Right Column
Armenian Translations
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Forms translated into ARMENIAN- AD 501 (9/03) - Relinquishment In or Out-of-County (Birth Mother/Presumed Father in California)
- AR 2 (12/12) - Reporting Changes For CalWORKs And CalFresh
- AR 2 SAR (11/13) - Reporting Changes For CalWORKs And CalFresh
- AR 3 (12/12) - Mid-Year Status Report For CalWORKs and CalFresh
- CF 10 (12/13) - Dependent Care Cost Affidavit
- CF 11 (9/13) ENG/SP - Notice To All CalFresh Recipients Important - Please Read
- CF 11A (9/13) Eng/Sp - Notice To All CalFresh Recipients Important - Please Read
- CF 23 CR (2/14) - CalFresh Benefits How To Report Household Changes
- CF 23 SAR (1/14) - CalFresh Benefits How To Report Household Changes
- CF 27 (2/13) - Non-Assistance CalFresh (NACF) Household Recertification Form
- CF 29 (10/13) - CalFresh Recertification Appointment Letter
- CF 32 (6/13) - CalFresh Request For Contact
- CF 285 (2/14) - Application For CalFresh And Benefits
- CF 377.1 (2/13) Notice Of Approval For CalFresh Benefits
- CF 377.2 (10/13) - CalFresh Notice Of Expiration Of Certification
- CF 377.2A (12/13) - CalFresh Notice Of Expiration Of Certification For Households In Which All Adults Are Elderly Or Disabled
- CF 377.2A1 (2/14) - Important Information For Households In Which All Adults Are Elderly Or Disabled With No Earned Income
- CF 377.2A2 (2/14) - Client Survey
- CF 377.4 CR (1/14) - CalFresh Notice Of Change For Change Reporting Households
- CF 377.4 SAR (6/13) - CalFresh Notice Of Change For Semi-Annual Reporting Households
- CF 377.5 CR (11/13) - CalFresh Household Change Report
- CF 377.5 SAR (9/13) - CalFresh Mid-Certification Period Status Report
- CF 377.6 (8/13) - Information/Verification Needed
- CF 377.7A1 (2/14) - Request For Restoration Of CalFresh Benefits After Administrative
- 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 377.7E1 (1/14) - CalFresh Repayment Agreement For Administrative Errors Only
- CF 377.9 (2/14) - Notice Of Back CalFresh Benefits
- CF 388 (8/13) - CalFresh Notice Of Restoration Approval
- CF 478 (2/14) - Disqualifiction Consent Agreement CalFresh Program
- CW 8 (3/13) - Statement of Facts For An Additional Person
- CW 8A (4/13) - Statement Of Facts To Add A Child Under 16
- CW 101 (6/11) - CalWORKs Immunization Rules
- CW 2200 (3/09) - Request For Verification Form
- CW 2211 (9/13) - Your CalWORKs Reporting Rules Have Changed
- CW 2212 (9/13) - The Rules For Your CalWORKs Case Have Change
- DFA 285C (4/99) - Food Stamp Supplemental Application For Special Medical Deductions
- DFA 377.1 (11/01) - Notice of Approval
- DFA 377.1A (3/02) - 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 377.7A (1/12) - Notice Of Administrative Disqualification
- DFA 377.7A1 (1/12) - Request For Restoration Of CalFresh Benefits After Administrative Disqualification
- DFA 377.7B (6/11) - CalFresh Overissuance Notice For Inadvertent Household Errors (IHE) Only
- DFA 377.7B1 (10/00) - Food Stamp Repayment Notice For Inadvertent Household Errors Only Final Notice
- DFA 377.7C (5/02) - Food Stamp Repayment Agreement For Inadvertent Household Errors Only
- DFA 377.7D2 (10/00) - Food Stamp Repayment Notice For Administrative Errors Only Final Notice
- DFA 377.7E (7/04) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7E1 (5/02) - Food Stamp Repayment Agreement For Administrative Errors Only
- DFA 377.7F (4/11) - CalFresh Overissuance Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IVP
- DFA 377.7G (5/02) - Food Stamp Repayment Agreement For An Intentional Program Violation (IPV) Only
