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 18: CalFresh Churn Monthly Report

Justin Brooks
(916) 651-8973
admCF18@dss.ca.gov

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)

  • CF358FS Automated Form (Updated 09/10/21)
  • Effective July 2021 report month
  • Automated form combines the CF 358F and CF 358S reports 

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

Jiawen Hu
(916) 653-1448
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

DSSDB@dss.ca.gov

CA237HA: Homeless Assistance Program Monthly Statistical Report

admCA237HA@dss.ca.gov

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

admCCB18@dss.ca.gov

CW115: Child Care Monthly Report (CalWORKs Families)

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

admCW115@dss.ca.gov

FSP14: Family Stabilization Program

admFSP14@dss.ca.gov

HDAP18: Housing and Disability Advocacy Program (HDAP)

admHDAP18@dss.ca.gov

HSP14: Housing Support Program (HSP)

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

HVP19: Home Visiting Program (HVP)

admHVP19@dss.ca.gov

STAT45: Teen Parent Cal-Learn Program

admSTAT45@dss.ca.gov

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

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

admWTW25@dss.ca.gov

admWTW25A@dss.ca.gov   

Childen's Programs

Automated Form Letters and Notices Contact Information

AD202B: Intercountry Adoption Program

Erwin Briones
(916) 653-1947
admAD202B@dss.ca.gov

AD42I: Independent Adoption Program (Individual Case)

Erwin Briones
(916) 653-1947
admReportAD42I@dss.ca.gov

AD56D: Independent Adoption Program and Adoption Set-Asides

Erwin Briones
(916) 653-1947
admAD56D@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admCA237EA@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admCA237FC@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admCA237KG@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admCA237KGF@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admFCAAP84@dss.ca.gov

LIC181: Licensing of Facilities for Children

admLIC181@dss.ca.gov

RFA181: Resource Family Approval (RFA)

admRFA181@dss.ca.gov

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

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

admSOC405X@dss.ca.gov

admSOC405XP@dss.ca.gov  

Disability and Adult Programs

Automated Form Letters and Notices Contact Information

ABD216: Adult Programs

admABD216@dss.ca.gov

CA1037: Cash Assistance Program for Immigrants

admCA1037@dss.ca.gov

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

Navin Watmore
(916) 653-1322
admGR237@dss.ca.gov 

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

admSOC242@dss.ca.gov

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

admSOC808@dss.ca.gov

Fraud Programs

Automated Form Letters and Notices Contact Information

CA812: Quarterly Report of Overpayments and Collections (CalWORKs)

admCA812@dss.ca.gov

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

admDPA482@dss.ca.gov

DSS466: Fraud Investigations Activity Report

admDSS466@dss.ca.gov

Immigration Programs

Automated Form Letters and Notices Contact Information

FY 20-21 IS-DACA: Deferred Action for Childhood Arrivals Application Assistance Quarterly Report

  • Report Instructions

admISDACA@dss.ca.gov

FY 20-21 IS-EO: Education and Outreach Quarterly Report

  • Report Instructions

admISEO@dss.ca.gov

FY 20-21 IS-EOW: Education and Outreach Workshop/ Online Events Quarterly Report

  • Report Instructions

raddISEOW@dss.ca.gov

FY 20-21 IS-LC: Legal Consultation Quarterly Report
  • Report Instructions 

admISLC@dss.ca.gov

FY 20-21 IS-LTTA: Legal Training and Technical Assistance Quarterly Report
  • Report Instructions

admISLTTA@dss.ca.gov

FY 20-21 IS-NAT: Naturalization Application Assistance Quarterly Report
  • Report Instructions 

admISNAT@dss.ca.gov

FY 20-21 IS-AIR: Affirmative Immigration Remedies Application Assistance Quarterly Report
  • Report Instructions 

raddISAIR@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

  • ABCD350 Automated Form
  • Effective July 2020 report month

admABCD350@dss.ca.gov