2015 Notice Of Forms Changes

  • 15-273
    HCS 402 (12/15) - Home Care Organization Dishonesty Bond 
  • 15-271
    HCS 9201 (12/15) - Home Care Organization Inspection Checklist
  • 15-270
    LIC 9163 (11/15) - Request For Live Scan Service - Community Care Licensing
  • 15-269
    LIC 9188 (10/15) - For posting info only - Criminal Record Exemption Transfer request
    LIC 9188 (11/15) - Criminal Record Exemption Transfer Request
  • 15-268
    LIC 9182 (11/15) - Criminal Background Clearance Transfer Request
  • 15-267
    LIC 9058 (12/15) - Applicant/Licensee Rights
  • 15-266
    LIC 9099 (12/15) - Complaint Investigation Report
  • 15-265
    LIC 809 (12/15) - Facility Evaluation Report
  • 15-264
    LIC 421E (12/15) - Civil Penalty Assessment-Serious Bodily Injury/Physical Abuse
    15-263

    LIC 421C (12/15) - Civil Penalty Assessment- Immediate $150
  • 15-262
    LIC 178 (12/15) - Deficiency/Penalty Review
  • 15-261
    LIC 421B (12/15) - Civil Penalty Assessment -Background Check/Child Care
  • 15-260
    LIC 421 (12/15) - Civil Penalty Assessment
  • 15-259
    TLR 2 (12/15) - Trustline Registry "The California Registry Of In-Home Child Care Providers" - In-Home/License Exempt Child Care Provider Application
  • 15-258
    TLR 4 (12/15) - TrustLine Registry "The California Registry of In-Home and License-Exempt Child Care Providers" Ancillary Day Care Center
  • 15-257
    LIC 421D (15/15) - Civil Penalty Assessment - Immediate $150
  • 15-256
    TLR 9163 (12/15) -  Request For Live Scan Service for Subsidized TrustLine Registry Applicants
  • 15-255
    SR 10 (5/15) - Certification Of Audited Cost Data
  • 15-254
    SR 9 (5/15) - Federal Expenditure Certification
  • 15-253
    SR 8 (5/15) - Financial Audit Report Transmittal
  • 15-252
    WTW 31 (7/15) - Request To Meet Welfare To Work Rules To Get My Cash Aid Back
    WTW 31 (8/15) - Request To Meet Welfare To Work Rules To Get My Cash Aid Back
  • 15-251
    WTW 29 (7/15) - Plan To Meet Welfare To Work Rules And Get My Cash Aid Back
    WTW 29 (8/15) - Plan To Meet Welfare To Work Rules And Get My Cash Aid Back
  • 15-250
    WTW 26 (7/15) - Good Cause Determination Guidelines
    WTW 26 (8/15) - Good Cause Determination Guidelines
  • 15-249
    WTW 17 (12/15) - Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
    WTW 18 (12/15) - Learning Needs Screening
    WTW 19 (11/15) - Learning Needs Screening - Client Copy
  • 15-248
    CF 286 SAR (12/15) - CalFresh Budget Worksheet/Semi-Annual Reporting Households
  • 15-247
    PUB 429 (10/15) - California EITC is Here! Claim Your 2015 State And Federal Credits - You Earned It - It's Your Money
  • 15-246
    PUB 428 (10/15) - It's Your Money - Get It - The State and Federal Earned Income Tax Credit (EITCs)
  • 15-245
    PUB 466 (10/15) - CDSS Employment Guide
  • 15-244
    Obsolete Form - M82-820C (1/02) - Eligible Child Left Home, Discontinue
    Obsolete Form - M82-820D (1/02) - No Longer Pregnant, Discontinue
  • 15-243
    M44-307A (11/15) - Voucher/Vendor Payment, Other
  • 15-242
    AD 70 (11/15) - Adoption Facilitator Registry Application
    AD 71 (11-15) - Adoption Facilitator Registry - Trainee Application
    AD 72 (11-15) - Adoption Facilitator Complaint Form
  • 15-241
    NA 1277 (11/15) - Notice of Action - Approved Relative Caregiver (ARC) Overpayment (no change)
    NA 1278 (12/15) - Notice of Action - Approve Approved Relative Caregiver (ARC) Payment
