report Of Electronic Theft Of Cash Aid And Instructions
  • 13-097
    CF 377.5 SAR (9/13) CalFresh Mid-Certification Period Status Report
  • 13-096
    PUB 415 (1/06) California Loves Kids - Obsolete
  • 13-095
    M40-105C (7/13) Notice Of Action - Immunizations
    M40-105E (7/13) Notice Of Action - School Attendance
  • 13-094
    GE 1 through GE 6 (7/12) - All languages
  • 13-093
    SOC 310 (1/03) English and Spanish - Statement Of Facts For In-Home Supportive Services
  • 13-092
    SOC 884 (8/12) County CMIPS II User Request Form Add/Modify User
  • 13-091
    SOC 882 (8/12) County CMIPS II User ID Confirmation CDSS Copy
  • 13-090
    SOC 829 (9/12) IHSS Provider Direct Deposit Enrollment/Change/Cancellation Form
  • 13-089
    SOC 872 (7/12) Statement Of Facts (SOF) Preparation Checklist IHSS Program Caregiver Background Check Bureau (CBCB), General Exception Unit (GEU)
  • 13-088
    SOC 871 (7/12) Statement Of Facts (SOF) Summary Sheet IHSS Program Caregiver Background Check Bureau (CBCB), General Exception Unit (GEU)
  • 13-087
    SOC 865 (7/12) English and Spanish  IHSS Request For Applicant Provider Reference
  • 13-086
    DFA 285-A3 QR (6/13) CalFresh Benefits Your Rights And Responsibilities
  • 13-085
    NA 1275 (7/13) Electronic Notification Cancellation Notice
  • 13-084
    NA 1274 (7/13) Electronic Notification Notice
  • 13-083
    NA 1273 (7/13) Electronic Notification Agreement
  • 13-082
    PUB 132 (5/05) California Child Abuse And Neglect Reporting Law - Obsolete
    PUB 132 (6/2012)  The California Child Abuse And Neglect Reporting Law
  • 13-081
    PUB 129 (12/06) Child Abuse Reporting And You - Obsolete
    PUB 270 (12/05) Never Shake A Baby - Medical Brochure - Obsolete
  • 13-080
    EFA 15 (5/13) English and Spanish  Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2013 Income Guidelines
  • 13-079
    EFA 14 (5/13) English and Spanish  Emergency Food Assistance Program (EFAP) 2013 Income Guidelines
  • 13-078
    SOC 834 (3/13) English and Spanish  Request For Grievance Hearing
  • 13-077
    WTW 38 (6/13) Welfare-To-Work 24-Month Time Clock Notice
  • 13-076
    SOC 832 (1/13) English and Spanish  Notice Of Child Abuse Central Index Listing
  • 13-075
    CF 377.2A2 (6/13) Client Survey
  • 13-074
    CF 377.2A1 (6/13) Important Information
  • 13-073
    CF 377.2A (7/13) CalFresh Notice Of Expiration Of Certification For Households In Which All Adults Are Elderly Or Disabled
  • 13-072
    NA BACK 9 (4/13) Your Hearing Rights
  • 13-071
    CF 377.6 (6/13) Notice Of Action Information/Verification Needed
  • 13-070
    CF 377.5 (6/13) CalFresh Mid-Certification Period Status Report
  • 13-069
    CF 377.4 SAR (6/13) CalFresh Notice Of Change For Semi-Annual Reporting Households
  • 13-068
    CF 377.2 (6/13) CalFresh Notice Of Expiration Of Certification
  • 13-067
    CF 285 SAR (6/13) CalFresh Budget Worksheet/Semi-Annual Reporting Households
  • 13-066
    CF 32 (6/13) CalFresh Request For Contact
  • 13-065
    CF 29 (6/13) CalFresh Recertification Appointment Letter
  • 13-064
    CF 23 SAR (6/13) CalFresh Benefits How To Report Household Changes
  • 13-063
    SOC 449 (6/13) In-Home Supportive Services Program Public Authority/Nonprofit Consortium Rate
  • 13-062
    PUB 367 (4/13) English and Spanish Reach For Your Dreams With Cal-Learn Brochures
  • 13-060
    TEMP 44-111A (4/13) Income Disregards - Change
  • 13-061
    SOC 885 (6/13) In-Home Supportive Services (IHSS) Program Notice Of Denial Of Request For In-Home Reassessment Based On State Law Change
  • 13-059
    NA 532 (4/13) Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue
  • 13-058
    NA 531 (4/13) Notice Of Action - Continuation Page - 48-Month Time Limit - Includes Budget
  • 13-057
    NA 300 (4/13) Notice Of Action - Continuation Page - Recipient Financial Eligibility Test
  • 13-056
    NA 281B (5/13) Notice Of Action - Continuation Page - Underpayment Computations On Or After 10/1/2013
  • 13-055
    NA 274G (5/13) Notice Of Action - Continuation Page - Overpayment Computations For 10/1/2013
  • 13-054
    NA 271 (4/13) Notice Of Action - Continuation Page - Family Income Computations - Cash Aid
  • 13-053
    NA 200 (4/13) Notice Of Action - Multipurpose
  • 13-052
