Right Column
Translated Russian Forms Beginning With The Letters A Through M
Problems with downloading forms? CDSS forms and publications are available only in Portable Document Format (PDF). For help with these files click here: Tips for Using Adobe PDF Files
The following are links to forms and publications on-line in Portable Document Format (pdf). If you have any problem reading these files, perhaps you do not have Adobe's free Acrobat Reader software. Download free Acrobat Reader .
Russian Forms beginning with the letters N through Z
For Russian Forms beginning with the following letters click below:
A | B | C | D | E | F | G | H | I | J | K | L | M
- ABCD 239.7A (08/01) - Notice Of Administrative Disqualification California Work Opportunity And Responsibility To Kids (CalWORKs) Program
- ABCD 478A (5/02) - Disqualification Consent Agreement California Work Opportunity And Responsibility To Kids (CalWORKs) Program
- AD 1C (3/06) - Consent To Adoption By Parent(s) (Outside California)
- AD 67 (2/07) - Information about The Birth Mother
- AD 67A (6/07) - Information About The Birth Father
- AD 880 (03/99) - Declaration Of Mother (To Be Completed By All Mothers Not Married To The Father Except When A Relinquishment Or Consent Has Been Obtained From The Father)
- AD 887 (3/08) - Statement Of Understanding - Independent Adoptions Program
- AD 908 (10/04) - Adoptions Information Act Statement
- AD 924 (3/06) - Independent Adoption Placement Agreement
- AD 926 (10/03) - Statement Of Understanding Independent Adoptions Program - Parent Who Places The Child With The Prospective Adoptive Parent(s)
- CCP 1 (1/08) - Declaration of Exemption from Trustline Registration and Health and Safety Self-Certification
- CCP 4 (1/08) - Health and Safety Self-Certification (for license exempt providers)
- CCP6 (8/99) - Health And Safety Checklist
- CCP 7 (1/08) - CalWORKs Stage One Child Care Request Form And Payment Rules
- CCP 2145 (5/04) - CalWORKs Child Care Reimbursement Report
- CALIFORNIA WORK OPPORTUNITY AND RESPONSIBILITY TO KIDS HANDBOOK
- CL 1 (4/99) - Cal-Learn Registration Program Information Orientation Appointment
- CL 2 (4/99) - Cal-Learn Program Requirements
- CL 3 (4/99) - Cal-Learn Notice Of A Participation Problem
- CL 4 (4/99) - Cal-Learn Notice To Parent/Legal Guardian Of Cal-Learn Participant
- CL 8 (3/99) - Cal-Learn Notice Of Report Card Submittal Schedule
- CL 9 (3/99) - Cal-Learn Notice Of Good Cause Determination
- CL 10 (4/99) - Cal-Learn Notice Of Exemption/Deferral
- CL 11 (4/99) - Cal-Learn Notice Of Incomplete Grades
- CW 2.1 N A(8/04) - Notice And Agreement For Child, Spousal And Medical Support
- CW 2.1Q (7/01) - Support Questionnaire
- CW 4 (06/02) - Immediate Need Payment Request
- CW 5 (07/01) - Veterans Benefits Verification and Referral
- CW 8 (07/01) - Statement of Facts For An Additional Person
- CW 8A (03/00) - Statement Of Facts To Add A Child Under 16
- CW 10 (07/01) - Notice of Withdrawn Application
- CW 13 (09/02) - Caretaker Relative Agreement
- CW 23 (03/00) - Senior Parent Statement Of Facts
- CW 25 (7/01) - Supplemental Statement Of Facts - Minor Parent
- CW 31 (5/04) - Receipt For Documents
- CW 40 - CalWORKs (03/00) - Reduced Income Supplemental Payment Request
- CW 42 (11/06) - Statement of Facts - Homeless Assistance
- CW 60 (05/01) - Release Of Information - Financial Institution
- CW 61 (07/01) - Authorization to Release Medical Information
- CW 61A (06/01) - Physical Capacities