- 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 (6/04) - 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 (9/04) - Food Stamp Notice Of Continuance 1st Failure To Meet ABAWD Work Requirement
- DFA 385 (9/11) - Application For Disaster CalFresh
- DFA 386 (10/11) - CalFresh Notice of Missed Interview
- DFA 387 (10/11) - CalFresh Request For Information
- DFA 390 (9/11) - Notice Of Approval/Denial For Disaster CalFresh
- DFA 478 (8/01) - Disqualification Consent Agreement Food Stamp Program
- DFA 1239 (9/12) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
- DPA 19 (12/10) - Authorized Representative
- 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)
- EFA 7A ENG/Armenian (3/11) - Emergency Food Assistance Program (EFAP) Certification Of Eligibility
- EFA 14 (5/13) - Emergency Food Assistance Program (EFAP) 2013 Income Guidelines
- EFA 15 (5/13) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2013 Income Guidelines
- FS 26 (12/09) -Food Stamp Program Qualifying Drug Felon Addendum
- 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
- GEN 1179 (9/12) - Complaint of Discrimination
- LIC 9224 (8/08) - Acknowledgement Of Receipt Of Licensing Reports
- M40-181 (9/13) - SAWS 2 Redetermination Of Eligibility
- M40-181C SAR (9/13) - Notice Of Action - Balderas Reminder Notice
- M44-316 SAR (9/13) - No Change/Mid-Period Reporting
- M44-316A (9/13) - Notice Of Action - Not Yet Changed
- M44-316B (9/13) - Notice Of Action - Change In Income Over IRT
- M44-316C SAR (9/13) - No Change/Mid-Period Report of Property
- M44-316D SAR (9/13) - Notice Of Action - Change In Income
- M44-350I SAR (9/13) - Notice Of Overpayment
- M44-352H SAR (9/13) - Notice Of Action Overpayment Adjustment
- NA Back 9 - Your Hearing Rights (revised 2011)
- NA 271 (4/13) - Notice of Action Continuation Page - Overpayment Computations For 10-1-2013
- NA 300 (4/13) - Notice of Action - Continuation Page - Recipient Financial Eligibility Tests
- NA 531 (4/13) - Notice Of Action Continuation Page - 48-Month Time Limit - Includes Budget
- NA 818 (10/06) - Notice Of Action - Taking You Out Of Welfare To Work
- NA 840A (10/03) - Notice Of Action - Determination Of Good Cause/No Good Cause
- NA 841 (10/06) - Notice Of Action - Welfare-To-Work Plan
- NA 960X QR (7/12) - Notice Of Action - Stop Aid; Report Not Received
- NA 960X SAR (9/13) - Notice Of Action - Stop Aid; Report Not Received
- NA 960Y QR (7/12) - Notice Of Action - Stop Aid; Report Incomplete
- NA 960Y SAR (9/13) - 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 1239 AR (10/12) - Notice Of Action - Continuation Page - Annual Reporting Budget
- NA 1239 SAR (10/12) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget
- NA 1240 (8/08) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account
- NA 1250 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Approval
- NA 1253 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Change
- NA 1263 (8/11) - Notice of Action - Overissuance Budget Worksheet
- NA 1267 (4/11) - CalFresh Informing Notice Of Receiving Intercounty Transfer
- NA 1268 (4/11) - CalFresh Informing Notice Of Sending Intercounty Transfer
- NA 1273 (7/13) - Electronic Notification Agreement
- NA 1274 (7/13) - Electronic Notification Notice
- NA 1275 (7/13) - Electronic Notification Cancellation Notice
- PUB 13 (6/11) - Your Rights Pamphlet (Requires 8 1/2" x 14" paper printed landscape)
- PUB 13 (6/11) - Your Rights Pamphlet (Large print 8 1/2" x 11")
- PUB 56 (12/06) - The In-Home Supportive Services Program
- PUB 190 (8/06) - How To Hire And Supervise Your In-Home Supportive Services (IHSS) Provider
- 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 (2/06) - 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 (5/09) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits.