    NA 1279 (12/15) - Notice of Action - Deny Approved Relative Caregiver (ARC) Payment
    NA 1280 (12/15) - Notice of Action - Discontinue Approved Relative Caregiver (ARC) Payment
  • 15-240
    NA 1277 (11/15) - Notice of Action - Approved Relative Caregiver (ARC) Overpayment
    NA 1278 (11/15) - Notice of Action - Approve Approved Relative Caregiver (ARC) Payment
    NA 1279 (11/15) - Notice of Action - Deny Approved Relative Caregiver (ARC) Payment
    NA 1280 (11/15) - Notice of Action - Discontinue Approved Relative Caregiver (ARC) Payment
  • 15-239
    CW 2215 (9/15) - New Rules in California Work Opportunity and Responsibility to Kids (CalWORKs) for Safety Net and Certain Child-Only Case
  • 15-238
    M44-316C SAR (10/15) - No Change/Mid-Period Report of Property
  • 15-237
    M42-207A (10/15) - Over Property Limit, Deny
  • 15-236
    HCS 200A (10/15) - Intent To Apply For Home Care Organization License
  • 15-235
    ADSA 1 (10/15) - Assistance Dog Special Allowance (ADSA) Application
  • 15-233
    GEN 1388 (9/15) - Language Accessibility Services Complaint Form
  • 15-232
    LIC 9163 (9/15) - Request For Live Scan Service - Community Care Licensing
  • 15-230
    LIC 9163 (10/15) - Request For Live Scan Service - Community Care Licensing
  • 15-229
    AD 908 (9/15) - Adoptions Information Act Statement
  • 15-228
    CF 377.9 (2/14) - Notice Of Back CalFresh Benefits
  • 15-227
    CF 385 (9/15) - Application For Disaster CalFresh
    CF 385 (10/15) - Application For Disaster CalFresh
  • 15-226
    CF 500 (10/15) - Informational Notice To CalFresh Recipients
  • 15-225
    CF 377.7E1 (1/14) - CalFresh Repayment Agreement For Administrative Errors Only
  • 15-224
    CF 377.7C (2/14) - CalFresh Repayment Agreement For Inadvertent Household Errors Only
  • 15-223
    CF 377.7B (2/14) - CalFresh Overissuance Notice For Inadvertent Household Errors (IHE) Only
  • 15-222
    CF 377.7A (2/14) - Notice Of Administrative Disqualification
  • 15-221
    CF 377.2A2 (2/14) - Client Survey
  • 15-220
    PUB 438 (8/15) - TrustLine Parent Pamphlet
  • 15-219
    CF 377.2A (12/13) - CalFresh Notice Of Expiration Of Certification For Households In Which All Adults Are Elderly Or Disabled
  • 15-218
    CF 377.5 CR (11/13) - CalFresh Household Change Report
  • 15-217
    PUB 269 (9/15) - California Child Passenger Safety Law
  • 15-216
    CF 386 (2/14) - CalFresh Notice Of Missed Interview
  • 15-215
    SAR 2 CR (7/15) - Reporting Changes For CalWORKs and CalFresh
  • 15-214
    AR 2 CR (7/15) - Reporting Changes For CalWORKs and CalFresh
  • 15-213
    PUB 486 (7/15) - Understanding The EBT Client Website
  • 15-212
    CF 11 (8/15) ENG/SP - Notice To All CalFresh Recipients Important - Please Read
  • 15-211
    CF 23 CR (8/15) - CalFresh Benefits How To Report Household Changes
  • 15-210
    CF 377.1 (9/15) - Notice Of Approval For CalFresh Benefits
  • 15-209
    CW 2202W (9/15) - CalWORKs Program Request For Policy Interpretation
  • 15-208
    NA 835 (5/15) - Notice of Action - Child Care Discontinuance
    NA 835 (8/15) - Notice of Action - Child Care Discontinuance
  • 15-207
    NA 834 (5/15) - Notice of Action - Child Care Denial
    NA 834 (8/15) - Notice of Action - Child Care Denial
  • 15-206
    AD 880 (9/15) - Declaration Of Mother - Agency And Independent Adoptions Program
  • 15-205
    PUB 461 (8/15) - Volunteer Emergency Services Team (VEST)
    PUB 462 (8/15) - Functional Assessment Service Team (FAST)