- CW 61B (06/01) - Mental Capacities
- CW 63 (04/01) - Income And Eligibility Verification Form
- CW 71 (3/00) - Statement Of Cash Aid Mother And Unrelated Adult Male
- CW 81 (7/01) - Lien Agreement
- CW 82 (3/00) - Important Information About This Agreement
- CW 86 (3/00) - Agreement - Restricted Account - California Work Opportunity And Responsibility To Kids (Calworks) Program
- CW 87 (06/02) - Reinforming Letter/Add a Person(s) Program
- CW 88 (05/00) - Diversion Services Agreement CalWORKs Program
- CW 89 (02/03) - Application Withdrawl Request
- CW 103 (7/99) - Transitional Medi-Cal
- CW 2102 (8/00) - The Maximum Family Grant (MFG) Rule for Recipients of Cash Aid
- CW 2166 (11/06) Work Pays Notice
- CW 2184 (11/02) - CalWORKs 60-Month Time Limit
- CW 2186A (12/05) - CalWORKs Time Limit and Welfare to Work Participation Exemption Request Form
- CW 2186B (06/04) - CalWORKs and Welfare to Work Time Limit Exemption Determination
- CW 2187 (06/04) - Your CalWORKs 60-Month Time Limit
- CW 2188 (04/02) - Verification Of Aid For The Temporary Assistance For Needy Families (TANF) Program
- CW 2189 (6/02) - Notice of Your CalWORKs Time Limit - 54th Month On Aid
- CW 2190A (6/04) - CalWORKs 60-Month Time Limit Extender Request Form
- CW 2190B (6/04) - CalWORKs 60-Month Time Limit Extender Request Form
- CW 2200 (3/09) - Request For Verification Form
- DFA 285-A1 (4/09) - Application For Food Stamp Benefits
- DFA 285-A2 (8/06) - Statement Of Facts
- DFA 285-A3 QR (5/06) - Food Stamp Benefits Your Rights And Responsibilities
- DFA 285C (4/99) - Food Stamp Supplemental Application For Special Medical Deductions
- DFA 303 (03/05) - Replacement Affidavit/Authorization
- DFA 377.1 (11/01) - Notice of Approval
- DFA 377.1A (03/02) - Notice Of Denial Or Pending Status
- DFA 377.4A (07/03) - Food Stamp Notice of Change
- DFA 377.4 QR (1/04) - Food Stamp Notice of Change For Change Reporting Household
- DFA 377.5 (8/06) - Food Stamp Household Change Report
- DFA 377.7A (7/99) - Notice of Administrative Disqualification
- DFA 377.7B (12/03) - Food Stamp Repayment Notice For Inadvertent Household Errors Only
- DFA 377.7B1 (10/00) - Food Stamp Repayment Notice for Inadvertant Household Errors Only, Final Notice
- DFA 377.7C (5/02) - Food Stamp Repayment Notice for Inadvertent Household Errors Only
- DFA 377.7D (6/01) - Food Stamp Repayment Notice for Administrative Errors Only
- DFA 377.7D1 (6/01) - Food Stamp Repayment Notice for Administrative Errors Only
- DFA 377.7D2 (10/00) - Food Stamp Repayment Notice for Administrative Errors Only, Final Notice
- DFA 377.7D3 (12/03) - Food Stamp Repayment Notice For Administrative Errors Only
- DFA 377.7E (7/04) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7E1 (5/02) - Food Stamp Repayment Notice for Administrative Errors Only
- DFA 377.7F (08/01) - Food Stamp Repayment Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IVP
- DFA 377.7F1 (10/00) - Food Stamp Repayment Notice For An Intentional Program Violation (IPV) Only Final Notice
- DFA 377.7G (5/02) - Food Stamp Repayment Notice for Intentional Program Violation (IPV) Only
- DFA 377.9 (8/01) - Notice of Back Food Stamp Benefits
- DFA 377.10 (06/04) - Food Stamp Notice Of Discontinuance
- DFA 377.11 (9/04) - Food Stamp Notice Of Discontinuance - Failure To Meet The ABAWDs Work Rule
- DFA 377.11A (09/04) - Food Stamp Notice Of Continuance 1st Failure To Meet ABAWD Work Requirement
- DFA 377.11B (11/00) - Food Stamp Notice of Discontinuance, 2nd or Subsequent
