Hindi

Hindi Translations

Problems with downloading forms? CDSS forms and publications are available only in Portable Document Format (PDF). Tips for Using Adobe PDF Files

Forms translated into HINDI

A | C | D | E | F | G | L | M | N | P | T | W |

A

• AD 1A (4/15) - Consent To Adoption By Parent(s) (In or Out-of-California) - Independent Adoption Program
• AD 67 (5/15) - Information About The Birth Mother - Agency And Independent Adoptions Program
• AD 67A (7/15) - Information About The Birth Father - Agency And Independent Adoptions Program
• AD 908 (9/15) - Adoptions Information Act Statement
• AD 929 (8/11) - Waiver Of Right To Revoke Consent Independent Adoption Program - Independent Adoptions Program

C

• CCP 4 (8/21) - Health And Safety Self-Certification (For license-exempt providers)
• CF 11 (8/20) - Notice To All CalFresh Recipients - Important - Please Read - Use Starting October 1, 2020
• CF 11 (9/21) - Notice To All CalFresh Recipients - Important - Please Read - Use Starting October 1, 2021
• CF 34 (12/20) – CalFresh Notice of Change: Semi-Annual Reporting Eliminated
• CF 285A (11/21) - Application For CalFresh Benefits
• CF 377.1 (5/20) - Notice Of Approval For CalFresh Benefits
• CF 377.1LP (5/20) - Notice Of Approval For CalFresh Benefits - Large Print 
• CF 377.1A (8/21) - Notice Of Denial Or Pending Status
• CF 377.2B (12/20) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members
• CF 377.2C (12/20) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members
• CF 377.9 (8/20) - Notice Of Back CalFresh Benefits
• CF 377.9LP (8/20) - Notice Of Back CalFresh Benefits - Large Print
• CF 1239 (12/20) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
• CR 6181 (11/20) - Interpreter Services Statement And Confidentiality Agreement
• CTRI 01 (10/20) - California Tax Return Information (CTRI) Notification To Client
• CW 52 (10/20) – California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Instead Of Cash Grant Option
• CW 63 (11/20) - Request For Income And/Or Resource Verification
• CW 2166 (12/20) - Multilingual Work Really Pays! Here's How - Use Starting June 1, 2021
• CW 2166 (4/21) - Multilingual Work Really Pays! Here's How - Use Starting May 1, 2022
• CW 2166 (11/21) - Multilingual Work Really Pays! Here's How - Use Starting June 1, 2022
• CW 2184 (4/21) - CalWORKs 60-Month Time Limit - Use Starting May 1, 2022
• CW 2186A (4/21) - CalWORKs Exemption Request Form - Use Starting May 1, 2022
• CW 2186B (4/21) - CalWORKs Exemption Determination - Use Starting May 1, 2022
• CW 2187 (4/21) - Your CalWORKs 60-Month Time Limit - Use Starting May 1, 2022
• CW 2189A (9/20) – Notice Of Your CalWORKs Time Limit – 54TH Month On Aid (Use Starting May 1, 2022)
• CW 2189B (9/20) – Notice Of Your CalWORKs Time Limit – 57TH Month On Aid (Use Starting May 1, 2022)
• CW 2190A (4/21) - CalWORKs 60-Month Time Limit Extender Request Form - Use Starting May 1, 2022
• CW 2190B (4/21) - CalWORKs 60-Month Time Limit Extender Determination Form - Use Starting May 1, 2022
• CW 2191 (4/21) - Time On Aid Verification For CalWORKs/TANF 60-Month Time Limits - Use Starting May 1, 2022
• CW 2192 (4/21) - Tracking Non-California TANF Assistance For Time Limits - Use Starting May 1, 2022
• CW 2215 (10/20) - California Work Opportunity and Responsibility to Kids (CalWORKs) Important Information for Safety Net And Certain Child-Only Case
• CW 2218 (6/21) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-Needy Caretaker Relative With Relative Foster Child) - Use Starting June 1, 202
• CW 2218 (3/22) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-Needy Caretaker Relative With Relative Foster Child) - Use Starting June 1, 2022 

D

• DPA 19 (6/22) - Appointment Of Authorized Representative

E

• EBT 1232 (6/22) - CalFresh Notice Of Action - EBT Account
• EBT 2260 (8/21) - Excessive Card Replacement Warning Letter
• EFA 7 (7/21) - The Emergency Food Assistance Program (TEFAP) Certification Of Eligibility
• EFA 7A ENG/HINDI(3/11) - Emergency Food Assistance Program (EFAP) Certification Of Eligibility
• EFA 14 (6/22) - The Emergency Food Assistance Program (TEFAP) 2022 Income Guidelines​
• EFA 15 (6/22) - Alternate Pick-Up Request Form The Emergency Food Assistance Program (TEFAP) 2022 Income Guidelines​

