2014 Notice Of Forms Changes

  • 14-141
    SOC 851 (10/14) - In-Home Supportive Services Program Notice To Applicant Provider Of Provider Ineligibility Incomplete Provider Process
  • 14-140
    SOC 2266 (10/14) - In-Home Supportive Services Program Notice To Recipient Approval Of Exception To Exceed Weekly Hour
  • 14-139
    SOC 2265 (10/14) - In-Home Supportive Services Program Notice To Provider Reduction Of Total Violation Count
  • 14-138
    SOC 2264 (10/14) - In-Home Supportive Services Program Notice To Recipient Rescinding Provider Violation
  • 14-137
    SOC 2263 (10/14) - In-Home Supportive Services Program Notice To Provider Rescinding Violation
  • 14-136
    AD 67 (10/14) - Information About The Birth Mother
  • 14-135
    SOC 2255 (10/14) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
  • 14-134
    SOC 2255 (9/14) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
  • 14-133
    SOC 2270 (11/14) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement
  • 14-132
    SOC 2270 (10/14) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement
  • 14-131
    SOC 855 (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process
  • 14-130
    SOC 2259 (12/14) - In-Home Supportive Services Program Notice To Provider Of Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limits
  • 14-129
    SOC 2258 (12/14) - In-Home Supportive Services Program Notice To Provider Of Third Violation And Three-Month Suspension For Exceeding Workweek And/Or Travel Time Limits
  • 14-128
    SOC 2257A (12/14) - In-Home Supportive Services Program Notice To Recipient Of Provider’s First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
  • 14-127
    SOC 2257 (12/14) - In-Home Supportive Services Program Notice To Provider Of First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
  • 14-126
    PUB 466 (12/14) - CDSS Employment Guide
  • 14-125
    PUB 467 (12/14) - Job Fair Flyer
  • 14-124
    M43-119H (11/14) - Missing SAR 72, Discontinue
  • 14-123
    M43-119G (11/14) - Missing SAR 72, Change
  • 14-122
    M42-769A (11/14) - Apply $100 Cal-Learn Penalty
  • 14-121
    M42-431A4 (11/14) - No Eligible Noncitizen Status/Proof of Eligible Noncitizen Status, Discontinue
  • 14-120
    M42-213A (11/14) - Restricted Account
  • 14-119
    M42-101C (11/14) - Age and School Requirements, Discontinue
  • 14-118
    M42-101B (11/14) - Age and School Requirements
  • 14-117
    M40-181E (11/14) - SAWS 2 PLUS Redetermination Immunizations/School Attendance, Change
  • 14-116
    M40-181A (11/14) - SAWS 2 Redetermination/Other Essential Information
  • 14-115
    M40-171A (11/14) - Failure to Cooperate, Deny
  • 14-114
    M40-129D5 (11/14) - Failed to Provide Proof of SSN Application, Deny
  • 14-113
    M40-129D1 (11/14) - Procedural Requirements, Deny
  • 14-112
    M40-105E (11/14) - Notice Of Action - School Attendance
  • 14-111
    M40-105C (11/14) - Notice Of Action - Immunizations
  • 14-110
    SOC 2259 (10/14) - In-Home Supportive Services Program Notice To Provider Of Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limits
  • 14-109
    SOC 2258 (10/14) - In-Home Supportive Services Program Notice To Provider Of Third Violation And Three-Month Suspension For Exceeding Workweek And/Or Travel Time Limits
  • 14-108
    SOC 2257A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider’s First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
  • 14-107
    SOC 2257 (10/14) - In-Home Supportive Services Program Notice To Provider Of First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
  • 14-106
    M40-105A (11/14) - Failed to provide SSN or proof of completed SSN Application
  • 14-105
    M40-105 (11/14) - Failed to Provide SSN When Received or Failure to Cooperate
  • 14-104
    CF 11 (8/14) - Notice To All CalFresh Recipients
  • 14-103
    PUB 467 (8/14) - Job Fair Flyer
  • 14-102
    CF 11A (9/13) - Notice To All CalFresh Recipients
  • 14-101
    WTW 43 (9/14) - Notice Of Your Welfare-To-Work (WTW) 24-Month Time Clock Ending Soon
  • 14-100
    CF 215 (9/14) - CalFresh Notification Of Inter-County Transfer
  • 14-099
    AD 887B (7/14) - Statement of Understanding - Independent Adoptions Program
  • 14-098