- DFA 385 (05/99) - Application For Emergency Food Stamp Assistance
- DFA 386 (3/08) - Notice of Missed Interview
- DFA 387 (03/02) - Request For Information
- DFA 478 (08/01) - Disqualification Consent Agreement Food Stamp Program
- DPA 19 (4/07) - Authorized Representative
- DPA 315 (7/99) - Withdrawal/Conditional Withdrawals Of Request For Hearing
- DPA 353 (4/00) - Notice Of Aid To Families With Dependent Children (AFDC) And/Or Food Stamp Administrative Disqualification Hearing
- DPA 435 (2/02) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification hearing)
- FS 11 ENG/RS (8/09) - Notice To All Food Stamp Recipients
- FS 11B ENG/RS (4/09) - Notice To All Food Stamp Recipients - Important Please Read - Things You Need To Know
- FS 17 (9/99) - Notice To All Food Stamp Recipients - Important Information For Legal Immigrants
- FS 22 QR (12/06) - Applying For Food Stamp Benefits
- FS 23 QR (3/05) - Food Stamp Benefits How To Report Household Changes
- FS 26 (8/09) -Food Stamp Program Qualifying Drug Felon Addendum
- FS 27 (7/08) - Non-Assistance Food Stamps (NAFS) Household Recertification Form
- FS 28 Coversheet (10/08) - Food Stamp Program Restricted Account Coversheet - Important To Know
- FS 28A (10/08) - Food Stamp Program Restricted Account Agreement Part A
- FS 28B (10/08) - Food Stamp Program Restricted Account Agreement Part B
- FS 29 (5/08) - Food Stamp Recertification Appointment Letter
- FS 31 ENG/RS (2/09) - Notice To All Food Stamp Recipients - Important-Please Read - Things You Need To Know
- GEN 1179 (11/07) - Complaint of Discrimination
- KG 2 (08/02) - Statement Of Facts Supporting Eligibility For Kinship Guardianship Assistance Payment (Kin-GAP) Program
- LIC 200A (6/08) - Application for a Child Care Center License
- LIC 215 (07/04) - Applicant Information
- LIC 279 (2/09) - Application For A Family Child Care Home License
- LIC 283 (01/03) - Foster Family Home Application
- LIC 503 (03/99) - Health Screening Report - Facility Personnel
- LIC 508D (10/09) - Out-Of-State Disclosure And Criminal Record Statement
- LIC 610B (06/02)- Emergency Plan For Foster Family Homes
- LIC 613A (8/08) - Personal Rights - Child Care Centers
- LIC 613B (01/03) - Personal Rights - Children's Residential Facilities
- LIC 9058 (08/05) - Applicant/Licensee Rights
- LIC 9108 (3/05) - Statement Acknowledging Requirement To Report Suspected Child Abuse
- LIC 9163 (4/08) - Request For Live Scan Service - Community Care Licensing
- M16_105 (7/02) - EBT Dormant Account
- M16_120A (10/08) - EBT Dormant Account
- M16_120B (10/08) - EBT Dormant Account: Suspend
- M16_120C (7/02) - EBT Dormant Account - Reactivate
- M16_215 (7/02) - EBT Availability
- M16_325A (7/02) - EBT Exemption Request
- M16_325B (7/02) - EBT Incomplete Document
- M16_325C (7/02) - EBT Exemption Deny
- M16-325D (8/08) - EBT Exemption Ended
- M16-325E (8/08) - Direct Deposit Cancellation
- M16_505A (7/02) - Designated Alternate Cardholder
- M16_505B (7/02) - Designated Alternate Cardholder - Need Additional Facts
- M16_505D (7/02) - Designated Cardholder - Deny
- M16-701 (8/08) - EBT Adjustment Advice
- M16-705 (8/08) - EBT Adjustment Denial
- M20-003 (7/01) - Duplicate Aid Match, Discontinue
- M20-003A (7/01) - Duplicate Aid Match, Deny
- M20_353C (6/98) - Fraud, Penalty Applied to AU
- M20_353D (6/98) - Fraud, Penalty Applied to AU
- M20_353F (6/98) - Fraud, Penalty Stops - Change
