Right Column
Vietnamese Translations
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- AAP 1 (06/01) - Request For Adoption Assistance (With Calculation)
- AAP 3 (06/01) - Reassessment Information Adoption Assistance Program
- ABCD 239.7A (8/01) - 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 1A (08/02) - Consent To Adoption By Parent(s) (In California)
- AD 1C (08/02) - Consent To Adoption By Parent(s) (Outside California)
- AD 9 (10/03) - Independent Adoption Questionnaire
- AD 67 (2/07) - Information about The Birth Mother
- AD 67A (6/07) - Information About The Birth Father
- AD 100 (2/08) - Authorization For Use And/Or Disclosure Of Health Information Independent Adoption Program
- AD 501 (09/03) - Relinquishment In or Out-of-County (Birth Mother/Presumed Father in California)
- 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 885 (3/06) - Mother Or A Presumed Father Of A Child Who Is Not Detained, A Juvenile Court Dependent In Out-of-home Care, Or The Ward Of A Legal Guardian
- AD 908 (10/04) - Adoptions Information Act Statement
- AD 918 (11/03) - Family Assessment Questionnaire II
- AD 922 (7/99) - Relinquishment Addendum
- AD 4310 (10/99) - Adoption Programs Notice Required By Information Practices Act
- AD 4324 (10/03) Adoption Questionnaire I This is a large PDF file. Click here if you have problems with it: Tips for Using Adobe PDF Files
- CALIFORNIA WORK OPPORTUNITY AND RESPONSIBILITY TO KIDS HANDBOOK
- CCAP (10/99) - Family Child Care Self-Assessment Guide
- CCAP (10/99) - Family Child Care - Guide to Waivers, Exceptions and Exemptions
- CCP 1 (4/99) - Declaration of Exemption from Trustline Registration and Health and Safety Self-Certification
- CCP 4 (4/99) - Health and Safety Self-Certification (for license exempt providers)
- CCP 6 (8/99) - Health And Safety Checklist
- CCP 7 (2/05) - CalWORKs Stage One Child Care Request Form And Payment Rules
- CCP 2145 (5/04) - CalWORKs Child Care Reimbursement Report
- 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 (6/02) - 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 (3/00) - Statement Of Facts To Add A Child Under Age 16
- CW 10 (07/01) - Notice of Withdrawn Application
- CW 13 (09/02) - Caretaker Relative Agreement
- CW 23 (3/00) - Senior Parent - Statement Of Facts
- CW 25 (7/01) - Supplemental Statement Of Facts - Minor Parent
- CW 40 (3/00) - CalWORKs - Reduced Income Supplemental Payment Request
- CW 43 (3/00) - CalWORKs Applicant Choice Form Immediate Need Payment/Expedited Grant
- 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 (UAM)
- CW 81 (07/01) - 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 (6/02) - 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 (07/02) - Work Pays Notice
- CW 2184 (11/02) - CalWORKs 60-Month Time Limit
- CW 2187 (06/04) - Your CalWORKs 60-Month Time Limit
- CW 2188 (4/02) - 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) - 60-Month Time Limit Extender Request Form
- CW 2190B (6/04) - 60-Month Time Limit Extender Request Form
- 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 377.2 (11/03) - Food Stamp Notice of Expiration Of Certification For Change Reporting Household
- 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 (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 377.7F (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 (05/02) - Food Stamp Repayment Agreement For An Intentional Program Violation (IPV) Only
- DFA 377.9 (8/01) - Notice Of Back Food Stamp Benefits
- DFA 377.10 (6/04) - Food Stamp Notice Of Disqualification
- DFA 377.11 (9/04) - Food Stamp Notice Of Discontinuance - Failure To Meet The ABAWDs Work Rule
- DFA 377.11A (9/04) - 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
- 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 5 (08/94) - Notice To All Food Stamp Recipients
- FS 9 (03/01) - Food Stamps Important Information
- FS 11 ENG/VT (08/07) - Notice To All Food Stamp Recipients
- FS 13 ENG/VIETNAMESE (09/99) - Notice To All Food Stamp Household Members Who Must Pay Child Support Important - Please Read
- FS 17 (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
- KG 2 (08/02) - Statement Of Facts Supporting Eligibility For Kinship Guardianship Assistance Payment (Kin-GAP) Program
- LIC 508 (01/03) - Criminal Record Statement
- LIC 508D (12/07) - Criminal Record Statement (Foster Family Homes, Small Family Homes, Certified Family Homes)
- LIC 613A (6/05) - Personal Rights - Child Care Centers
- LIC 9150 (3/05) - Parent Notification Additional Children in Care
- LIC 9151 (3/05) - Property Owner/Landlord Notification Family Child Care Home
- LIC 9224 (12/06) - Acknowledgement Of Receipt Of Licensing Reports
- M16_105 (7/02) - EBT Dormant Account
- M16_120A (7/02) - EBT Dormant Account Inform
