Data Systems and Survey Design Section (DSSDS) 

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 DSSDS report analysts to request an older automated form version for revisions.

CalFresh Programs

Automated Form Letters and Notices Contact Information

CF 296: CalFresh Monthly Caseload Movement Statistical Report 

Jacquelyn Alvarez
(916) 653-1340
admCF296@dss.ca.gov

DFA 256: Food Stamp Program Participation and Benefit Issuance Report

Jacquelyn Alvarez
(916) 653-1340
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)

Jacquelyn Alvarez
(916) 653-1340
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 

Haris Ahmed
(916) 657-1959
admSTAT47@dss.ca.gov

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

Haris Ahmed
(916) 657-1959
admWINS2@dss.ca.gov

CalWORKs Programs

Automated Form Letters and Notices Contact Information

Cal-OAR: CalWORKs Outcomes and Accountability Review

Greg Downey
(916) 653-1370
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

Sajana Subramanya
(916) 657-1642
DSSDB@dss.ca.gov

CA237HA: Homeless Assistance Program Monthly Statistical Report

Jenn Greaves
(916) 653-1349
admCA237HA@dss.ca.gov

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

Jilzy Christensen
(916) 653-1354
admCCB18@dss.ca.gov

CW115: Child Care Monthly Report (CalWORKs Families)

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

Jilzy Christensen
(916) 653-1354
admCW115@dss.ca.gov

FSP14: Family Stabilization Program

Jilzy Christensen
(916) 653-1354
admFSP14@dss.ca.gov

HDAP18: Housing and Disability Advocacy Program (HDAP)

Jenn Greaves
(916) 653-1349
admHDAP18@dss.ca.gov

HSP14: Housing Support Program (HSP)

Jenn Greaves
(916) 653-1349
admHSP14@dss.ca.gov

STAT45: Teen Parent Cal-Learn Program

Jilzy Christensen
(916) 653-1354
admSTAT45@dss.ca.gov

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

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

Sajana Subramanya
(916) 657-1642
admWTW25@dss.ca.gov

admWTW25A@dss.ca.gov   

Childen's Programs

Automated Form Letters and Notices Contact Information

AD202B: Intercountry Adoption Program

Hilary Berwick
(916) 651-9770
admAD202B@dss.ca.gov

AD42I: Independent Adoption Program (Individual Case)

Hilary Berwick
(916) 651-9770

AD56D: Independent Adoption Program and Adoption Set-Asides

Hilary Berwick
(916) 651-9770
admAD56D@dss.ca.gov

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

Chris Tai
(916) 653-1350
admCA237EA@dss.ca.gov

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

Katherine Chang
(916) 653-1308
admCA237FC@dss.ca.gov

CA237KG: Kinship Guardian Assistance Payment (Kin-GAP) Program

Chris Tai
(916) 653-1350
admCA237KG@dss.ca.gov

CA237KG-F: Kinship Guardian Assistance Payment (Kin-GAP) Program (Federal Only)

Chris Tai
(916) 653-1350
admCA237KGF@dss.ca.gov

FC-AAP-KG84: Supplement to the Rate Requests for Dual Agency AFDC-FC, AAP, and KG Children

Katherine Chang
(916) 653-1308
admFCAAP84@dss.ca.gov

LIC181: Licensing of Facilities for Children

Katie Girimonte
(916) 653-1363
admLIC181@dss.ca.gov

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

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

Katie Girimonte
(916) 653-1363
admSOC405X@dss.ca.gov

admSOC405XP@dss.ca.gov  

Disability and Adult Programs

Automated Form Letters and Notices Contact Information

ABD216: Adult Programs

Chris Tai
(916) 653-1350
admABD216@dss.ca.gov

CA1037: Cash Assistance Program for Immigrants

Minnie Yang
(916) 651-7173
admCA1037@dss.ca.gov

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

Katherine Chang
(916) 653-1308
admGR237@dss.ca.gov 

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

Katie Girimonte
(916) 653-1363
admSOC242@dss.ca.gov

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

Minnie Yang
(916) 651-7173
admSOC808@dss.ca.gov

Fraud Programs

Automated Form Letters and Notices Contact Information

CA812: Quarterly Report of Overpayments and Collections (CalWORKs)

Eli Tuisku
(916) 653-1339
admCA812@dss.ca.gov

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

Eli Tuisku
(916) 653-1339
admDPA482@dss.ca.gov

DSS466: Fraud Investigations Activity Report

Eli Tuisku
(916) 653-1339
admDSS466@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

Chris Tai
(916) 653-1350
admABCD350@dss.ca.gov