- M40_105 (10/95) - Failed to Provide SSN/Cooperate - Change
- M40_105A (10/95) - Failed to Provide SSN/Partial Approval
- M40_105B (7/98) - Change: Required Documentation Received, Immunization
- M40_105C (7/98) - Change: Required Documentation NOT Received, Immunization
- M40_105D (7/98) - Change: Required Documentation Received, School Attendance
- M40_105E (7/98) - Change: Documentation Not Received, School Attendance
- M40_105I (3/00) - Deny: SFIS Requirements, Failure to Cooperate
- M40_105J (3/00) - Deny: SFIS Requirements, Refusal to Cooperate
- M40_107A (11/02) - Other: CalWORKs 60-Month Time Limit, Time on Aid (no previous NOA issued)
- M40_107B (11/02) - Other: CalWORKs 60-Month Time Limit, Time on Aid at Redetermination or Application (previously noticed)
- M40_107C (11/02) - Other: CalWORKs 60-Month Time Limit, Time on Aid at 54th and 58th
- M40_107E (4/04) - Change: CalWORKs 60-Month Time Limit, 60th month On Aid
- M40_107F (11/02) - Other: CalWORKs 60-Month Time Limit, Extended Beyond 60th month On Aid
- M40_107f1 (4/04) - Other: CalWORKs 60-Month Time Limit, Extended Beyond 60th month On Aid
- M40_107f2 (4/04) - Change: CalWORKs 60-Month Time Limit, Extender Met after 60th month
- M40_107G (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid
- M40_107H (11/02) - Change: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only
- M40_107I (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only
- M40_107J (11/02) - Partial Approval: CalWORKs 60-Month Time Limit, Time-Out Adult
- M40_107J1 (4/04) - Approval: Application Processing, Approval after 60-month On Aid
- M40_107k (4/04) - Change: CalWORKs 60-Month Time Limit, Increase Grant due to TOA Adjustment
- M40_118A (8/96) - Application Processing DENY
- M40_129D5 (10/95) - Immediate Need: Failed to Prove SSN App - Deny
- M40_171A (11/96) - Failure to Cooperate - DENY
- M40_171B (1/97) - Refusal to Cooperate - Denial
- M40_171C (6/98) - Approve: Application Processing, Basic Approval
- M40_171D (4/99) - Approve: Application Processing, Basic Approval
- M40_171M (7/87) - Denial: Application Processing, Not a California Resident
- M40_181A (11/99) - Application Processing: CA 2 Reverification/Otheressential Info
- M40_181E (7/98) - Denial: Application Processing, Not a California Resident
- M41_401A (12/86) - Denial: Deprivation, No Deprivation
- M41_440F (6/98) - DENY: Deprivation, CalWORKs-U, 100 Hours Work Rule
- M41_450A (1/98) - Deprivation: Uniformed services - DENY
- M42_101B (5/87) - Age and School Requirements (Change)
- M42_101C (5/87) - Age and School Requirements (Discontinue)
- M42-207A (7/98) - DENY: Property, $2,000 Property Limit
- M42_221K (4/99) - Suspend: Property, Transfer w/out Fair Consideration
- M42_221L (4/00) - Suspend: Income, Transfer w/out Fair Consideration
- M43_119E (1/98) - Sponsored Non-Citizen: Some needs Met - Change
- M43_119G (1/98) - Sponsored Non-Citizen: Missing CA 72 - Change
- M43_119I (7/98) - Change: Sponsored Alien, Deemed & Family Property
- M43_119J (7/98) - Change: Sponsored Alien, Deemed Property
- M43_119K (7/98) - DENY: Sponsored Alien, Deemed Property & Family Property
- M43_119L (7/98) - DENY: Sponsored Alien, Deemed Property
- M43_119M (1/98) - Sponsored non-Citizen: Deemed Income-Change
- M44_113A (6/98) - Change: Income, Change in Income
- M44_113G1 (6/98) - Change: Income, Change in Income
- M44_133D (6/98) - Change: Income, Change in Income
- M44_133Q (6/98) - Change: Income, Change in Income