  • 15-204
    HCS 200 (8/15) - Application For A Home Care Organization License
    HCS 215 (8/15) - Home Care Organization Licensee Applicant Information
    HCS 281 (8/15) - Application Instructions For A Home Care Organization License
    HCS 308 (8/15) - Designation Of Home Care Organization Responsibility
    HCS 309 (8/15) - Partnership/Corporation/Limited Liability Company Organization Structure
    HCS 402 (8/15) - Employee Dishonesty Bond
    HCS 9165 (8/15) - Board Of Director Statement
  • 15-203
    ADSA 1 (8/15) - Assistance Dog Special Allowance (ADSA) Application
  • 15-202
    TEMP CF 1468 (2/15) - CalFresh Notice Of Change
  • 15-201
    CF 28B (2/14) - CalFresh Program Restricted Accounting Agreement part B
  • 15-200
    CF 389 (2/14) - Notice Of Denial Of Restoration
  • 15-199
    CF 377.4A (2/14) - CalFresh Notice Of Change (Non-Citizen)
  • 15-198
    CF 21 (3/14) - Release Form
  • 15-197
    CF 20 (2/14) - You Do Not Owe Anything For Receiving CalFresh Benefits
  • 15-196
    CF 842 (2/14) - Claim Determination Worksheet
  • 15-195
    CF 478 (2/14) - Disqualification Consent Agreement CalFresh Program
  • 15-194
    CF 303 (2/14) - Replacement Affidavit/Authorization
  • 15-193
    CF 18 ENG/SP (2/14) - Important Information
  • 15-192
    CF 28 Coversheet (2/14) - CalFresh Program Restricted Account Coversheet - Important To Know
  • 15-191
    SAR 90 (1/14) - Reminder Letter
  • 15-190
    Pub 485 (6/15) - Enjoy Surcharge-Free ATMs Nationwide - Poster
  • 15-189
    PUB 484 (7/15) - Keep More Of Your Money - Poster
  • 15-188
    AD 925 (8/15) - Independent Adoption Placement Agreement - Indian Child - Independent Adoptions Program
  • 15-187
    AD 908 (8/15) - Adoptions Information Act Statement
  • 15-186
    CF 37 (7/15) - Recertification For CalFresh Benefits
  • 15-185
    AD 861 (8/15) - Consent To Adoption Of Indian Child By Alleged Father (In Or Out Of California) - Independent Adoption Program
  • 15-184
    AD 860 (8/15) - Presumed Father's Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program
  • 15-183
    AD 859 (8/15) - Parental Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program
  • 15-182
    SOC 295 (1/15) - Application For Social Services (14pt Font)
    SOC 295L (1/15) - Application For Social Services (18pt Font)
  • 15-181
    NA Description Of Services L (3/15) - Description Of services (18pt Font)
    NA IHSS Back L (3/15) - Your Hearing Rights (18pt Font)
    NA 1250L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval (18pt Font)
    NA 1251L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval Continuation (18pt Font)
    NA 1252L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Denial (18pt Font)
    NA 1253L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change (18pt Font)
    NA 1254L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change Continuation (18pt Font)
    NA 1255L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Termination (18pt Font)
    NA 1256L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Share Of Cost (18pt Font)
    NA 1257L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Multi (18pt Font)
  • 15-180
    PUB 439 (7/15) - License Exempt Provider Pamphlet
  • 15-179
    PUB 438 (7/15) - TrustLine Parent Pamphlet
  • 15-178
    AD 20B (5/15) - Refusal To Give Consent To Adoption - Alleged Father - Independent Adoption Program
  • 15-177
    AD 860 (4/15) - Presumed Father's Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program