    CW 2166 (5/13) Work Pays Notice - Multilingual
  • 13-051
    CW 30 (4/13) CalWORKs Budget Worksheet
  • 13-050
    TEMP 2252 (5/13) State Law Changes The CalWORKs Earned Income Disregard
  • 13-049
    LIC 406 (5/13)  Client/Resident Cash Sheet
  • 13-048
    FA 10B (4/13) Fiscal Audit Summary Of Exit Conference Pont Sheet(s)1 No. __
  • 13-047
    FA 10A (5/13) Fiscal Audit Summary of Exit Conference
  • 13-046
    FA 7 (4/13) Fiscal Audit Entrance Conference Questionnaire
  • 13-045
    SAWS 2A SAR (4/13) Rights, Responsibilities And Other Important Information
  • 13-043
    SAR 73 (3/13) Senior Parent Semi-Annual Income Report
  • 13-042
    SAR 72 (3/13) Sponsor's Semi-Annual Income And Resources Report (Supplement To The SAR 7)
  • 13-041
    SAR 23 (3/13) Senior Parent Statement Of Facts (Supplement to The SAWS 2)
  • 13-040
    SAR 22 (3/13) Sponsored Noncitizens Applying For Or Receiving Cash Aid And/Or CalFresh
  • 13-039
    SAR 7 Addendum (4/13) Instructions And Penalties SAR 7 Eligibility Status Report For Cash Aid And CalFresh
  • 13-038
    SAR 3 (4/13) Mid-Period Status Report For Cash Aid And CalFresh
  • 13-037
    CW 2103 (2/13) Reminder For Teens Turning 18 Years Old
  • 13-036
    CW 31 SAR (4/13) Receipt For Documents
  • 13-035
    CW 29 (1/13) Applicant Test - Intake Financial Test
  • 13-034
    CW 25A (2/13) Payee Agreement For Minor Parent
  • 13-033
    CW 8A (4/13) Statement Of Facts To Add A Child Under Age 16
  • 13-032
    CW 8 (3/13) Statement Of Facts For An Additional Person
  • 13-031
    SOC 449 (4/13) IHSS Public Authority/Nonprofit Consortium Rate
  • 13-030
    CF 27 (2/13) Non-Assistance CalFresh (NACF) Household Recertification Form
  • 13-029
    FS 27 (3/10) Non-Assistance Food Stamps (NAFS) Household Recertification Form
  • 13-028
    AD 501 (4/13) Relinquishment In or Out-of-County (Birth Mother/Presumed Father In California)
  • 13-027
    AAP 7 (3/13) Adoption Assistance Program Statement Of Acknowledgment
  • 13-026
    SOC 824 (2/13) IHSS Quality Assurance/Quality Improvement QA/QI Quarterly Activities Report
  • 13-025
    DFA 285-A3 QR (1/13) English and Spanish CalFresh Benefits Your Rights And Responsibilities
  • 13-024
    AD 925 (9/12) Independent Adoption Placement Agreement (Indian Child)
  • 13-023
    List Of Obsoleted Forms - TEMP CL 1, TEMP CL 2, TEMP CL 4, TEMP CL 8, TEMP CL 10, TEMP M42-769, TEMP WTW 5, TEMP CW 2186C, TEMP NA BACK 9
  • 13-022
    List Of Obsoleted Forms - FS 11B, FS 11C, FS 17, FS 25, FS 31, NA 1215, NA 1216, QR 25A, TEMP 2193, TEMP 2193A, TEMP 2224, TEMP 2225, TEMP 2227, TEMP 2230
  • 13-021
    AD 508 (4/13) Request For Rescission Of Relinquishment
  • 13-020
    CW 2208 (2/13) Your Welfare To Work (WTW) 24-Month Time Clock
  • 13-019
    CF 377.1 (2/13) Notice Of Approval For CalFresh Benefits
  • 13-018
    CF 1 (1/13) Notice To All CalFresh Recipients Important - Please Read
  • 13-017
    Notice Of Action - NA 791 (10/12) Required Form - Substitute Permitted AAP - Approval/Change
  • 13-016
    TEMP AR 1 (2/13) Important Information - New Reporting Requirements For CalWORKs and CalFresh
  • 13-015
    AR 3 (12/12) Mid-Year Status Report For CalWORKs And CalFresh
  • 13-014
    AR 2 (12/12) Reporting Changes For CalWORKs And CalFresh
  • 13-013
    PUB 269 (2/13) California Child Passenger Safey Law
  • 13-012
    PUB 403, PUB 403A, PUB 403B, PUB 403C (1/13) EBT Farmers Market Posters
  • 13-011
    SOC 2244 (1/13) English and Spanish - IHSS Providers Notice Of New Timesheets
  • 13-010
    SOC 2243 (1/13) English and Spanish - IHSS Recipients Notice Of New Timesheets
  • 13-009
    DFA 377.1 (1/13) English and Spanish Notice Of Approval Of CalFresh Benefits
  • 13-007
    NA 1250 (11/12) Notice Of Action - IHSS Approval
    NA 1253 (11/12) Notice Of Action - IHSS Change
  • 13-006
    DFA 377.1 (12/12) Notice Of Approval Of CalFresh Benefits
  • 13-005
    TEMP 2259 (12/12) Report Of Electronic Theft Of Cash Aid
  • 13-004
    CW 2186B (12/12) CalWORKs Exemption Determination
  • 13-003
    CW 2186A (12/12) CalWORKs Exemption Request Form
  • 13-002
    CW 2206 (1/13) Young Child Exemption Ends December 31, 2012 New Rules For CalWORKs Welfare-To-Work Activities
  • 13-001
    WTW 2 (12/12) Welfare-To-Work Plan Activity Assignment