- M16_120B (7/02) - EBT Account Aging - 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_505A (7/02) - Designated Alternate Cardholder
- M16_505B (7/02) - Designated Alternate Cardholder - Need Additional Facts
- M16_505D (7/02) - Designated Cardholder - 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_107 (11/02) - Addendum 1
- M40_107 (11/02) - Addendum 2
- 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_157A1 (5/91) - Incomplete Citizen/Alien Documentation: Approval
- 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_181D (5/91) - Denial: Application Processing, Not a California Resident
- 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
- M44-307C (7/98) - Voucher/Vendor Payment, Change
- 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_315b (9/98) - CHANGE: Aid Payment Levels, ICT between Reg-2
- M44_340 (4/00) - 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) - Change: Priority order Overpayment Recoupment - MFG
- M44_352G (1/98) - Demand: Overpayment - MFG
- M44_401A (6/98) - Approve: Hardship Supplement RISP - MFG
- 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
- M82-510A (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
- M82-836A (8/91) - Denial: Au Composition, Unborn not Eligible for Aid
- 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 v. Saenz Lawsuit, Age Requirement, Change
- MT42-101.2E (11/04) - Fry v. Saenz Lawsuit, Age Requirement, Discontinue
- NA 200 (01/02) - Multipurpose
- NA 210 (01/02) - Discontinue, Suspend Financial Eligibility
- NA 211 (01/00) - Notice of Action
- NA 213 (01/02) - Deny - Financial Eligibility
- NA 214 (01/02) - Discontinue, Suspend Transfer of Property
- NA 290 (01/02) - Multipurpose Required Form - Substitute Permitted
- NA 281 (04/00) - Underpayment Amount Owed (For Underpayment Occurring On Or After 01/01/98)
- NA 530 (11/02) - 60 Month Time Limit - Required Form - No Substitute Permitted
- NA 531 (6/04) - Continuation Page - 60 Month Time Limit - includes Budget
- NA 532 (12/02) - Continuation Page 60 Month Time Limit Discontinue - Includes Budget
- NA 690 (3/03) – IHSS Notice of Action
- NA 692 (12/07) - Notice Of Change Cash Assistance Program For Immigrants (Capi)
- NA 693 (04/99) - Notice Of Approval Cash Assistance Program For Immigrants (Capi)
- NA 801 (11/99) - Notice of Action
- NA 802 (11/99) - Notice of Action
- NA 803 (11/99) - Notice of Action (Continued)
- NA 820 (01/01) - Notice Of Action - Transportation Approval
- NA 821 (01/01) - Notice Of Action - Transportation Approval/Denial
- NA 822 (01/01) - Notice Of Action - Transportation Change
- NA 823 (08/00) - Notice Of Action - Ancillary Expenses Approval/Denial
- NA 824 (04/99) - Notice Of Action
- NA 825 (08/00) - Notice Of Action - Payment Adjust Transportation
- NA 827 (07/99) - Notice Of Action - Recoupment Unused Advance Payment
- NA 828 (07/99) - Notice Of Action - Transportation And Ancillary Exp Overpayment
- NA 832 (04/99) - Notice of Action - CCP Approval
- NA 833 (06/99) - Notice of Action - CCP Change
- NA 834 (06/99) - Notice of Action - CCP Denial
- NA 835 (07/99) - Notice of Action - CCP Discontinuance
- NA 840A (10/03) - Notice Of Action - Cash Aid
- NA 843 (06/99) - Notice of Action - Ineligible
- NA 844 (08/99) - Notice of Action - Adequate Progress
- NA 960XQR (07/04) - Stop Aid; Report Not Received
- NA 960YQR (07/04) - Stop Aid; Report Incomplete
- NA 991 (10/03) - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
- NA 992 (05/03) - Refugee Cash Assistance (RCA) Application Approval
- NA 995 (02/00) - Food Stamp Notice Of Denial/Disqualification For The California Food Assistance Program
- NA 1205 (01/00) - Notice of Action
- NA 1208 (02/00) - Notice Of Action - Basic Approval
- NA 1209 (02/02) - Notice of Action - Change In The Amount Of Kin-Gap Payment
- NA 1211 (02/00)- Notice Of Action - Denial
- NA 1212 (02/00) - Notice Of Action - Discontinue Property
- NA 1213 (02/00) - Notice Of Action - Discontinue Restricted Account
- NA 1214 (02/00) - Notice Of Action - Change Under/Overpayment
- NA 1216 (04/00) - Food Stamp Notice Of Change
- NA 1230 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Approval
- NA 1231 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Partial Waiver Approval
- NA 1232 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Denial
- NA 1239 (5/04) - Continuation Page - Quarterly Reporting Budget
- NA 1240 (05/05) - Food Stamp Overissuance & Dormant EBT account
- NA Back 9 - Your Hearing Rights
- PUB 13 (3/07) - Your Rights Pamphlet (Requires 8 1/2" x 14" paper printed landscape)
- PUB 104 (12/06) - In-Home Supportive Services Individual Provider Benefits and Services Information
- PUB 129 (01/04) - Child Abuse Reporting And You - What happens When A Report Is Made?