  • 15-176
    AAP 8 (5/15) - Adoption Assistance Program Nonrecurring Adoption Expenses Agreement
  • 15-175
    SSP 18 (4/15) - Notice Of Action And Right To Request A State Hearing On Interim Assistance
  • 15-174
    Obsoleted Form - AD 1C (ENG/SP) (3/10) ? Parental Consent to Adoption (Outside California) - Independent Adoptions Program
  • 15-173
    LIC 508 (7/15) Criminal Record Statement
  • 15-172
    PUB 475 (1/15) - Residential Care Facility for the Elderly (RCFE) Complaint Poster
  • 15-171
    Obsoleted Form - AD 590B (9/13) - Waiver Of Right To Further Notice Of Adoption Planning (Presumed Father In Or Out Of California) Indian Child
  • 15-170
    AR 2 CR (3/15) - Reporting Changes For CalWORKs and CalFresh
  • 15-169
    GEN 1321 (3/00) - CDSS System And Application Access Form
    GEN 1321A (11/03) - HHSDC Teale Data Security Access Request
  • 15-168
    AD 590A (6/15) - Waiver Of Right To Further Notice Of Adoption Planning - Presumed Father In Or Out Of California - Agency And Independent Adoptions Program
  • 15-167
    NA 1261B (5/15) - Form And Instructions - For Kinship-Guardians Only
  • 15-166
    NA 1261A (5/15) - Form And Instructions - For Approved Relatives, Non-Relative Extended Family Members, Foster Family Homes, Non-Related Legal Guardians or Non-Minor Dependents Residing In A Supervised Independent Living Setting
  • 15-165
    NA 1261 (5/15) - Form And Instructions - For Group Homes And Foster Family Agencies Only
  • 15-164
    SOC 841 (10/09) Notice of Overpayment And Request For Voluntary Repayment - Obsolete
  • 15-163
    EFA 15 (6/15) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2015 Income Guidelines
  • 15-162
    EFA 14 (4/15) - Emergency Food Assistance Program (EFAP) 2015 Income Guidelines
  • 15-161
    M82-832F (4/15) - Eligible Person Leaving AU, Discontinue
  • 15-160
    M82-832E (4/15) - Eligible Person Leaving AU, Change
  • 15-159
    M40-171D (4/15) - Basic Approval
  • 15-158
    AAP 6 (5/15) - Adoption Assistance Program Negotiated Benefit Amount and Approval
  • 15-157
    CAS 854 (4/15) - Agency Adoption Fee - Reduction Request
  • 15-156
    CF 23 SAR (1/14) - CalFresh Benefits How To Report Household Changes
  • 15-155
    CF 23 CR (2/14) - CalFresh Benefits How To Report Household Changes
  • 15-154
    PI 2 (6/15) - IRS Office Of Safeguards Data Incident Report
  • 15-153
    PI 1 (6/15) - SSA Data Incident Report
  • 15-152
    Obsolete Form - SOC 293A (11/99) - In-Home Supportive Services Needs Assessment-Face Sheet
  • 15-151
    CF 377.1 (4/15) - Notice Of Approval For CalFresh Benefits
  • 15-150
    Obsoleted Form - SAWS 2 (4/13) - Statement Of Facts For Cash Aid, CalFresh, And Medi-Cal/34-County Medical Services Program (CMSP)
  • 15-149
    CF 31 (4/15) - CalFresh Supplemental Form For Special Medical Deductions
  • 15-148
    AAP 2 (5/15) - Payment Instructions Adoption Assistance Program
  • 15-147
    AD 859 (4/15) - Parental Consent To Adoption Of Indian Child (In Or Out-Of-California)
  • 15-146
    Obsoleted Form - AD 922 (7/99) - Relinquishment Addendum
  • 15-145
    CCP 1 (3/15) - Declaration Of Exemption From TrustLine Registration And Health And Safety Self-Certification
  • 15-144
    PUB 111 (5/15) - Deaf Access Program
  • 15-143
    M40-195A (12/14) ICT Reminder
  • 15-142
    SAWS 2 PLUS (4/15) - Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
  • 15-141