- PUB 389 (5/09) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase. (This Publication Is Designed To Be Folded For Use As A Wallet Card.)
- PUB 390 (2/06) - 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 (6/04) - 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 (12/08) - Eligibility/Status Report - Quarterly For Cash Aid and Food Stamps
- QR 7A (8/09) - How To Fill Out Your QR 7 Quarterly Eligibility/Status Report
- QR 7 Addendum (12/08) - Instructions And Penalties Quarterly Eligibility/Status Report For Cash Aid and Food Stamps
- 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 (5/08) - 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
- SAR 2 (9/13) - Reporting Changes For Cash Aid And CalFresh
- SAR 3 (4/13) - Mid-Period Status Report For Cash Aid and CalFresh
- SAR 7 Addendum (4/13) - Instructions And Penalties SAR 7 Eligibility Status Report - For Cash Aid and CalFresh
- SAR 7A (9/13) - How To Fill Out Your SAR 7 Eligibility Status Report
- SAR 22 (3/13) - Sponsored NonCitizens Applying For Or Receiving Cash Aid and/or CalFresh
- SAR 23 (3/13) - Senior Parent Statement Of Facts
- SAR 72 (3/13) - Sponsor's Semi-Annual Income And Resources Report
- SAR 73 (3/13) - Senior Parent Semi-Annual Income Report
- SAR 90 (1/14) - Reminder Letter
- SAWS 1 (12/06) - Application For Cash Aid, Food Stamps, And/Or Medi-Cal/State CMSP
- SAWS 1 (8/13) - Initial Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs (Do Not Use Until January 1, 2014)
- 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 2 PLUS (9/13) - Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
- SAWS 2A SAR (4/13) - Rights and Responsibilities And Other Important Information For The Cash Aid And CalFresh Programs, And/Or Medi-Cal/34-County Medical Services Program (CMSP)
- SOC 295 (10/09) - Application For Social Services
- SOC 310 (1/03) - Statement Of Facts For In-Home Supportive Services
- SOC 332 (9/09) - In-Home Supportive Services (Recipient/Employer Responsibility Checklist)
- SOC 404 (10/11) - In-Home Supportive Services Program Direct Deposit Enrollment/Change/Cancellation Form
- SOC 409 (7/03) - IHSS/CMIPS Elective State Disability Insurance (SDI) Form
- SOC 426 (4/12) - In-Home Supportive Services (IHSS) Program Provider Enrollment Form
- SOC 426A (4/12) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider
- SOC 426C (10/10) - In-Home Supportive Services (IHSS) Program California Code Sections
- SOC 445 (6/99) - Medi-Cal Recovery For The Personal Care Services Program
- SOC 450 (4/99) - Voluntary Services Certification
- SOC 455 (1/99) - Authorization for State Reimbursement of Interim Assistance
- SOC 804 (11/99) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI)
- SOC 825 (6/06) - Protective Supervision 24-Hours-A-Day Coverage Plan
- SOC 827 (12/06) - IHSS Program Individual Emergency Back-Up Plan
- SOC 829 (9/12) - In Home Supportive Services Provider Direct Deposit
- SOC 831 (10/11) - IHSS Provider Letter
- SOC 838 (10/12) - In-Home Supportive Services (IHSS) Recipient Request For Assignment Of Authorized Hours To Providers
- SOC 839 (10/12) - In-Home Supportive Services (IHSS) Recipient Time Sheet Signature Authorization
- SOC 840 (10/12) - In-Home Supportive Services (IHSS) Program Provider Or Recipient Change Of Address And/Or Telephone
- SOC 846 (10/09) - In-Home Supportive Services (IHSS) Provider Enrollment Agreement
- SOC 847 (4/12) - Important Information For Prospective Providers About The In-Home Supportive Services (IHSS) Program Provider Enrollment Process
- SOC 848 (1/11) - In-Home Supportive Services Program Notice Of Provider Eligibility
- SOC 849 (10/09) - In-Home Supportive Services Program Notice Of Incomplete Provider Enrollment Form
- SOC 850 (10/09) - In-Home Supportive Services Program Notice Of Provider Ineligibility