    AD 861 (5/14) - Consent To Adoption Of Indian Child By Alleged Natural Father (In Or Out Of California)
  • 14-097
    AAP 6 (7/14) - Adoption Assistance Program Negotiated Benefit Amount And Approval
  • 14-096
    TEMP 3000 (9/14) - IHSS Program Overtime and Workweek Requirements Recipient Declaration
  • 14-095 (not used)
  • 14-094 (not used)
  • 14-093 (not used)
  • 14-092 (not used)
  • 14-091
    SOC 846 (9/14) - IHSS Program Provider Enrollment Agreement
  • 14-090 (not used)
  • 14-089 (not used)
  • 14-088 (not used)
  • 14-087 (not used)
  • 14-086
    SOC 426A (9/14) - English and Spanish - IHSS Program Recipient Designation of Provider
  • 14-085
    FSP 3 (8/14) - Family Stabilization Program Notice of Change in Program Status
  • 14-084
    FSP 2 (8/14) - Family Stabilization Program Denial Notice
  • 14-083
    FSP 1 (8/14) - Family Stabilization Program Evaluation Request
  • 14-082
    CF 1 (9/14) - Notice To All CalFresh Recipients
  • 14-081
    AAP 4 (9/13) - Eligibility Certification Adoption Assistance Program (Combines AAP4 And FC 9)
  • 14-080
    AD 501 ENG/SP (6/14) - Relinquishment In or Out-of-County (Birth Mother/Biological Father/Presumed Father in California)
  • 14-079
    AD 842 (7/14) - Consent To Adoptive Placement By Alleged Natural Father (Outside California In Armed Forces)
  • 14-078
    TEMP 2250 (8/14) - State Law Changes MAP Levels For Cash Aid Recipients
    TM44-315H (9/14) - Law Change To MAP Levels
  • 14-076
    DPA 302 (8/11) Interpreter/Translator Billing
  • 14-075
    NA 1271 (5/14) - Notice Of Action - Denial Of Home Assessment/Approval
  • 14-074
    NA 816 (3/14) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan
  • 14-073
    NA 817 (3/14) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan
  • 14-072
    NA 1268 (4/13) - CalFresh Informing Notice Of Sending Intercounty Transfer
  • 14-071
    NA 840 (3/14) - Notice Of Action - Welfare To Work Plan
  • 14-070
    NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work
  • 14-068
    NA 1240 (4/13) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account
  • 14-067
    NA 845 (3/14) - Notice Of Action - Sanction and Removal Of The Other Parent's Needs
  • 14-066
    NA 1267 (4/13) - CalFresh Informing Notice Of Receiving Intercounty Transfer
  • 14-065
    NA 995 (5/13) - Food Stamp Notice of Denial/Disqualification For The California Food Assistance Program
  • 14-064
    CF 1239 (5/13) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
  • 14-063
    NA 841 (3/14) - Notice Of Action - Welfare-To-Work Plan
  • 14-062
    PUB 463 (10/13) - Education Travel Reimbursement
  • 14-061
    NA 290 (2/14) - Notice of Action - Multi-purpose
  • 14-060
    CF 387 (5/14) - CalFresh Request For Information
  • 14-059
    List of Obsolete Forms - DFA 377.9, DFA 386, DFA 389, DFA 478, DFA 842
  • 14-058
    List Of Obsolete Forms - DFA 377.4A, DFA 377.7A1, DFA 377.7B, DFA 377.7B1, DFA 377.7C, DFA 377.7E1
  • 14-057
    AD 885 (3/14) - Mother Or A Biological/Presumed Father Of A Child Who Is Not Detained, A Juvenile Court Dependent In Out-of-home Care, Or The Ward Of A Legal Guardian
  • 14-056
    SAR 7A (5/14) - How To Fill Out Your SAR 7 Eligibility Status Report
  • 14-055
    SAR 7 (5/14) - SAR 7 Eligibility Status Report
  • 14-054
    EFA 14 (4/14) - Emergency Food Assistance Program (EFAP) 2014 Income Guidelines
  • 14-053
    FC 1637 (5/14) - 90-Day Transition Plan
  • 14-052
    AD 885A (4/14) - Mother or a Biological/Presumed Father of a Child Who is Detained, a Juvenile court Dependent in Out-of-home Care, or the Ward of a Legal Guardian
  • 14-051
    AD 887 (4/14) - Statement Of Understanding - Independent Adoptions Program
  • 14-050
    AD 594 (4/14) - Alleged Natural Father's Consent To Adoption (In Or Out Of California)
  • 14-049
    WINS 1 (5/14) - Notice To All CalFresh Recipients Work Incentive Nutritional Supplement (WINS) Benefit Important - Please Read
  • 14-048
    WINS 1239 (5/14) - CalFresh Notice Of Approval/Denial/Termination Work Incentive Nutritional Supplement (WINS) Benefit
  • 1 4-047
    CW 215 (4/14) - Notification Of Intercounty Transfer
  • 14-046
    CF 377.2A1 (4/14) - Important Information For Households In Which All Adults Are Elderly Or Disabled With No Earned Income
