riverside county dpss forms riverside county dpss forms

38670 Sky Canyon Drive, Suite 200 . If buying food to prepare at home is not an option, you may qualify for Riverside Countys Restaurant Meals Program. Californias new, All Rights Reserved by The County of Riverside, Restaurant Meals Program Vendor Information, https://www.cdss.ca.gov/inforesources/calfresh/disaster-calfresh, How interested restaurants can become a vendor, California Electronic Benefit Transfer (EBT) Card Brochure, How to Use Your EBT Card to Make a Purchase, Using Your CalFresh Benefits to Eat and Stay Healthy, Women, Infants and Children (WIC) Supplemental Nutrition Program. : FAX NO. Health Insurance Premium Program (HIPP) Application. Adult Services | Riverside County Department of Public Social Services For CalFresh: The head of household, a responsible household member, or the household's authorized representative. If you suspect fraud call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. Apply Your county will call you within a week or two for an eligibility interview. IHSS Public Authority The Public Authority manages a public registry that matches Riverside County Adult Services clients with a trusted in-home caregiver. We will get back to your as soon as we possibly can! If you need assistance completing any of these forms, please contact the IHSS Helpline at (888) 822-9622. All Rights Reserved by The County of Riverside, Restaurant Meals Program Vendor Information, Cash Assistance Program for Immigrants (CAPI), Meet Medi-Cal eligibility requirements in the state of California, Have a disability which is expected to continue longer than 12 months. Forms and Publications (Q-T) PDF fill and print forms may be completed online and printed to hardcopy to be signed and mailed in or submitted in person to an eligibility worker for processing. To learn more about our services and partners visit the links below. How do I apply for cash aid online in California? 120E, Indio, CA 92201 RIVERSIDE 9991 County Farm Rd., Riverside, CA 92503 MURRIETA 30755-G Auld Rd., Murrieta, CA 92563 RI-JV041 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO. Murrieta Office. If you suspect fraud call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. In the form included, fill out some information about yourself, and include details on how we can assist. By phone - via public line (661) 631-6000 or CAT line (877) 410-8812. For more information about APS, visit Adult Abuse. Copyright 2023 All Rights Reserved by The County of Riverside. PDF Riverside County Department of Public Social Services AFFIDAVIT Find your local participating farmers market, use your CalFresh benefits, and receive credit toward the purchase of fruits and vegetables. Public assistance programs are designed out of good-will to help those in need. All cardholders may use their EBT card at participating retailers with a Point-of-Sale (POS) device and Automated Teller Machines (ATM) for cash withdrawals displaying the Quest logo throughout California and across the country. The program allows you to use your CalFresh benefits, or your EBT card, to buy meals from participating restaurants, locally and statewide! Access the most extensive library of templates available. CAPI payment standards are $10 less than SSI/SSP payment standards ($20 for a couple). Find the template you need in the library of legal forms. The advanced tools of the editor will guide you through the editable PDF template. Riverside Office. **Due to browser constraints please download forms for full functionality. PDF Superior Court of California County of Riverside Proposed Local Rule Riverside County Department of Public Social Services 1-800-665-KIDS (5437) Foster/Adoption Resource Family Program Orientation Packet Welcome Future Foster/Adoptive Resource Family! Sorry, you need to enable JavaScript to visit this website. Healthcare is vital. Have you received Childrens Services, In-Home Supportive Services or assistance with benefits through our Self Sufficiency Division? Who is eligible for CalWORKS? Check your BenefitsCal.com account to see the month of your renewal, and make sure your contact information, such as changes to your name, address, phone number, and email address, is correct. Read all the field labels carefully. How do I apply for cash assistance in Riverside County? The easiest and quickest way to apply for CalWORKs, CalFresh and/or Medi-Cal is online at www.C4Yourself.com. . Quality Assurance Fee Program. Medi-Cal renewals begin June 2023, and mailing begins April 2023. Address Moreno Valley Office 23119 Cottonwood Avenue Building B Moreno Valley, CA 92553 Get Directions Phone (951) 413-5050 Moreno Valley Office Phone (888) 960-4477 IHSS Toll Free Application and Information Line Web https://rivcodpss.org/ Email dpssinquiry@riversidedpss.org Hours Mon-Fri 8am-5pm Visit KeepMediCalCoverage.org for more details. In-Home Supportive Services (IHSS) Public Authority The IHSS Public Authority comes alongside In-Home Supportive Services (IHSS) consumers by recruiting, screening, and training in-home care providers. Reasonable accommodations are available. Dpss Riverside County Csd 2004 Verification Of Dependent Medical And Medi-Cal renewals begin June 2023, and mailing begins April 2023. Forms and Brochures If you suspect fraud call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. To report suspected abuse, call our 24-hour hotline at 1-800-442-4918 or click here. Call 1-877-410-8827 Monday Friday between the hours of 8:00 AM 5:00 PM and request an application be sent to you by mail, Find fax numbers by clicking on your nearest, The signature of a responsible member of the household or authorized representative, Your permission to make decisions on your behalf, Has a monthly gross income less than $150 and less than $100 in liquid resources, Has a combined monthly gross income and liquid resources that are less than the households monthly rent/mortgage and utilities, Is a migrant household with less than $100 in liquid resources, Is a seasonal farmworker household with less than $100 in liquid resources, Are a United States (U.S.) citizen or legal resident, Are an immigrant that meets certain criteria, Receive Supplemental