    SOC 341A (3/15) - Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders
  • 15-140
    SOC 341 (3/15) - Confidential Report - Not Subject To Public Disclosure - Report Of Suspected Dependent Adult/Elder Abuse
  • 15-139
    Obsoleted Form - CF 285 SAR - CalFresh Budget Worksheet/Semi-Annual Reporting Households
  • 15-138
    SAR 2 (3/15) - Reporting Changes For Cash Aid And CalFresh
  • 15-137
    AR 2 SAR (3/15) - Reporting Changes For CalWORKs And CalFresh
  • 15-136
    NA 960Y SAR (10/14) - Notice Of Action - Stop Aid; Report Incomplete
  • 15-135
    M40-105E (2/15) - Notice Of Action - School Attendance
  • 15-134
    M40-105D1 (1/15) - Notice Of Action - School Attendance
  • 15-133
    M82-820A (3/15) - No Eligible Person, Deny
  • 15-132
    CW 8 (11/14) - Statement of Facts For An Additional Person
  • 15-131
    SAWS 2A SAR (4/15) - Rights and Responsibilities And Other Important Information For The Cash Aid And CalFresh Programs, And/Or Medi-Cal/34-County Medical Services Program (CMSP)
  • 15-130
    SAR 3 (2/15) - Mid-Period Status Report For Cash Aid and CalFresh
  • 15-129
    CW 80 (2/15) - Self-Certification Form For Motor Vehicles - CalWORKs
  • 15-128
    AD 590 (4/15) - Waiver Of Right To Further Notice Of Adoption Planning (Alleged Natural Father In Or Out Of California) - Independent Adoptions Program
  • 15-127
    AD 588 (4/15) - Denial Of Paternity By Alleged Natural Father - In Or Out Of California - Independent Adoptions Program
  • 15-126
    AD 20 (4/15) - Refusal To Give Parental Consent To Adoption - Independent Adoptions Program
  • 15-125
    AD 4336 (4/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father (Outside California In Armed Forces) - Independent Adoption Program
  • 15-124
    AD 4320 (5/15) - Adoption Assistance Program (AAP) Agreement
  • 15-123
    PUB 439 (4/15) - License Exempt Provider Pamphlet
  • 15-122
    PUB 438 (4/15) - TrustLine Parent Pamphlet
  • 15-121
    AD 1F (4/15) - Parental Consent To Adoption Outside California In The Armed Forces - Independent Adoption Program
  • 15-120
    AD 1A (4/15) - Consent To Adoption By Parent(s) (In or Out-of-California) - Independent Adoption Program
  • 15-119
    WTW 47 (3/15) - Online CalWORKs Appraisal Tool Rights And Privacy
  • 15-118
    EBT 2216 (4/15) - EBT Surcharge Free ? Direct Deposit Handout
  • 15-117
    EBT 2260 (3/15) - Excessive Card Replacement Warning Letter
  • 15-116
    NA 791 (10/12) - Notice Of Action - Approval/Denial Change
  • 15-115
    Obsoleted Form - BCII 8016 Rohnert Park - Request For Live Scan Service
  • 15-114
    CF 37 (12/14) - Recertification For CalFresh Benefits
    CF 37 (5/15) - Recertification For CalFresh Benefits
  • 15-113
    TEMP AD 525 (1/15) - Child Welfare Services Disaster Response Plan Template
  • 15-112
    PUB 391 (5/15) - Basic Medical Sign Language
  • 15-111
    PUB 179A (5/15) - A Manual Communication Guide For Field Officers
  • 15-110
    PUB 179 (5/15) - American Sign Language - Signs For Work Or What To Do Until The Interpreter Arrives
  • 15-109
    CF 26 (3/14) - CalFresh Program Qualifying Drug Felon Addendum
  • 15-108
    AD 594 (3/15) - Alleged Father's Consent to Adoption (In or Out-of-California)
  • 15-107
    AD 165 (3/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father In-Or-Out-of-California
  • 15-106
    List Of Obsoleted Forms - FS 18, FS 20, FS 21, NA 1215, NA 1216, TEMP 2223, TEMP CA 600, TEMP CA 601, TEMP QR 1, TEMP SAR 1
  • 15-105
