Right Column
Farsi Translations
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 FilesFor Farsi forms beginning with the following letters click below:
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |- AD 501 (09/03) - Relinquishment In or Out-of-County (Birth Mother/Presumed Father in California)
- CW 8 (07/01) - Statement of Facts For An Additional Person
- CW 8A (03/00) - Statement Of Facts To Add A Child Under 16
- DFA 285-A1 (1/07) - 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 (04/99) - 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 377.4 QR (1/04) - Food Stamp Notice Of Change For Change Reporting Household
- DFA 377.4A (07/03) - Food Stamp Notice of Change
- DFA 377.5 (8/06) - Food Stamp Household Change Report
- DFA 377.7A (07/99) - 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 Inadvertent Household Errors Only Final Notice
- DFA 377.7C (05/02) - Food Stamp Repayment Agreement For Inadvertent Household Errors Only
- DFA 377.7D (06/01) - Food Stamp Repayment Notice For Administrative Errors Only
- DFA 377.7D1 (06/01) - 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 (05/02) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7G (05/02) - Food Stamp Repayment Agreement For An Intentional Program Violation (IPV) 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 377.9 (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 385 (05/99) - Application For Emergency Food Stamp Assistance
- DFA 386 (03/02) - Notice of Missed Interview
- DFA 387 (03/02) - Request For Information
- DPA 353 (4/00) - Notice Of Aid To Families With Dependent Children (AFDC) And/Or Food Stamp Administrative Disqualification Hearing
- DFA 478 (08/01) - Disqualification Consent Agreement Food Stamp Program
- DPA 435 (2/02) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification hearing)
- FS 11 ENG/FARSI (8/07) - Notice To All Food Stamp Recipients
- FS 13 ENG/FARSI (09/99) - Notice To All Food Stamp Household Members Who Must Pay Child Support Important - Please Read
- FS 17 ENG/FARSI (09/99) - 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 (3/05) -Food Stamp Program Qualifying Drug Felon Addendum
- GEN 1179 (11/07) - Complaint of Discrimination
- LIC 9224 (12/06) - Acknowledgement Of Receipt Of Licensing Reports
- NA 960X QR (7/04) - Notice Of Action - Stop Aid; Report Not Received
- NA 960Y QR (7/04) - Notice Of Action - Stop Aid; Report Incomplete
- NA 1215 (6/00) - Food Stamps Notice of Change
- NA 1216 (4/00) - Food Stamp Notice of Change
- NA Back9 - Your Hearing Rights
- PUB 13 (3/07) - Your Rights Pamphlet (Requires 8 1/2" x 14" paper printed landscape)
- PUB 373 (Print 8 1/2 X 11) (5/07) - Important Food Stamp Information For Noncitizens
- PUB 373 (Print 11 X 17) (5/07) - Important Food Stamp Information For Noncitizens
- PUB 387 (1/04) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp benefits. This is a VERY LARGE file. Please download it to your computer prior to opening it by using the instructions from item #2 on this page: Tips for Using Adobe PDF Files
- PUB 388 (1/04) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits. This is a VERY LARGE file. Please download it to your computer prior to opening it by using the instructions from item #2 on this page: Tips for Using Adobe PDF Files
- PUB 389 (1/04) California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase. This is a VERY LARGE file. Please download it to your computer prior to opening it by using the instructions from item #2 on this page: Tips for Using Adobe PDF Files
- PUB 390 (1/04) California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Buy Food. This is a VERY LARGE file. Please download it to your computer prior to opening it by using the instructions from item #2 on this page: Tips for Using Adobe PDF Files
- PUB 412 (4/04) - State Hearing Information
- QR 2 (06/04) - Reporting Changes For Your Cash Aid Assistance Unit And Food Stamp Household
- QR 3 (7/06) - Mid-Quarter Status Report For Cash Aid And Food Stamps
- QR 7 (04/03) - Quarterly Eligibility/Status Report
- QR 7 Addendum (04/03) - Instructions And Penalties Quarterly Eligibility/Status Report
- QR 7A (04/03) - How To Fill Out Your QR 7 Quarterly Eligibility/Status Report
- QR 22 (12/06) - Sponsored Noncitizens Applying For Or Receiving Cash Aid And/Or Food Stamps
- QR 72 (12/06) - Sponsor's Quarterly Income And Resources Report
- QR 377.1 (4/04)- Food Stamp Notice Of Approval
- QR 377.2 (4/04) - Food Stamp Notice Of Expiration Of Certification
- QR 377.4 (1/04) - Food Stamp Notice Of Change For Quarterly Reporting Household
- QR 377.5 (2/04) - Food Stamp Mid-Quarter Status Report
- SAWS 1 (12/06) - Application For Cash Aid, Food Stamps, And/Or Medi-Cal/State CMSP
- SAWS 2 (7/07) - Statement Of Facts For Cash Aid, Food Stamps, And medi-Cal/34-County Medical Services Program (CMSP)
- SAWS 2A QR (1/07) - Rights, Responsibilities And Other Important Information For The Cash Aid and Food Stamp Programs, and/or Medi-Cal/State-Run County Medical Services Program (CMSP)
- SOC 829 (3/08) In-Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form
- SOC 831 (3/08)- IHSS Provider Letter
- TEMP 2201 (07/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Request For A Designated Alternate Card Holder/Authorized Representative
- TEMP 2202 (07/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Service Request
- TEMP 2203 (07/02) - Request For Cash Aid Electronic Benefit Transfer - EBT Exemption
- TEMP 2214 (01/05) - Additional Information About Electronic Benefit Transfer (EBT)
- TEMP 2215 (07/02) - Electronic Benefit Transfer (EBT) Important Information
- TEMP NA 1232 (3/06) - Food Stamp Notice of Action - EBT Account
- TEMP NA 1238 (07/04) - Required Form - Substitute Permitted
- TEMP NA 1239 (3/04) - Food Stamp Notice of Approval/Termination Transitional Benefits
- TEMP QR 1 (8/03) - New Reporting Requirements For CalWORKs And Food Stamp Recipients