Security Income/State Supplementary Payment (SSI/SSP), Housing, utilities, and other allowable income deductions. How do I apply for medical in Riverside County? Get Dpss 1917 Affidavit 2020-2023 - US Legal Forms We want to hear from you. riverside county department of social services photos, Identity Find resources to support your search for an exciting new career. For more information about APS, visit Adult Abuse. DO NOT submit a copy of this form to the Department of Justice (DOJ). Locations. SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE INDIO 46-200 Oasis St. Rm. Want to speak to someone face-to-face? Enter your official identification and contact details. Stay vigilant against potential scams! COUNTY OF RIVERSIDE . PDF Notice of Personal Chiropractic or Personal Acupuncturist This is the States health insurance marketplace from the Affordable Care Act. Riverside County Dpss Forms - Fill Online, Printable, Fillable, Blank The County of Riverside has established family and medical leave practices that enables employees to be away from work while maintaining the status of employee. To be eligible for CalWORKs, a family must have a child who: Is under age 18 (or under age 19 if the child is currently attending high school or vocational school), and. Using these apps comes with the risk of allowing the app access to steal your CalFresh and/or cash assistance benefits. If you need help finding affordable health coverage, consider Covered California. Here's How, CW 2166 (4/21) - Multilingual Work Really Pays! We want to help you find stable housing while receiving workforce training and support services. Learn more here: English / Spanish, Copyright 2023 All Rights Reserved by The County of Riverside. CalWORKs is designed to give families with children a way to meet their basic living needs. Join millions of satisfied users who are already filling out legal documents from their apartments. An EBT (Electronic Benefit Transfer) card is the benefit delivery system that allows CalFresh and cash assistance recipients to access their food and cash benefits, much like a debit card. CalFresh puts food-buying power into the hands of working-class households. TheRiverside County Department of Public Social Services(DPSS) is comprised of employees who work collectively and in partnership with community-based organizations to serve the needs of the community.The Riverside County Department of Public Social Services (DPSS) provides services and assistance to protect and empower vulnerable people in our . 1. MCED Forms MC 200 - California Home | County of Riverside, CA Our CalFresh Employment & Training Program provides free services for personalized one-on-one career/employment counseling, assistance with resume writing, interview and job searching skills, supportive services and job leads, and job fair information. The program is the first of its kind in the Country and ensures that your children are fed both physically and mentally. Visit KeepMediCalCoverage.org for more details. http://www.cdss.ca.gov/inforesources/Translated-Forms-and-Publications. We strive to provide exceptional customer service through outreach services. Sorry, you need to enable JavaScript to visit this website. Visit KeepMediCalCoverage.org for more details. QPI also prioritizes helping the child maintain connections with their birth family. Be a U.S. citizen or meet residency requirements. Home | Riverside County Department of Public Social Services This means a CAPI applicant must apply or SSI/SSP, or submit other proof of ineligibility from the Social Security Administration. A copy of your ID. Keep you and your family covered! Dental, Request for Access to Protected Health Information. Estate Recovery Forms. Keep you and your family covered! Medi-Cal will NEVER require payment in the application or recertification process. Want more information or to apply? Spanish, Localized All Rights Reserved by The County of Riverside, Restaurant Meals Program Vendor Information, Tentative employment agreement to raise In-Home Supportive Services wages over three years, Aprueban contrato tentativo para aumentar sueldo de trabajadores de ayuda a domicilio durante los tres aos prximos, CalFresh households can receive replacement benefits for food destroyed during recent winter storms, Beneficios de CalFresh para personas que perdieron alimentos durante las recientes tormentas invernales, Riverside County Recognizes In-Home Caregivers at November Appreciation Events, Annual Event Brings Holiday Joy to Young Adults in Foster Care, El Condado de Riverside reconoce a los cuidadores del hogar en eventos de agradecimiento de noviembre, Over 80 children and their families celebrate historic day for adoptions in Riverside County, Ms de 80 nios y sus familias celebran un da histrico de adopcin en el Condado de Riverside, Advierten sobre robos de beneficios pblicos en el Condado de Riverside, Da del Nio Celebration at Coachella Library, Norco College Month CalFresh & Medi-Cal Application Assistance. Complete all the requested boxes (these are yellowish). Employee Services The following Commonly Used Recipient and Provider State Forms is available on the California Department of Social Services website at: http://www.cdss.ca.gov/inforesources/Forms-Brochures/Forms-Alphabetic-List/Q-T#soc. Disaster Services Branch CDSS Programs CalFresh Forms and Brochures Forms and Brochures Forms and Notices CF 1 (10/14) - Notice To All CalFresh Recipients - Important Please Read CF 10 (12/13) - Dependent Care Cost Affidavit CF 11 (8/15) ENG/SP - Notice To All CalFresh Recipients Important - Please Read CF 18 ENG/SP (2/14) - Important Information Visit KeepMediCalCoverage.org for more details. Includes attachment of exhibits pertaining to this application. Check out the SNAP-Ed Nutrition Education Materials from the U.S. Department of Agriculture. Here's the list of Riverside County DPSS office locations that handle CalFresh applications and benefits. The client decides which caregiver can meet their needs. Riverside County is the fourth largest county in California and the eleventh largest in the United States. As a result, most immigrants who were not receiving SSI/SSP in August 1996 are no longer eligible for