    GEN 1031 (4/15) - Annual County Training Plan
  • 15-104 - (Not Used)
  • 15-103
    AD 885D (2/15) - Alleged Natural Father of the Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian
  • 15-102
    AD 885C (2/15) - Statement of Understanding Agency Adoptions Program - Alleged Natural Father Of The Child Who Is Not Detained, A Juvenile Court Dependent In Out-Of-Home Care, Or The Ward Of A Legal Guardian
  • 15-101
    TEMP 2198 (11/01) - Important Food Stamp Information For Noncitizens
  • 15-100
    FS 28B (10/08) - Food Stamp Program Restricted Account Agreement Part B
  • 15-99
    FS 28A (12/09) - Food Stamp Program Restricted Account Agreement Part A
  • 15-98
    FS 28 (10/08) - Food Stamp Program Restricted Account Coversheet
  • 15-97
    FS 26 (12/09) - Food Stamp Program Qualifying Drug Felon Addendum
  • 15-96
    DFA 1239 (10/11) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
  • 15-95
    CF 285 (4/15) - English And Spanish - Application For CalFresh Benefits
  • 15-94
    AR 3 (2/15) - Mid-Year Status Report For CalWORKs and CalFresh
  • 15-93
    SAR 7 (12/14) - SAR 7 Eligibility Status Report
  • 15-92
    SAR 7A (12/14) - How To Fill Out Your SAR 7 Eligibility Status Report
  • 15-91
    SOC 449 (2/15) - IHSS Public Authority/Nonprofit Consortium Rate
  • 15-90
    CW 8A (12/14) - Statement Of Facts To Add A Child Under 16
  • 15-89 - (Not Used)
  • 15-88
    CW 2212 (11/14) - The Rules For Your CalWORKs Case Have Change
  • 15-87
    CW 2211 (11/14) - Your CalWORKs Reporting Rules Have Changed
  • 15-86
    DFA 387 (10/11) - Request For Information
  • 15-85
    AD 900 (7/14) - Statement Of Understanding Independent Adoptions Program ? Parent Who Gave Physical Custody (Custodial Parent) of the Indian Child to the Petitioner(s)
  • 15-84
    CF 26 (3/14) - CalFresh Program Qualifying Drug Felon Addendum
  • 15-83
    NA 1276 (1/15) - Notice Of Action - Welfare-to-Work 24-Month Time Clock Limit Notice
  • 15-82
    PUB 474 (12/14) - Rights of Resident Councils
  • 15-81
    WTW 45 (1/15) - Welfare To Work (WTW) 24-Month Time Clock Extension Determination
  • 15-80
    WTW 44 (1/15) - Welfare To Work (WTW) 24-Month Time Clock Extension Request Form
  • 15-79
    CF 1 (10/14) - Notice To All CalFresh Recipients - Important Please Read
  • 15-78
    CW 2215 (10/14) - New Rules in California Work Opportunity and Responsibility to Kids (CalWORKs) for Safety Net and Certain Child-Only Case
  • 15-77
    |CW 2217 (1/15) - CalWORKs Request For Voluntary Repayment
  • 15-76
    TEMP 3005 (12/14) - Changes For People With A Prior Felony Drug Conviction
  • 15-75
    TEMP 2250 (8/14) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients
  • 15-74
    TEMP 2215 (7/02) - Electronic Benefit Transfer (EBT) Important Information
  • 15-73
    TM82-832 (12/14) - Basic Approval
  • 15-72
    TEMP 3006 (1/15) - Recipient/Provider Mailer Regarding Overtime Implementation Halt
  • 15-71
    WTW 46 (1/15) - End Of Welfare-To-Work 24-Month Time Clock Review Appointment Letter
  • 15-70
    PUB 428 (12/14) - ENG/SP - It's Your Money - Claim It & Save It - File For Your 2014 Earned Income Tax Credit
  • 15-69
    PUB 429 (12/14) - ENG/SP - 2014 Earned Income Tax Credit - It's Your Money You Earned It - Now Claim It And Save It
  • 15-68
    ARC 1 (12/14) - Statement Of Facts Supporting Eligibility For The Approved Relative Caregiver (ARC) Funding Option Program
  • 15-67
    EBT 2260 (11/14) - Excessive Card Replacement Warning Letter