- PUB 244 (12/03) - ESTABLISHING PATERNITY FOR YOU AND YOUR CHILD
- PUB 275 (1/04) - Family Planning...Making the Commitment for a Healthy Future
- PUB 337 (1/04) - STATEWIDE FINGERPRINT IMAGING SYSTEM
- PUB 367 (1/04) - Reach For Your Dreams With Cal-Learn
- PUB 370 (10/05) - Public Benefits For Asylees In California
- 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 large PDF file. Please save it to your computer before opening and printing. For help with these files click here: Tips for Using Adobe PDF Files
- PUB 388 (01/04) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits. Single Column . This is a large PDF file. Please save it to your computer before opening and printing. For help with these files click here: 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 .
- PUB 412 (4/04) - State Hearing Information
- QR 2 (6/04) - Reporting Changes For Your Cash Aid Assistance Unit And Food Stamp Household
- QR 3 (07/06) - Mid-Quarter Status Report For Cash Aid And Food Stamps
- QR 7 (04/03) - 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 25A (5/04) - Payee Agreement For Minor Parent
- QR 72 (12/06) - Sponsor's Quarterly Income And Resources Report
- QR 73 (6/04) - Senior Parent Quarterly Income Report
- QR 377.1 (04/04) - Food Stamp Notice Of Approval For Quarterly Reporting Household
- QR 377.2 (04/04) - Food Stamp Notice Of Expiration Of Certification - Quarterly Reporting
- 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
- QR 2103 (5/05) - Reminder For Teens Turning 18 Years Old
- RCA 43 (5/03) - Refugee Cash Assistance (RCA) Notice Of A Participation Problem
- RCA 44 (5/03) - Refugee Cash Assistance (RCA) Notice Of No Good Cause Determination And Compliance Plan Appointment
- RS 3 (5/03) - Service Provider Referral/Notification Form
- RS 36 (10/03) - Employment And Training Requirements For Refugee Cash Assistance(RCA)
- 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 State Run County Medical Services Program (CMSP) . This is a large PDF file. Click here if you have problems with it: Tips for Using Adobe PDF Files
- 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)
- Script on Learning Disabilities Screening (9/02)
- SOC 155 (05/99) - Voluntary Placement Agreement - Placement Request
- SOC 295 (02/00) - Application For Social Services
- SOC 310 (01/03) - Statement Of Facts For In-Home Supportive Services
- SOC 404 (8/00) - In-Home Supportive Services Program Direct Deposit Enrollment/Change/Cancellation Form
- SOC 426 (9/02) - Personal Care Services Program Provider/Enrollment Agreement
- SOC 445 (6/99) - Medi-Cal Recovery For The Personal Care Services Program
- SOC 451 (08/02) - Cash Assistance Program For Immigrants Supplemental Application Form
- SOC 453 (11/02) - Cash Assistance Program For Immigrants (CAPI) Statement Of Household Expenses And Contributions
- SOC 804 (11/99) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI)
- SOC 809 (07/03) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Statement
- SOC 813 (08/02) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination
- SOC 814 (11/02) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI)
- SOC 818 (07/04) - Relative Or Non-Relative Extended Family Member Caregiver Assessment
- SOC 829 (3/08) In-Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form
- SOC 831 (3/08)- IHSS Provider Letter
- SSP 4A (1/99) - Application And Verification For Special Circumstances Program
- TEMP 2102 (09/99) - The Maximum Family Grant (MFG) Rule For Recipients Of Cash Aid
- TEMP 2131 (05/99) - Addendum To Food Stamp Application
- TEMP 2160 (8/04) - Region 1 - State Law Changes Maximum Aid Payments (MAPs) for Cash Aid Recipients