SSI/SSP. US Legal Forms enables you to rapidly make legally binding papers based on pre-built web-based blanks. If you suspect fraud call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. Dpss Login Form - Fill Out and Sign Printable PDF Template | signNow A one-on-one connection can help people quickly find programs and services that improve their health, safety, and wellbeing. English and Spanish Riverside County DPSS - Affidavit (General Purpose) - DPSS 1917 English and Spanish Authorized Representative Designation Form Register to Vote Cash Assistance Program for Immigrants (CAPI) Low Income Utility Resources for Riverside County Office on Aging Friendship Line Office on Aging Hospital Liaison Services By Mail Call 1-877-410-8827 Monday - Friday between the hours of 8:00 AM - 5:00 PM and request an application be sent to you by mail, or RFA 00A (2/17) - Conversion - Resource Family Application. RFA Forms Copyright 2023 All Rights Reserved by The County of Riverside. These rules apply in all departments of the Riverside Superior Court hearing family Use professional pre-built templates to fill in and sign documents online faster. All Rights Reserved by The County of Riverside, Restaurant Meals Program Vendor Information. Click here for a list of locations that accept EBT cards. My Account, Forms in In-Home Supportive Services (IHSS) is a home care program that prioritizes the safety of older adults, dependent adults, and minors in their own homes. To report suspected abuse, call our 24-hour hotline at1-800-442-4918orclick here. The Women, Infants, and Children (WIC) Supplemental Nutrition Program provides supplemental food, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5. County of Riverside Human Resources Department For families who receive CalWORKs and have children, we offer the Housing Support Program! services, For Small Phones: (888) 470-4477 or (951) 321-6160 Information & Assistance Office: CUSTODIAN OF RECORDS Riverside County In-Home Supportive Services (IHSS) Public Authority (PA) 12125 Day Street, Suite S-101 Moreno Valley, CA 92557 Provider Signature:Date: County Representative:Date: Employer MUST complete this information DPSS 4365 (6/18) TheFactsAbout Through strategic partnerships with departments, we attract and retain a motivated and skilled workforce by championing a Great Place to Work so that employees are committed to delivering valuable and effective services to the people of Riverside County. All Rights Reserved by The County of Riverside, Restaurant Meals Program Vendor Information. Riverside County Department of Public Social Services 1-800-665-KIDS (5437) Foster/Adoption Resource Family Program Orientation Packet Welcome Future Foster/Adoptive Resource Family! 3. Need to apply for food, cash or health coverage assistance but dont want to wait in line? CAPI payment amounts vary depending on a person's marital status, living arrangements and other income. Copyright 2023 All Rights Reserved by The County of Riverside. Californias new Universal Meals program offers free breakfast and lunch to all school children. Keep you and your family covered! Use signNow to e-sign and share Dpss 3731 ihss form for collecting e-signatures. Medi-Cal will NEVER require payment in the application or recertification process. and get a STEP 1: ACCESS THE DPSS WEBSITE For computers: Enter website address: dpssbenefits.lacounty.gov For a mobile device: Note: Your mobile device must have a QR Code Reader to scan the code. Text message or email asking for your personal EBT information. We are part of a countywide multidisciplinary team of legal and health advocates to provide community education and investigate reports of elder and dependent adult abuse. Get money If approved, you will get an EBT card for groceries within 10 days. You can use your EBT card to buy food items at: For information on how and where to use your EBT card, click on the following links: How to Use Your EBT Card, California Electronic Benefit Transfer (EBT) Card Brochure, How to Use Your EBT Card to Make a Purchase, How to Use Your EBT Card to Buy Food, Enjoy Surcharge-Free ATMs Nationwide, BE AWARE OF SCAMS AND THIRD-PARTY APPLICATIONS. Riverside County Adult Services Division Programs Adult Protective Services (APS) Adult Protective Services (APS) responds to reports of abuse against older and dependent adults in Riverside County. For Forms beginning with the following letters click below: Problems with downloading forms? To learn more, contact your HR Department Representative. We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use. Riverside County Attachment to Petition to Determine Succession of Real Property (Form DE-310) (pdf ) RI-PR101. Stay vigilant against potential scams! Customer Support Representative II - Materials Management Stay vigilant against potential scams! Visit KeepMediCalCoverage.org for more details. If you suspect fraud call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. Helping you and your family be self-sufficient. Be taking care of at least one child who is under the age of 18 (or 19, if the child is expected to graduate from high school before their 19th birthday). USLegal fulfills industry-leading security and compliance standards. As a Resource Family, you may be eligible to receive funds under the Approved Relative Caregiver (ARC) program. Sorry, you need to enable JavaScript to visit this website. Choose the Get form button to open the document and move to editing. Visit KeepMediCalCoverage.org for more details. Get access to thousands of forms. Your data is well-protected, as we keep to the newest security standards. If you are between the ages of 21 and 64 and need help to pay for acute illnesses and medical care to prevent disability, help is available through the Medically Indigent Services Program (MISP). The way to fill out the DSS los angeles form on the web: To start the document, utilize the Fill camp; Sign Online button or tick the preview image of the blank. Theft, Personal CAPI is a 100 percent state-funded program designed to provide monthly cash benefits to aged, blind, and disabled non-citizens who are ineligible for SSI/SSP solely due to their immigrant status. The Auditor-Controller is the chief accounting