  • 14-045
    CF 377.7B1 (2/14) CalFresh Repayment Notice For Inadvertent Household Errors Only Final Notice
  • 14-044
    CF 377.7A1 (2/14) Request For Restoration Of CalFresh Benefits After Administrative Disqualification
  • 14-043
    WINS 1 (4/14) Notice To All CalFresh - Work Incentive Nutritional Supplement (WINS) Benefit
  • 14-042
    AD 887 (4/14) - Statement Of Understanding - Independent Adoptions Program
  • 14-041
    CF 377.4 CR (1/14) CalFresh Notice Of Change For Change Reporting Households
  • 14-040
    SOC 2250 (3/14) Application For Qualified Agency Certification
  • 14-039
    SOC 2249 (3/14) Qualified Agency Certification Application Checklist
  • 14-038
    WINS 1239 (4/14) CalFresh Notice Of Approval/Denial/Termination Work Incentive Nutritional Supplemnt (WINS) Benefits
  • 14-037
    CF 285 (2/14) English and Spanish - Application For CalFresh Benefits
  • 14-036
    KG 5 (2/14) Kinship Guardianship Assistance Payment (Kin-GAP) Program - Nonrecurring Legal Guardianship Expenses Form
  • 14-035
    KG 4 (2/14) Kinship Guardianship Assistance Payment (Kin-GAP) Program - Nonrecurring Legal Guardianship Expense Agreement
  • 14-033
    CW 2200 (2/14) Request For Verification
  • 14-032
    AD 842 (10/13) - Consent To Adoptive Placement By Alleged Natural Father (Outside California In Armed Forces)
  • 14-031
    STO CA 0034 (3/14) Forged Endorsement Affidavit
  • 14-030
    CF 29C (2/14) CalFresh Recertification Appointment
  • 14-029
    CF 29B (2/14) CalFresh Initial Recertification On-Demand Appointment Letter
  • 14-028
    CF 29D (2/14) CalFresh Recertification On-Demand Appointment Letter
  • 14-027
    CF 29A (2/14) CalFresh Initial Appointment Letter
  • 14-026
    AD 512 (1/14) Psychosocial And Medical History Of Child
  • 14-025
    LIC 184D (1/14) Notification of Incomplete Application (NOIA) Child Care Centers 30-Day NOIA
  • 14-024
    LIC 184C (1/14) Notification Of Incomplete Application (NOIA) Child Care Centers - Pre-30-Day NOIA
  • 14-023
    LIC 184B (1/14) English and Spanish - Notification Of Incomplete Application - Family Child Care Home
  • 14-022
    DFA 303 (3/05) English and Spanish - Replacement Affidavit/Authorization (DFA 303)
  • 14-021
    WTW 40 (2/14) Assembly Bill (AB) 74 County Welfare Department Family Stabilization (FS) Plan
  • 14-020
    List Of Obsolete Forms - TEMP 2230 ENG/SP, TEMP 2227 ENG/SP, TEMP 2225 ENG/SP, TEMP 2224 ENG/SP, TEMP 2193 ENG/SP, TEMP 2193A ENG/SP, TEMP NA 1239 ENG/SP
  • 14-019
    QR 2104 (6/10) English and Spanish - Food Stamp Notice Of Restoration Approval
  • 14-018
    List Of Obsolete Forms - FS 11 ENG/SP, FS 29 ENG_SP, FS 11B ENG/SP, FS 11C ENG/SP, FS 17 ENG/SP, FS 25 ENG_SP, FS 31 ENG/SP, FS 23 QR ENG_SP
  • 14-017
    List Of Obsolete Forms - DFA 377.5, DFA 377.7D, DFA 377.7D1, DFA 377.7D3
  • 14-016
    CF 377.7D (1/14) CF 377.7D1 (1/14) and CF 377.7D3 (1/14)
  • 14-015
    SOC 2247 (1/14) IHSS UHV Findings Report
  • 14-014
    SOC 2251 (1/14) To Request Appeal Of Agency Certification Denial
  • 14-013
    SOC 2250 (1/14) Application For Qualified Agency Certification
  • 14-012
    SOC 2249 (1/14) Qualified Agency Certification Application Checklist
  • 14-011
    TEMP 2250 (1/14) State Law Changes MAP Levels For Cash Aid Recipients
    TM44-315G (12/13) Law Change To MAP Levels
  • 14-010
    SOC 2245 (1/14) IHSS Fraud Data Reporting Form
  • 14-009
    AD 501 (11/13) Relinquishment In Or Out-of-County (Birth Mother/Biological Presumed Father In California)
  • 14-008
    CF 377.7D1 (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
  • 14-007
    CF 377.D3 (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
  • 14-006
    CF 377.7D (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
  • 14-005
    FS 22 QR (10/13) English and Spanish - Applying For Food Stamp Benefits
  • 14-004
    DFA 285-A2 (8/06) English and Spanish - Statement Of Facts
  • 14-003
    DFA 285-A1 (2/13) English and Spanish - CalFresh Benefits
  • 14-002
    DFA 285-A3 QR (6/13) English and Spanish - CalFresh Benefits Your Rights And Responsibilities
  • 14-001
    CW 80 (12/13) Self-Certification Form For Motor Vehicles - CalWORKs