- TEMP 2160A (8/04) - Region 2 - State Law Changes Maximum Aid Payments (MAPs) for Cash Aid Recipients
- TEMP 2166 (8/99) - Work Pays Notice - Recommended Form
- TEMP 2171 (09/99) - California Self-Initiated Program (SIP) Review Request Form
- TEMP 2172 (09/99) - Notice Of Action
- Temp 2173 (3/00) - New Cash Aid And Food Stamp Rules - Fingerprint Imaging And Photo Imaging
- TEMP 2174 (06/99) - Notice Of Action
- TEMP 2174 A (06/99) - Notice Of Action
- TEMP 2175 (07/99) - Notice Of Action
- TEMP 2177 (11/99) - CFAP Work Rule
- TEMP 2181 (4/00) - Notice Of Action
- Temp 2193 (Eng/VN) (5/06) - Notice To All Food Stamp Recipients
- Temp 2193A (Eng/VN) (5/06) - Notice To All Food Stamp Recipients
- TEMP 2198 (11/01) - Important Food Stamp Information For Noncitizens
- TEMP 2200 (2/02) - CalWORKs Welfare-To-Work Activities Review Request Form
- 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 2206 (4/02) - Notice Of Action
- TEMP 2207 (5/02) - Notice Of Action
- TEMP 2208 (04/02) - Notice Of Action
- TEMP 2209 (04/02) - Notice Of Action
- TEMP 2211 (04/02) - Notice Of Action
- TEMP 2212 (5/02) - Notice Of Action
- TEMP 2214 (01/05) - Additional Information About Electronic Benefit Transfer (EBT)
- TEMP 2215 (7/02) - Electronic Benefit Transfer (EBT) Important Information
- TEMP 2223 (3/05) - Notice To All Quarterly Reporting (QR) Households Not Receiving Cash Aid
- TEMP 2224 (9/05) - Application for Food Stamp Benefits for Evacuees of Hurricane Katrina
- TEMP 2229 (3/07) ENG/VN - Important Notice - KinGAP Informing Notice
- TEMP CA 600 (04/99) - Annual Review For Cash Aid And Food Stamps
- TEMP CW 2185 (02/02) - What You Should Know About The CalWORKs 60-Month Time Limit
- TEMP M40-107A (7/01) - Time on Aid (no previous NOA issued)
- TEMP NA 1225 (09/01) - Underpayment Computation
- TEMP NA 1228 (06/01) - Notice Of Action
- TEMP NA 1229 (06/01) - Notice Of Action
- TEMP NA 1230 (01/02) - Retroactive Approval - Child Citizen Act Of 2000
- TEMP NA 1231 (05/02) - Continuation Page - Underpayment computation Pre 1/1/98- Required Form- No Substitute Permitted
- TEMP NA 1232 (3/06) - Food Stamp Notice - EBT Account
- TEMP NA 1234 (01/03) - No Adjustment To WtW Time Limit On Learning Disabilities
- TEMP NA 1235 (09/02) - Adjustment To WtW Time Limit Based On Learning Disabilities
- TEMP NA 1236 (08/03) - Retroactive Eligibility - Deny (MBSAC)
- TEMP NA 1237 (08/03) - Retroactive Eligibility (MBSAC)
- 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
- Welfare to Work Handbook
- WTW 1 (12/05) - Welfare to Work Plan Rights and Responsibilities
- WTW 2 (12/05) - Welfare to Work Plan Activity Assignment
- WTW 4 (08/04) - Notice to Other Parent
- WTW 5 (5/99) - WELFARE TO WORK PROGRAM NOTICE
- WTW 8 (6/04) - Student Financial Aid Statement Welfare to Work Supportive Services
- WTW 9 (7/99) - WELFARE TO WORK APPRAISAL APPOINTMENT LETTER
- WTW 10 (7/99) - REQUEST FOR WELFARE TO WORK THIRD-PARTY ASSESSMENT
- WTW 11 (07/99)- Welfare to Work/Cal-Learn Supportive Service Overpayment/Underpayment Notice
- WTW 12 (07/99) - Welfare to Work/Cal-Learn Supportive Service Repayment Agreement
- WTW 13(07/99) - Welfare to Work/Cal-Learn Supportive Service Overpayment Final Notice
- WTW 16 (12/05) - Grant-Based On-The-Job Training Participation: Voluntary Consent Form
- WTW 17 (12/05) - Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
- WTW 26 (8/03) - Good Cause Determination Guidelines
- WTW 27 (10/03) - Request For Good Cause Determination
- WTW 29 (9/03) - Plan To Stop A Welfare To Work Sanction
- WTW 32 (10/03) - Welfare To Work Compliance Plan
- WTW 34 (4/04) - Welfare To Work Family Reunification Plan