and disbursement officer of the County. An application for Health Care assistance can be done online or by phone. We believe in your right to dignity, to self-determination, and to live with as much independence as possible. We understand that our services and benefits are vital to you. Sorry, you need to enable JavaScript to visit this website. Attorney, Terms of 1-877-847-3663 Third Party Liability Notification. LAW ENFORCEMENT COUNTY PROBATION AGENCY COUNTY WELFARE / CPS (Child Protective Services) ADDRESS Street City Zip DATE/TIME OF PHONE CALL OFFICIAL CONTACTED - TITLE TELEPHONE ( ) C. VICTIM One report per victim . It is important to answer every question. The Riverside County Department of Public Social Services (DPSS) provides services and assistance to protect and empower vulnerable people in our community. Thank you for. Visit https://RiversideIHSS.org. LLC, Internet RFA 02 (3/22) - Resource Family Background Checklist. Services include locating and establishing paternity; creating, modifying and enforcing a court order for child support and health coverage. Keep you and your family covered! RFA Forms Under CDSS Review: Please note these forms are currently under revision FFA Forms: CAPI provides monthly cash benefits to older and disabled adults who are ineligible for Supplemental Security Income/State Supplementary Payment (SSI/SSP) solely due to their immigrant status. They give a telephone number that is close to a real customer service helpline telephone number (maybe one number is different). County of Riverside Human Resources Department > HR Services Riverside County Library System celebrates National Library Week April 23-29 Maximize your nutrition dollar with Market Match. (Optional): Staff of the Parking Services Division monitor over 5,000 parking spaces in downtown Riverside. Name Source of income One time payment or monthly How much CERTIFICATION - FRAUD WARNING SIGNATURE OR MARK SIGNATURE OF WITNESS TO MARK, INTERPRETER, OR OTHER PERSON COMPLETING FORM DATE SIGNED HOME PHONE CONTACT/CELL PHONE 3939 Thirteenth Street Riverside, California 92501. The investigating agency is required under Penal Code Section . CalFresh Benefits Helpline Stay vigilant against potential scams! Download a copy of the Suspected Child Abuse Report form. Adult Protective Services (APS) responds to reports of abuse against older and dependent adults in Riverside County. Update! PDF Superior Court of California, County of Riverside We work for you, 24-hours a day, 7 days a week. For questions, you can call the Public Authority at (888) 960-4477or click here to connect with the Public Authority. Dpss 3731 - Fill Out and Sign Printable PDF Template | signNow Technology, Power of Sorry, you need to enable JavaScript to visit this website. To learn more about our services and partners visit the links below. Healthcare is critical to human life. We are proud to announce that we help 1 million people in Riverside County each year by offering vital services and programs that support and protect the health, safety, and wellbeing of children, adults, and families in our communities. Please, see below for location details, contact numbers, and hours of operation. Keep you and your family covered! Sorry, you need to enable JavaScript to visit this website. Provides programs and services to protect children and adults from abuse and/or neglect. RFA 01B (5/21) - Resource Family Criminal Record Statement. The program provides cash aid to qualified refugees who are not eligible for CalWORKs or Supplemental Security Income (SSI). Are you pregnant, breastfeeding or a caretaker to an infant or child under age 5? Stay vigilant against potential scams! Therefore, we take fraud and abuse seriously. Tips for Using Adobe PDF Files, Copyright 2023 California Department of Social Services, AAP 1 (11/22) - Request For Adoption Assistance Program Benefit, AAP 2 (11/22) - Payment Instructions Adoption Assistance Program, AAP 3 (6/22) - Reassessment Information - Adoption Assistance Program, AAP 4 (4/22) - Eligibility Certification Adoption Assistance Program, AAP 5 (9/18) - Adoptions Assistance Program Independent Adoptions Program, AAP 6 (11/22) - Adoption Assistance Program Negotiated Benefit Amount and Approval, AAP 7 (12/17) - Adoptions Assistance Program Statement Of Acknowledgement, AAP 8 (9/18) - Adoption Assistance Program Nonrecurring Adoption Expenses Agreement, AAP 9 (6/21) -Adoption Assistance Program (AAP) Level Of Care Rate Determination Matrix (AAP LOCMatrix) Instruction Guide, AAP 9A (5/21) -Adoption Assistance Program (AAP)Level Of Care Rate Determination Protocol Matrix, AAP 10 (10/21) -Prospective Or Adoptive Parent(s) Level Of Care (LOC) Reporting Tool, ABCD 239.7A (8/01) - Notice Of Administrative Disqualification California Work Opportunity And Responsibility To Kids (CalWORKs) Program, ABCD 478A (5/20) - Disqualification Consent Agreement California Work Opportunity And Responsibility To Kids (CalWORKs) Program, ABCDM 228 (ENG/SP) (6/99) - Applicant's Authorization For Release Of Information, ABCDM 229 (1/23) -Applicant/Recipients Authorization For Release Of Information To Community-Based Organization (CBO) In BenefitsCal, AD 1A (4/22) - Parental Consent To Adoption(In Or Out-Of-California), AD 1F (4/15) - Parental Consent To Adoption Outside California In Armed Forces - Independent Adoption Program, AD 2 (6/02) - Stepparent Adoption (Consent To Adoption By Parent Retaining Custody, AD 2A/2B (5/11) - Stepparent Adoption (Consent to Adoption by a Parent in or outside of California Giving Custody to Husband or Wife or Domestic Partner of Other Parent), AD 2D (3/08) - Stepparent Adoption Consent To Adoption By Parent Outside California In Armed Forces Giving Custody To Husband Or Wife Or Domestic Partner Of Other Parent, AD 8 (10/01) - Marriage/Divorce Verification (Combined With AD 19) - Agency And Independent Adoptions Program, AD 9 (11/07) - Independent Adoption Questionnaire - Independent Adoptions Program, AD 20 (4/15) - Refusal To Give Parental Consent To Adoption - Independent Adoptions Program, AD 20B (5/15) - Refusal To Give Consent To Adoption - Alleged Father - Independent Adoption Program, AD 22 (7/02) - Health Facility Minor Release Report - Agency And Independent Adoptions Program, AD 28 (8/03) - Notification Of Subsequent Action, AD 40 1 (8/03) - Adoptions Worksheet (Print 8 1/2 x 14), AD 42 I (3/02) - Independent Adoptions Program (Individual Case Report), AD 56D (1/02) - Independent Adoption Program & Adoption Set Asides - Independent Adoptions Program, AD 65 (2/02) - Parent's Authorization For Medical And Surgical Care, 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 70 (11/15) - Adoption Facilitator Registry Application, AD 71 (11/15) - Adoption Facilitator Registry - Trainee Application, AD 72 (4/22) - Adoption Facilitator Complaint Form, AD 90 (6/13) - Supporting Information For Issuance Of California Department Of Social Services Acknowledgement And Confirmation Of Receipt Of Child Freeing Documents, AD 100 (9/22) - Authorization For Release, Use And/Or Disclosure Of Health And Other Information - Agency And Independent Adoption Programs, AD 100A (7/20) - Authorization For Release, Use And/Or Disclosure Of Health Information, AD 165 (3/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father (In Or Out-Of-California) - Independent Adoptions Program, AD 196 (2/02) - Request For Release Of Information, AD 200 (1/02) - Request For Case Record/Documents, AD 202B (1/13) - Intercountry Adoption Program Quarterly Statistical Report, AD 501 (6/14) - Relinquishment In or Out-of-County (Birth Mother/Biological Father/Presumed Father In California), AD 501A (9/14) - Relinquishment Out-of-State (Birth Mother/Biological Father/Presumed Father) (ENG/SP), AD 504 (5/15) - Relinquishment Out of State In Armed Forces (Birth Mother/Biological Father/Presumed Father), AD 508 (7/13) - Rescission Request/Rescission Of Relinquishment, AD 512 (1/14) - Psychosocial And Medical History Of Child, AD 512 NMD (8/13) - Psychosocial And Medical History Of Non-Minor Dependent, AD 513 NMD (8/22) - Non-Minor Dependent Adoption Mutual Disclosure Agreement, AD 521 (8/11) - Application For Adoption Of A Child, AD 524 (Bilingual) (3/99) - Physician's Examination Of Adoption Applicant/Petitioner, AD 551A (11/13) - Notification Of Procedure In Lieu Of Signing Relinquishment, Waiver or Denial, AD 558 (7/10) - Notice Of Placement (To Be Sent Within 15 Days of Placement), AD 580 (7/10) - Notice of Removal Of Child From Adoptive Home, AD 583 ENG/SP (5/15) - Relinquishment In Or Out Of County - Presumed Father Denies He Is The Birth Father in California, AD 584 (8/12) - Relinquishment Out of State - Presumed Father Denies He is the Birth Father, AD 586 (7/14) - Relinquishment In or Out-of-County (Alleged Natural Father In California), AD 588 (4/15) - Denial Of Paternity By Alleged Father - In Or Out Of California - Agency And Independent Adoptions Program, AD 590 (4/15) - Waiver Of Right To Further Notice Of Adoption Planning (Alleged Father In Or Out Of California) - Agency And Independent Adoptions Program, AD 590A (6/15) - Waiver Of Right To Further Notice Of Adoption Planning - Presumed Father In Or Out Of California - Agency And Independent Adoptions Program, AD 591 (12/14) - Relinquishment - Out-of-State (Alleged Natural Father), AD 593 (5/22) - Relinquishment Out of State in Armed Forces (Alleged Natural Parent), AD 594 (3/15) - Alleged Father's Consent To Adoption (In Or Out Of California) - Independent Adoptions Program, AD 824 (7/10) - Adoption Petition - Consent and Joinder, AD 830 (6/99) - Summary Claim For Reimbursement Private Adoption Agency Reimbursement Program (Welfare Institutions Code Section 16122), AD 836 (5/99) - Report Of Physician Attending Birth Of Child Placed For Adoption, AD 842 (3/17) - Alleged Father's Consent To Adoption (Outside California In The Armed Forces), AD 856 (5/21) - Notice To Discontinue Foster Care (FC) Payment, AD 859 (8/15) - Parental Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program, AD 860 (8/15) - Presumed Father's Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program, AD 861 (8/15) - Consent To Adoption Of Indian Child By Alleged Father (In Or Out Of California) - Independent Adoption Program, AD 862 (3/12) - Relinquishment Of An Indian Child Out-Of-State (Alleged Natural Father), AD 863 (9/12) - Relinquishment Of An Indian Child Out of State - Birth Mother/Presumed Father, AD 864 (9/14) - Relinquishment Of An Indian Child In Or Out-Of-County - Birth Mother/Presumed Father In California, AD 866 (10/14) - Relinquishment Of An Indian Child In Or Out-of-County - Presumed Father Denies He Is The Birth Father In California, AD 867 (3/08) - Relinquishment of an Indian Child - Out-of-State - Presumed Father Denies He is the Birth Father, AD 868 (8/14) - Relinquishment Of Indian Child - In/Out of County - Alleged Natural Father In California, AD 880 (2/21) Declaration Of Birth Parent - Agency And Independent Adoptions Program, AD 885 (3/14) - Mother Or A Biological/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 885A (4/22) -Statement Of Understanding Agency AdoptionProgram- Parent Or APresumed Parent Of AChild Who Is Detained, AJuvenile Court Dependent In Out-Of-Home Care, Or The Ward Of ALegal Guardian, AD 885C (2/15) - Statement of Understanding Agency Adoptions Program - Alleged Natural Father Of The Child Who Is Not Detained, A Juvenile Court Dependent In Out-Of-Home Care, Or The Ward Of A Legal Guardian, AD 885D (11/21) -Statement of Understanding - Alleged Parent of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian, AD 887 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The Child To The Petitioner(s), AD 887A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The Child To The Petitioner(s), AD 887B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father, AD 898 (1/11) - Consent Of CDSS Or Delegated County Adoption Agency - Independent Adoptions Program, AD 899 (3/08) - Statement of Understanding - Mother or a Presumed Father of the Indian Child Who is Not Detained, a Juvenile Court Dependent in Out-of-home Care, or a Ward of a Legal Guardian, AD 899A (11/21) - Statement of Understanding - Mother or a Presumed Father of an Indian Child Who is Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 899C (3/06) - Statement Of Understanding - Alleged Natural Father of the Indian Child Who is Not Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 