Back to Top

F

• FSP 2 (1/21) - Family Stabilization Program Denial Notice - Use Starting May 1, 2022

Back to Top

G

• GEN 102 (1/22) - Appointment Letter
• GEN 1179 (5/18) - Complaint of Discrimination

L

• LIC 184B (3/22) - Notification Of Incomplete Application - Family Child Care Home
• LIC 198 (1/22) - Child Abuse Central Index Check For County Licensed Facilities
• LIC 279B (1/22) - Current Children In Your Home - Application For A Family Child Care Home License
• LIC 300A (01/22) - Removal Confirmation - Exemption Needed
• LIC 421A (6/22) - Civil Penalty Assessment (Unlicensed Facility)
• LIC 610A (01/22) - Emergency Disaster Plan For Family Child Care Homes
• LIC 700 (10/19) - Identification And Emergency Information Child Care Centers/Family Child Care Homes
• LIC 9052 (1/22) - Notice Employee Rights
• LIC 9058 (3/22) - Applicant/Licensee Rights
• LIC 9217 (5/22) - Pre-Licensing Readiness Guide - Family Child Care Home

M

• M40-107 (4/21) - Addendum 1 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107 (4/21) - Addendum 2 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107A (4/21) - Time On Aid (no previous NOa issued), Other - Use Starting May 1, 2022
• M40-107B (4/21) - Time On Aid at Redetermination - Use Starting May 1, 2022
• M40-107C1 (9/20) - Time on Aid Between 54th and 57th Month - Use Starting May 1, 2022
• M40-107D (4/21) - Time On Aid To Former CalWORKs Recipients - Use Starting May 1, 2022
• M40-107F (4/21) - Extended Beyond 60 Months of Aid - Use Starting May 1, 2022
• M40-107F1 (4/21) - Extender Met After 60th Month - Use Starting May 1, 2022
• M40-107F2 (4/21) - Extender Ended - Use Starting May 1, 2022
• M40-107G (4/21) - 60th Month On Aid, Discontinue - Use Starting May 1, 2022
• M40-107I (7/22) - 60th Month On Aid, No eligible child, Discontinue
• M40-107J (4/21) - Timed-Out Adult, Partial Approval - Use Starting May 1, 2022
• M40-107J1 (4/21) - Approval After 60 Months on Aid - Use Starting May 1, 2022
• M40-107K (4/21) - Increase Grant due to TOA Adjustment - Use Starting May 1, 2022
• M40-129B (11/09) - Full Payment - Approve
• M40-129B1 (12/90) - Approval after Immediate Need Payment, Approve
• M40-129C (12/90) - Miscellaneous, Deny
• M40-129D2 (12/90) - Procedural Requirements, Deny
• M40-129D3 (12/90) - Procedural Requirements, Deny
• M40-129D4 (9/00) - Procedural Requirements, Deny
• M40-129D5 (11/14) - Failed to Provide Proof of SSN Application, Deny  
• M40-129E1 (12/90) - No Emergency, Deny
• M40-129E2 (12/90) - No Emergency, Deny
• M40-129E4 (12/90) - No Emergency, Deny
• M40-129E5 (12/90) - No Emergency, Deny
• M40-129E6 (12/90) - No Emergency, Deny
• M40-181F (7/22) - No Change at Redetermination​
• M40-195A (8/22) - ICT Notice Of Transfer, Sending
• M40-195B (8/22) - ICT Notice Of Transfer, Receiving
• M44-133T (9/20) - Minor Parent, Financial Eligibility, Partial Approval
• M44-207K (5/20) – Financial Eligibility, Discontinue
• M44-207K1 (5/20) - Minor Parent, Financial Eligibility
• M44-207M (8/20) - Financial Eligibility, Deny
• M44-211N (9/21) - No Longer Pregnant, Change
• M44-315A (5/20) - $10 Minimum Payment, Change - Use Until April 30, 2022
• M44-315A (8/21) - $10 Minimum Payment, Change - Use Starting May 1, 2022
• M44-350K (11/21) - EBT Replacement Denial
• M81-215E (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M81-215F (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M82-820A (9/21) - No Eligible Person, Deny
• M82-832H (10/20) - Child Does Not Meet Requirements (SB 380)