  • 15-66
    AD 4349E (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent
  • 15-65
    AD 4349D (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent
  • 15-64
    AD 4349C (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent
  • 15-63
    AD 4349B (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent
  • 15-62
    AD 4349A (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent
  • 15-61
    SOC 2274 (11/14) - In-Home Supportive Services (IHSS ) Program Accompaniment To Medical Appointment
  • 15-60
    SOC 2271 (11/14) - In-Home Supportive Services (IHSS) Program Provider Notice Of Recipient Authorized Hours And Services
  • 15-59
    SOC 2271A (10/14) - In-Home Supportive Services (IHSS) Program Recipient Notice Of Weekly Authorized Hours
  • 15-58
    PUB 462 (8/14) - Functional Assessment Service Team (FAST)
  • 15-57
    PUB 461 (8/14) - Volunteer Emergency Services Team (VEST)
  • 15-56
    LIC 9223 (2/15) - Child Care Advocate Program
  • 15-55
    AAP 2 (1/15) - Payment Instructions Adoption Assistance Program
  • 15-54
    PUB 468 (12/14) Approved Relative Caregivers Funding Option Program
  • 15-53
    CW 2209 (12/14) - Immunization Good Cause Request Form
  • 15-52
    FCR 16 (2/15) - Group Home Shelter Costs, Self-Dealing Transactions Declaration And Survey
  • 15-51
    CF 28A (2/14) - CalFresh Program Restricted Account Agreement Part A
  • 15-50
    AD 4339 (12/14) - Relinquishment - Out-Of-State (Birth Mother/Biological Father/Presumed Father)
  • 15-49
    AD 504 (12/14) - Relinquishment - Out-Of-State in Armed Forces (Birth Mother/Biological Father/Presumed Father)
  • 15-48
    SOC 846 (10/09) - In-Home Supportive Services (IHSS) Program Provider Enrollment Agreement
  • 15-47
    SOC 426A (4/12) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider
  • 15-46
    SOC 851 (1/11) - In-Home Supportive Services Program Notice To Applicant Provider Of Provider Ineligibility Incomplete Provider Process
  • 15-45
    SOC 855 (1/11) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process
  • 15-44
    SOC 2245 (2/15) - In-Home Supportive Services (IHSS) Fraud Data Reporting Form
  • 15-43
    TEMP 3002 (9/14) - Important Information For The In-Home Supportive Services (IHSS) Recipient
  • 15-42
    TEMP 3002 (9/14) - Important Information For The In-Home Supportive Services (IHSS) Recipient
  • 15-41
    TEMP 3001 (9/14) - Important Information For The In-Home Supportive Services (IHSS) Provider
  • 15-40
    TEMP 3001 (9/14) - Important Information For The In-Home Supportive Services (IHSS) Provider
  • 15-39
    TEMP 3000 (9/14) - IHSS Program Overtime and Workweek Requirements Recipient Declaration
  • 15-38
    SOC 2270 (11/14) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement
  • 15-37
    SOC 2269 (10/14) - In-Home Supportive Services Program Notice To Provider Approval To Work Alternate Schedule Due To Recurring Event
  • 15-36
    SOC 2269 (10/14) - In-Home Supportive Services Program Notice To Provider Approval To Work Alternate Schedule Due To Recurring Event
  • 15-35
    SOC 2268 (10/14) - In-Home Supportive Services Program Notice To Recipient Approval For Provider To Work Alternate Schedule Due To Recurring Event
  • 15-34
    SOC 2268 (10/14) - In-Home Supportive Services Program Notice To Recipient Approval For Provider To Work Alternate Schedule Due To Recurring Event
  • 15-33
    SOC 2267A (10/14) - In-Home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours
  • 15-32
    SOC 2267A (10/14) - In-Home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours
  • 15-31
    SOC 2267 (10/14) - In-Home Supportive Services Program Notice To Recipient Denial Of Exception To Exceed Weekly Hours
  • 15-30
    SOC 2267 (10/14) - In-Home Supportive Services Program Notice To Recipient Denial Of Exception To Exceed Weekly Hours
  • 15-29
    SOC 2259A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider's Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limit
  • 15-28
    SOC 2259A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider's Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limit
  • 15-27
    CL1 (4/99) - Cal-Learn Registration/Program Information/Orientation Appointment Notice
  • 15-26
    SOC 2277 (2/15) - Service Report
  • 15-25
    SOC 2277 (1/15) - Contract Mode Service Report
  • 15-24
    SOC 2278 (1/15) - IHSS Qualified Agency Change Of Ownership Form
  • 15-23
    SOC 2266A (10/14) - In-Home Supportive Services Program Notice To Provider Approval Of Exception To Exceed Weekly Hours
  • 15-22
    SOC 2266A (10/14) - In-Home Supportive Services Program Notice To Provider Approval Of Exception To Exceed Weekly Hours
  • 15-21
    SOC 2258A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider's Third Violation And Three-Month Suspension for Exceeding Workweek And/Or Travel Time Limits
  • 15-20
    SOC 2258A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider's Third Violation And Three-Month Suspension for Exceeding Workweek And/Or Travel Time Limits
  • 15-19
    SOC 2266 (10/14) - In-Home Supportive Services Program Notice To Recipient Approval Of Exception To Exceed Weekly Hour
  • 15-18
    SOC 2265 (10/14) - In-Home Supportive Services Program Notice To Provider Reduction Of Total Violation Count
  • 15-17
    SOC 2264 (10/14) - In-Home Supportive Services Program Notice To Recipient Rescinding Provider Violation
  • 15-16
    SOC 2263 (10/14) - In-Home Supportive Services Program Notice To Provider Rescinding Violation
  • 15-15
    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
  • 15-14
    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
  • 15-13
    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
  • 15-12
    SOC 2257 (12/14) - In-Home Supportive Services Program Notice To Provider Of First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
  • 15-11
    SOC 2255 (10/14) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
  • 15-10
    SOC 2256 (9/14) - In-Home Supportive Services Program Recipient and Provider Workweek Agreement - English/Spanish
  • 15-09
    SOC 2256 (9/14) - In-Home Supportive Services Program Recipient and Provider Workweek Agreement - English/Spanish
  • 15-08
    CF 31 (1/15) - CalFresh Supplemental Form For Special Medical Deductions
  • 15-07
    CF 31 (12/14) - CalFresh Supplemental Form For Special Medical Deductions
  • 15-06
    NA 833 (10/14) - Notice of Action - Child Care Change
  • 15-05
    NA 832 (10/14) - Notice of Action - Child Care Services
  • 15-04
    CCP 7 (10/14) - CalWORKs Stage One Child Care Request Form And Payment Rules
  • 15-03
    CCP 4 (10/14) - Health And Safety Self-Certification (For license-exempt providers)
  • 15-02
    CCP 1 (10/14) - Declaration Of Exemption From Trustline Registration And Health And Safety Self-Certification
  • 15-01
    AD 591 (12/14) - Relinquishment - Out-Of-State (Alleged Natural Father)