899D (11/21) - Statement Of Understanding -Alleged Parent of an INDIAN Child Who is Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 900 (8/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The INDIAN Child To The Petitioner(s), AD 900A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The INDIAN Child To The Petitioner(s), AD 900B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father Of An INDIAN Child, AD 902 (2/22) - Consent For Arranging Contact, AD 904A (8/20) - Waiver Of Rights To Confidentiality For Siblings, AD 904B (9/20) - Waiver Of Rights To Confidentiality For Siblings Under The Age Of 18, AD 907 (7/10) - Adoptive Placement Agreement, AD 907A (3/23) -Adoptive Placement Agreement for Non-Minor Dependent Adoption, AD 908 (5/22) - Adoptions Information Act Statement, AD 908A (1/11) - Adoptions Information Act Statement, AD 909 (12/99) - Photo Listing Data Sheet, AD 918 (11/03) - Family Assessment Questionnaire II, AD 924 (6/22) - Independent Adoption Placement Agreement - Independent Adoptions Program, AD 925 (8/15) - Independent Adoption Placement Agreement - Indian Child - Independent Adoptions Program, AD 926 (1/18) - Statement Of Understanding Independent Adoptions Program Parent Who Places The Child With The Prospective Adoptive Parent(s), AD 927 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Places The Indian Child With The Prospective Adoptive Parent(s), AD 928 (7/02) - Revocation Of Consent Independent Adoption Program - Independent Adoptions Program, AD 929 (9/18) - Waiver Of Right To Revoke Consent Independent Adoption Program - Independent Adoptions Program, AD 929A (4/21) - Waiver Of Right To Revoke Relinquishment Agency Adoption Program, AD 930 (7/11) - Independent Adoption Placement Agreement Transmittal - Independent Adoptions Program, AD 931 (2/20) - Independent Adoption Of A Foreign-Born Child - Statement Of Acknowledgment, AD 932 (2/21) - Notice of Entry for Intercountry Adoptions, AD 933 (12/20) - Intercountry Readoption Acknowledgment, AD 934 (1/21) Court Filing Cover Sheet For Intercountry Readoptions, AD 4040 (7/20) - Private Adoption Agency Reimbursement Program (PAARP) (Posted July 1, 2020), AD 4310 (8/07) - Adoption Programs Notice Required By Information Practices Act, AD 4313 (8/03) - Letter Requesting Parent Be Interviewed - Independent Adoptions Program, AD 4317 (3/20) - Revocation Of Relinquishment, AD 4320 (6/22) - Adoption Assistance Program (AAP) Agreement, AD 4324 (2/21) - Adoption Questionnaire I, AD 4328 (3/06) - Authorization For Release Of Personal Items, AD 4336 (4/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father (Outside California In Armed Forces) - Independent Adoption Program, AD 4337 (10/21) - Criminal Record Statement, AD 4339 (12/14) - Relinquishment Out of State (Birth Mother/Biological Father/Presumed Father), AD 4348 (3/13) - Private Adoption Agency Reimbursement Program (PAARP), AD 4349A (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent, AD 4349B (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent, AD 4349C (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent, AD 4349D (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent, AD 4349E (12/14) - The Private Adoption Agency Reimbursement Program (PAARP) Full Time Equivalent, ADM 36 (6/99) - Medical Report Regarding Child To Be Adopted, ADSA 1 (3/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits, ADSA 1A (5/21) - Assistance Dog Special Allowance (ADSA) Application For Renewal Of Benefits, ADSA 1AL (11/21) - Assistance Dog Special Allowance (ADSA) Application For Renewal Of Benefits, ADSA 1B (6/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits For Recipients Of Social Security Disability Insurance (SSDI) Benefits, ADSA 1L (5/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits, ADSA 1BL (7/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits For Recipients Of Social Security Disability Insurance (SSDI) Benefits, ADSA 2 (10/21) Your Hearing Rights Under The Assistance Dog Special Allowance (ADSA) Program, ADSA 2L (12/21) Your Hearing Rights Under The Assistance Dog Special Allowance (ADSA) Program, ADSA 3 (10/21) - Assistance Dog Special Allowance (ADSA) Enclosure, ADSA 3L (11/21) - Assistance Dog Special Allowance (ADSA) Enclosure, AR 2 (11/13) - Reporting Changes For CalWORKs And CalFresh, AR 2 SAR (3/15) - Reporting Changes For CalWORKs And CalFresh, AR 3 (2/15) - Mid-Year Status Report For CalWORKs and CalFresh, ARC 1 (4/22) - Statement Of Facts Supporting Eligibility For The Approved Relative Caregiver (ARC) Funding Option Program, ARC 1A (6/21) - Rights, Responsibilities And Other Important Information For the Approved Relative Caregiver Funding Option Program (ARC), ARC 2 (11/19) - Redetermination: Statement Of Facts Supporting Eligibility For The Approved, AUD 1400 (5/22) - Audited Attendance And Fiscal Report For Special Programs For The Severely Handicapped, AUD 2507 (5/22) - Audited Fiscal Report For Resource And Referral Programs, AUD 9500 (7/22) - Audited Attendance And Fiscal Report For Child Development Programs, AUD 9500A (5/22) - Audited Fiscal Report For Migrant Special Contracts, AUD 9500AP (8/22) - Audited Fiscal Report For CALWORKs, Alternative Payment Or Family Child Care Home Programs, AUD 9500MHCS (7/22) - Audited Attendance And Fiscal Report For Child Development Programs With Early Childhood Mental Health Consultation Services, AUD 9500S (7/22) - Audited Days Of Enrollment For Child Development Programs Three Years And Older One-Half-Time Direct Service Counties, AUD 9529 (5/22) - Audited Fiscal Report For Child Development Support Contracts, AUD 9530A (5/22) - Audited Reserve Account Activity Report, CAC 1 (3/22) - Request For One-Time Exception Corrective Action Plan, CAC 3(3/22) -Uncashed Child And Adult Care Food Program Reimbursement Remittance, CCD 9 (7/21) - Equipment Purchase Approval Request, CCD 11 (6/22) -Local Planning Council (LPC) County Priorities Report Form, CCD 17 (7/22) - California County Local Child Care Planning Council Needs Assessment - Template, CCD 19A (3/22) -Summary Request for Voluntary Temporary Interagency Transfer of Funds (Attachment A), CCD 19B (5/22) - Request to Release a Voluntary Temporary