- M44_133S (10/02) - Minor Parent Financial Eligibility (Change)
- M44_133S1 (10/02) - Financial Eligibility (Change)
- M44_133T (10/02) - Minor Parent Financial Eligibility (Denial)
- M44_133V (10/02) - Minor Parent Financial Eligibility (Suspend)
- M44_207J (6/98) - DENY: Income, Financial Eligibility Test
- M44_207K1 (10/02) - Minor Parent Financial Eligibility (Discontinue)
- M44_207K2 (10/02) - Financial Eligibility (Discontinue)
- M44_207L (6/98) - SUSPEND: Income, Financial Eligibility Test
- M44_211L (7/01) - Change: Special Needs - Pregnancy
- M44_305 (9/97) - Minor Parent Change of Payee
- M44_307A (11/02) - Voucher Vendor Payment
- M44_307B (1/99) - Voucher/Vendor Payment
- M44_307C (7/98) - Voucher Vendor Payment
- M44_314 (11/00) - Increase in MAP
- M44_314a (11/00) - Other: Aid Payments
- M44_314b (11/00) - Change: Aid Payments
- M44_314c (9/97) - Change: Aid Payments
- M44_315 (8/04) - Law Change - Increase in Map
- M44_315B (9/98) - CHANGE: Aid Payment Levels, ICT between Reg-2
- M44-315C (4/09) - Notice of Action - Four Percent Grant Reduction
- M44_340 (4/01) - Approval: Underpayments, Underpayment Adjustment
- M44_340A (7/05) - Approval: Underpayments, Underpayment Adjustment
- M44_350A (1/98) - Change: Excess Property Overpayment Adjustment w/out Good Faith
- M44_350E (1/98) - Change: Excess Property Overpayment Adjustment w/out Good Faith
- M44_350F (1/98) - Demand: Excess Property Overpayment Adjustment w/out Good Faith
- M44_350G (1/98) - Change: Excess Property Overpayment Adjustment w/Good Faith
- M44_350H (1/98) - Demand: Excess Property Overpayment Adjustment w/Good Faith - MFG
- M44_352A (1/98) - Demand: Notice of Overpayment - MFG
- M44_352C (1/98) - Change: Overpayment Recovery - MFG
- M44-352D (1/98) - Overpayment Recovery, Change
- M44-352G (1/98) - Demand Overpayment
- M44_401A (6/98) - Approve: Hardship Supplement RISP - MF G
- M44_401B (6/98) - Deny: Hardship Supplement RISP - MFG
- M81_215A (6/98) - DENY: Aid Payments, Diversion payment provided
- M81_215B (6/98) - DENY: Aid Payments, Diversion services provided
- M81_215D (6/98) - Change: Aid Payments, Diversion Repayment Stops
- M81_215E (6/98) - Other time limit, Diversion
- M81_215F (6/98) - Other time limit, Diversion
- M82-506 (6/98) - Change: Assignment of Support Rights, Failure to Cooperate
- M82-506A (6/98) - Partial Approval: Assignment of Support Rights, Failure to Cooperate
- M82-510 (6/02) - Failure to Cooperate, Change
- M82-510A (6/98) - Change: Support Process/Assignment, Cooperate
- M82-820A (1/00) - Deny: AU Composition - No Eligible Person
- M82-832A (2/99) - Change: Aid Payments, Fleeing Felons
- M82-832B (2/99) - Partial Approval: Application Processing, Fleeing Felons
- M82-832C (1/99) - Partial Approval: Application Processing, Drug Felons
- M82-832D (1/99) - Change: Aid Payments, Drug Felons
- M82-832E (12/99) - Change: Aid Payments, Eligible Person Leaving AU
- M82-832F (1/02) - Eligible Person Leaving AU, Discontinue
- M89_110 (1/98) - Exempt: Change
- M89_110A (1/98) - Non-Exempt Change
- M89_110B (1/98) - Exemption: Deny
- M89_201 (11/96) - Minor Parent exemption: Deny
- MT42_101.2A (8/04) - Fry vs Saenz Lawsuit 18 year old - (Rescind Discontinuance)
- MT42_101.2B (8/04) - Fry vs Saenz Lawsuit 18 year old - Change
- MT42_101.2C (8/04) - Fry vs Saenz Lawsuit 18 year old - Change
- MT42_101.2D (11/04) - Fry vs Saenz Lawsuit Age Requirement - Change
- MT42_101.2E (11/04) - Fry vs Saenz Lawsuit Age Requirement - Discontinue