N

• NA Back 9 (5/22) - Your Hearing Rights (Full Rights Are Listed in CDSS PUB 412)
• NA 200 (12/20) - Notice Of Action - Multipurpose - Include Budget - Use Starting June 1, 2021
• NA 200 (7/21) - Notice Of Action - Multipurpose - Include Budget - Use Starting June 1, 2022
• NA 210 (5/20) - Discontinue, Suspend Financial Eligibility - Use Starting June 1, 2020
• NA 213 (10/21) - Deny - Financial Eligibility
• NA 213A (12/20) – Notice Of Action – Deny – Financial Eligibility - Use Starting June 1, 2021
• NA 213A (7/21) – Notice Of Action – Deny – Financial Eligibility - Use Starting June 1, 2022
• NA 271 (12/20) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid - Use Starting June 1, 2021
• NA 271 (7/21) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid - Use Starting June 1, 2022
• NA 274H (12/20) - Notice Of Action - Continuation Page - Overpayment Computations Between 6/1/2020 and 05/31/2021
• NA 274I (7/21) - Notice Of Action - Continued - Overpayment Amount Owed For Overpayments Occurring Between 6-1-2021 and 5-31-2022
• NA 274J (7/21) - Notice of Action – Continued - Overpayment Amount Owed For Overpayments Occurring On or after 6-1-2022
• NA 281C (12/20) - Notice Of Action Continuation Page - Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2020 and 5-31-2021) – Use Starting June 1, 2021
• NA 281D (7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2021 and 5-31-2022)
• NA 281E (7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring On Or After 6-1-2022)
• NA 290 (2/14) -Notice Of Action - Multipurpose
• NA 300 (7/19) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Test - Use Until May 31, 2021
• NA 300 (10/21) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Tests - Use Starting June 1, 2021
• NA 301 (10/21) - Continuation Page - Applicant Financial Eligibility Test
• NA 530 (4/21) - Notice Of Action - 60-Month Time Limit - Use Starting May 1, 2022
• NA 531 (7/19) - Notice Of Action - Continuation Page - 48-Month Time Limit - Use Starting June 1, 2020
• NA 531 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget - Use Starting May 1, 2022
• NA 531 (7/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget - Use Starting June 1, 2022
• NA 532 (12/20) - Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue - Includes Budget - Use Starting June 1, 2021
• NA 532 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit Discontinue - Includes Budget - Use Starting May 1, 2022
• NA 532 (11/21) - Notice Of Action - Continuation Page - 60-Month Time Limit Discontinue - Includes Budget - Use Starting June 1, 2022
• NA 1239 AR (12/20) - Notice Of Action - Continuation Page - Annual Reporting Budget  - Use Starting June 1, 2021
• NA 1239 AR (8/21) - Notice Of Action - Continuation Page - Annual Reporting Budget - Use Starting June 1, 2022
• NA 1239 SAR (12/20) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget - Use Starting June 1, 2021
• NA 1239 SAR (8/21) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget - Use Starting June 1, 2022

P

• PUB 13 (5/22) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California​
• PUB 470 (4/21) - Your Rights Under Adult Protective Services
• PUB 520 (11/21) - Great News! Based On Your Medi-Cal Eligibility Your Household May Be Eligible For CalFresh Food Benefits

T

• TEMP 2250 (7/22) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients​
• TEMP 2252 (12/20) - State Law Changes The CalWORKs Earned Income Disregard - Use Starting June 1, 2021
• TEMP 2252 (3/22) - State Law Changes The CalWORKs Earned Income Disregard - Use Starting June 1, 2022
• TEMP CW 2225 (10/20) - Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Disregard/Pass-Through Rules
• TEMP 3022 - (8/21) - Important Information For CalWORKs Families -State Law Increases The CalWORKs Time Limit To 60 Months
• TM44-315K (7/19) - Law Change To MAP Levels
• TM44-315M (7/22) - Law Change To MAP Levels
• TNB 4 (8/20) - Notice Of Recertification For Transitional Nutrition Benefit (TNB) Program

W

• WI 10072A (11/21) - EBT Replacement Approval
• WI 10072B (11/21) - EBT Replacement Review
• WTW 2 (5/21) - Welfare To Work Plan Activity Assignment - Use Starting May 1, 2022
• WTW 16A (12/20) - Grant-Based OJT Income Examples For Region 1 - Use Starting June 1, 2021
• WTW 16A (3/22) - Grant-Based OJT Income Examples For Region 1 - Use Starting June 1, 2022
• WTW 16B (12/20) - Grant-Based OJT Income Examples For Region 2 - Use Starting June 1, 2021
• WTW 16B (3/22) - Grant-Based OJT Income Examples For Region 2 - Use Starting June 1, 2022
• WTW 51 (1/21) - Welfare To Work Noncompliance Checklist Tool - Use Starting May 1, 2022