Transfer of the California Department of Social Services Contract Funds (Attachment B), CCD 19C (3/23) - Request to Accept a Voluntary Temporary Transfer of the California Department of Social Services Contract Funds (Attachment C), CCD 20 (4/22) - Out-of-State Travel Approval Request Form, CCD 21 (8/22) - Parent Plan For Seeking Employment (PPSE), CCD 23 (9/21) - Fiscal Year 202122 Program Calendar, CCD 23 (12/21) - Fiscal Year 202223 Program Calendar, CCD 24 (2/22) - CCDD Emergency Closure Requests For Fiscal Year 2021-22, CCD 24 (8/22) - CCDD Emergency Closure Requests For Fiscal Year 2022-23, CCD 25 (9/22) Child Care And Development Monitoring Tool, CCD 26 (1/22) Confidential Application for Child Development Services and Certification of Eligibility, CCD 26A (1/22) Instructions for Completing Form CCD 26: Confidential Application for Child Development Services and Certification of Eligibility, CCD 27 (8/22) - Statement Of Parental Incapacitation, CCD 28 (1/22) Program Narrative Change Fiscal Year 2022-23, CCD 28 (9/21) -Program Narrative Change - Fiscal Year 2021-22, CCD 29 11/22) - CD-ICW Income Calculation Work Sheet Cash, Wages, Or Salary, CCD 30(11/21) - Continued Funding Application Fiscal Year 2022-23, CCD 30B (10/22) - Subcontract Certification, CCD32 (10/22) - Program Staffing Plan (FY 202223 CCTR Expansion RFA), CCD 33 (11/21) - Continued Funding Application Program Calendar For Fiscal Year 2022-23, CCD 33 (10/22) - Fiscal Year 2023-24 Program Calendar, CCD 34 (2/23) - Fiscal Year 202223 General Child Care And Development Program Expansion Funds Request For Applications, CCD 35 (8/22) - Educational Programs or Vocational Training Verification for Parent or Caretaker Attending Educational Programs or Receiving Vocational Training, CCD 38 (3/22) - Site Supervisor or Program Director Staffing Qualifications Waiver Request, CCD 39 (3/22) - Site Supervisor or Program Director Staffing Qualifications Waiver Extension Request, CCD 43 (9/22) - Certification Statement Regarding Composition Of LPC Membership, CCP 1 (3/15) - Declaration Of Exemption From TrustLine Registration And Health And Safety Self-Certification, CCP 4 (8/21) - Health And Safety Self-Certification (For license-exempt providers), CCP 6 (8/99) - Health And Safety Facility Checklist, CCP 7 (10/19) - CalWORKs Child Care Request Form And Child Care Payment Rules, CCP 8 (10/19) - CalWORKs Stage One Child Care Authorization Form, CCP 9 (8/17) - Child Care Program (CCP) 9 Request For Policy Interpretation, CCP 2145 (6/21) - CalWORKs Child Care Reimbursement Report, CF 1 (10/14) - Notice To All CalFresh Recipients - Important Please Read, CF 10 (12/13) - Dependent Care Cost Affidavit, CF 11 (9/21) - Notice To All CalFresh Recipients, CF 11 (9/22) - Notice To All CalFresh Recipients, CF 18 ENG/SP (2/14) - Important Information, CF 20 (2/14) - You Do Not Owe Anything For Receiving CalFresh Benefits, CF 24 (6/17) - CalFresh Program Request For Policy/Regulation Interpretation, CF 28 Coversheet (2/14) - CalFresh Program Restricted Account Coversheet - Important To Know, CF 28A (2/14) - CalFresh Program Restricted Account Agreement Part A, CF 28B (2/14) - CalFresh Program Restricted Accounting Agreement Part B, CF 29 (10/13) - CalFresh Recertification Appointment Letter, CF 29A (2/14) - CalFresh Appointment Letter, CF 29B (2/14) - CalFresh Initial On-Demand Appointment Letter, CF 29C (2/14) - CalFresh Recertification Appointment Letter, CF 29D (2/14) - CalFresh Recertification On-Demand Appointment Letter, CF 31 (6/19) - CalFresh Supplemental Form For Excess Medical Deductions, CF 31LP (6/19) - CalFresh Supplemental Form For Excess Medical Deductions, CF 32 (6/13) - CalFresh Request For Contact, CF 33 (6/19) - CalFresh Budget Worksheet - Special Medical/Shelter Deductions, CF 34 (12/20) CalFresh Notice of Change: Semi-Annual Reporting Eliminated, CF 37 (11/16) - Recertification For CalFresh Benefits, CF 100 (11/20) - CalFresh Request For Authorized Representative Drug Or Alcohol Treatment Center Resident, CF 101 (11/20) - CalFresh Request For Authorized Representative, CF 215 (6/19) - CalFresh Notification Of Inter-County Transfer, CF 285 (8/21) - Application For CalFresh Benefits, CF 285 LP (8/21) - Application For CalFresh Benefits, CF 285A (11/21) - Application For CalFresh Benefits, CF 286 SAR (12/15) - CalFresh Budget Worksheet/Semi-Annual Reporting Households, CF 303 (8/19) Replacement Or Disaster Supplement Affidavit, CF 304A (9/20) - Important Information About Your CalFresh Benefits - CalFresh Water Pilot, CF 304B (9/20) -Notice Of Approval For The CalFresh Water Pilot, CF 304C (9/20) - Notice Of Discontinuance For The CalFresh Water Pilot, CF 304D (10/22) - Notice Of CalFresh Water Pilot Extension, CF 377.1 (5/20) - Notice Of Approval For CalFresh Benefits, CF 377.1LP (5/20) - Notice Of Approval For CalFresh Benefits, CF 377.1A (8/21) - Notice Of Denial Or Pending Status, CF 377.1A LP (8/21) - Notice Of Denial Or Pending Status, CF 377.11 (6/18) - CalFresh Time Limit Notice - Failure To Meet The Able-Bodied Adults Without Dependents (ABAWDs) Work Requirement, CF 377.11A (6/18) - CalFresh Time Limit Notice - Expiration Of Three Consecutive Months For Able-Bodied Adults Without Dependents (ABAWDs), CF 377.11B (6/18) - CalFresh Countable Month Letter - Use Of Countable Month For Able-Bodied Adults Without Dependents (ABAWDs), CF 377.11C (1/20) - CalFresh Informational Notice - CalFresh Time Limit For Able-Bodied Adults without Dependents (ABAWDs), CF 377.11D (1/20) CalFresh Discretionary Exemption For Able-Bodied Adults Without Dependents (ABAWDs), CF 377.11E (1/20) CalFresh Able-Bodied Adult Without Dependents (ABAWD) Time Limit Exemption Screening Form, CF 377.2 (9/18) - CalFresh Notice Of Expiration Of Certification, 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 377.2D (3/18) - CalFresh Notice Of Status Change For Households With Only Elderly And/Or Disabled Members, CF 377.4 SAR (6/13) - CalFresh Notice Of Change For Semi-Annual Reporting Households, CF 377.4A (2/14) - CalFresh Notice Of Change (Non-Citizen), CF 377.4 CR (1/14) - CalFresh Notice Of Change For Change Reporting Households, CF 377.5 SAR (9/13) - CalFresh Mid-Certification Period Status Report, CF 377.5A (2/20) - Drug Addiction Or Alcoholic Treatment And Rehabilitation Centers And Group Living Arrangements: Periodic Resident Report, CF 377.5B (1/20) - Drug Addiction Or Alcoholic Treatment Centers And Group Living Arrangements: Change Report For Departing Residents, CF 377.6 (8/13) - Information/Verification Needed, CF 377.7A (2/14) - Notice Of Administrative Disqualification, CF 377.7A1 (2/14) - Request For Restoration Of CalFresh Benefits After Administrative Disqualification, CF 377.7B (4/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only, CF 377.7B LP (2/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only, CF 377.7B1 (10/17) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice, CF 377.7B1 LP (2/18) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice, CF 377.7C (2/14) - CalFresh Repayment Agreement For Inadvertent Household Errors Only, CF 377.7D (1/14) - CalFresh Overissuance Notice For Administrative Errors (AE) Only, CF 377.7D1 (1/14) - CalFresh Overissuance Notice For Administrative Errors (AE) Only, CF 377.7D2 (10/17) - CalFresh Repayment Final Notice - County Administrative Error (AE), CF 377.7D2 LP (2/18) - CalFresh Repayment Final Notice - County Administrative Error (AE), CF 377.7D3 (10/17) - CalFresh Overissuance Notice For Administrative Errors (AE), CF 377.7D3 LP (6/18) - CalFresh Overissuance Notice For Administrative Errors (AE), CF 377.7E1 (1/14) - CalFresh Repayment Agreement For Administrative Errors Only, CF 377.7F (10/17) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV), CF 377.7F LP (2/18) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV), CF 377.7F1 (10/17) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV), CF 377.7F1 LP (2/18) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV), CF 377.7G (3/18) - CalFresh Intentional Program Violation (IPV) Notice - Due To Trafficking, CF 377.7H (2/23) - CalFresh Informational Notice - Potential Intentional Program Violation (IPV), CF 377.9 (8/20) - Notice Of Back CalFresh Benefits, CF 377.9LP (8/20) - Notice Of Back CalFresh Benefits, CF 385 (2/23) - Application For Disaster CalFresh, CF 386 (2/14) - CalFresh Notice Of Missed Interview, CF 387 (5/14) - CalFresh Request For Information, CF 388 (8/13) - CalFresh Notice Of Restoration Approval, CF 389 (2/14) - Notice Of Denial Of Restoration, CF 390 (5/19) Notice of Approval/Denial For Disaster CalFresh, CF 478 (2/14) - Disqualification Consent Agreement CalFresh Program, CF 502 (2/23) -Notice To All CalFresh Recipients - End Of CalFresh Emergency Allotments, CF 842 (2/14) - Claim Determination Worksheet, CF 886 (8/22) - CalFresh Notice Of Work Rules, CF 1239 (12/20) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits, CF 6177 (10/22) - CalFresh Student Exemption Screening Form, CF SSA 1 (8/21) - Information For Households Applying For CalFresh With The Social Security Administration, CF SSA 1LP (8/21) - Information For Households Applying For CalFresh With The Social Security Administration, 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, CL 15 (1/00) - Cal-Learn Case Management Information Intercounty Transfer Form, CL 16 (1/00) - Cal-Learn Case Management Inter-County Transfer Summary, CR 6181 (11/20) - Interpreter Services Statement And Confidentiality Agreement, CRF 01 (10/20) - Coronavirus Relief Fund (CRF) Certification Of Eligibility, CSFP 001 (7/22) - Commodity Supplemental Food Program (CSFP) Participant Application, CSFP 006 (7/22) - Commodity Supplemental Food Program (CSFP) Notice Of Action, CTRI 01 (10/20) - California Tax Return Information (CTRI) Notification To Client, CW 2.1 N A (8/04) - Notice And Agreement For Child, Spousal And Medical Support, CW 4 (6/02) - Immediate Need Payment Request, CW 5 (7/01) - Veterans Benefits Verification and Referral, CW 8 (11/14) - Statement of Facts For An Additional Person, CW 8A (12/14) - Statement Of Facts To Add A Child Under 16, CW 10 (7/01) - Notice of Withdrawn Application, CW 13 (9/02) - Caretaker Relative Agreement, CW 23 (3/00) - Senior Parent Statement Of Facts, CW 25 (7/01) - Supplemental Statement of Facts - Minor Parent, CW 25A (2/13) - Payee Agreement For Minor Parent, CW 40 (3/00) - CalWORKs - Reduced Income Supplemental Payment Request, CW 42 (10/21) - Statement of Facts - Homeless Assistance, CW 43 (3/00) - CalWORKs Applicant Choice Form Immediate Need Payment/Expedited Grant, CW 51 (10/11) - Child Support - Good Cause Claim For Noncooperation, CW 52 (7/18) - Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Assistance Unit And Child Support Rules, CW 52 (10/20) California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Instead Of Cash Grant Option, CW 60 (5/01) - Release Of Information - Financial Institution, CW 61 (7/01) - Authorization to Release Medical Information, CW 63 (11/20) - Request For Income And/Or Resource Verification, CW 71 (3/00) - Statement Of Cash Aid Mother An Unrelated Adult Male (UAM), CW 74 (9/19) - Permanent Housing Search Document, CW 80 (2/18) - Self-Certification Form For Motor Vehicles - CalWORKs, CW 82 (3/00) - Coversheet - Agreement To Sell Property, CW 86 (10/21) - 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 Coversheet (6/11) - You May Be Eligible For Diversion Services, CW 88 Coversheet (4/21) - You May Be Eligible For Diversion Services, CW 88 (6/11) - Diversion Services Agreement CalWORKs Program, CW 88 (4/21) - Diversion Services Agreement CalWORKs Program, CW 89 (2/03) - Application Withdrawl Request, CW 101 (7/17) - CalWORKs Immunization Rules, CW 103 (11/09) - Multilingual - Transitional Medi-Cal, CW 215 (10/19) - Notification Of Intercounty Transfer, CW 371 (7/01) - Referral To Local Child Support Agency (LCSA), CW 377 (2/23) - CalWORKs Informational Notice - Potential Intentional Program Violation (IPV), CW 801 (11/00) - Summary Report Of Performance Incentives For Grant Reductions Due To Employment Earnings And Diversion For The California Work Opportunity And Responsibilities To Kids (CalWORKs), CW 801.2 (2/00) - California Work Opportunity And Responsibility To Kids (CalWORKs) Diversion Grant Summary, CW 1725 (10/20) School Attendance/Enrollment Verification, CW 2103 (6/16) - Reminder For Teens Turning 18 Years Old, CW 2166 (7/19) - Multilingual Work Really Pays!