- SOC 851 (1/11) - In-Home Supportive Services Program Notice To Applicant Provider Of Provider Ineligibility Incomplete Provider Process
- SOC 852 (1/11) - In-Home Supportive Services Program Notice Of Provider Ineligibility Tier 1 Crimes (Elder Or Dependent Adult Abuse/Child Abuse & Fraud Against A Government Health Care Of Supportive Services Program)
- SOC 852A (1/11) - IHSS Program Notice To Provider Applicant Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies)
- SOC 853 (10/09) - In-Home Supportive Services Program Notice Of Provider Ineligibility
- SOC 854 (1/11) - In-Home Supportive Services Program Notice To Recipient Of Provider Eligibility
- SOC 855 (1/11) - IHSS Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process
- SOC 855A (1/11) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes (Elder Or Dependent Adult Abuse/Child Abuse & Fraud Against A Government Health Care Or Supportive Services Program)
- SOC 855B (1/11) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies)
- SOC 856 (1/12) - To Request Appeal Of Provider Enrollment Denial
- SOC 857 (1/11) - IHSS Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver
- SOC 857A (4/12) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Provider Ineligibility Acknowledgement Of Receipt Of Invalid Request For Provider Waiver
- SOC 858 (12/11) - In-Home Supportive Services Provider Notification
- SOC 858A (1/11) - IHSS Program Notice To Provider Of Provider Ineligibility Tier 1 Crimes Ineligibility - Subsequent Conviction
- SOC 858B (1/11) - IHSS Program Notice To Provider Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction
- SOC 859A (1/11) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes Ineligibility - Subsequent Conviction
- SOC 859B (1/11) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction
- SOC 860 (12/09) - Sponsor's Statement Of Facts Income And Resources
- SOC 862 (4/12) - In-Home Supportive Services (IHSS) Recipient Request For Provider Waiver
- SOC 863 (1/11) - In-Home Supportive Services (IHSS) Applicant Provider Request For General Exception
- SOC 864 (3/11) - In-Home Supportive Services (IHSS) Program Individualized Back-up Plan and Risk Assessment
- SOC 865 (7/12) - IHSS Request For Applicant Provider Reference
- SOC 870 (1/12) - In-Home Supportive Services Program (IHSS) Notice To Provider Of Provider Eligibility Acknowledgment Of Receipt Of Waiver
- SOC 873 (11/11) - In-Home Supportive Services (IHSS) Program Health Care Certification Form
- SOC 874 (11/11) - In-Home Supportive Services (IHSS) Program Notice To Applicant Of Health Care Certification
- SOC 875 (11/11) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Health Care Certification
- SOC 876 (10/11) - In-Home Supportive Services (IHSS) Program Notice Of Provisional Approval Health Care Certification Exception Granted
- SOC 885 (6/13) - In-Home Supportive Services (IHSS) Program Notice Of Denial Of Request For In-Home Reassessment Based On State Law Change
- SOC 2243 (1/13) - IHSS Recipients Notice Of New Timesheets - Please Keep For Future Use
- SOC 2244 (1/13) - IHSS Providers Notice Of New Timesheets - Please Keep For Future Use
- SSP 14 (9/10) - Authorization For Reimbursement Of Interim Assistance Initial Claim Or Posteligibility Case
- SSP 18 (10/10) - Notice Of Action And Right To Request A State Hearing On Interim Assistance
- TEMP 2201 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Request For A Designated Alternate Card Holder/Authorized Representative
- TEMP 2202 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Service Request
- TEMP 2203 (7/02) - Request For Cash Aid Electronic Benefit Transfer - EBT Exemption
- TEMP 2214 (7/08) - Additional Information about EBT
- TEMP 2240 (3/10) - IHSS Recipients Notice Of New Timesheets. Please Keep For Future Use
- TEMP 2250 (1/14) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients
- TEMP AR 1 (2/13) - New Reporting Requirements For CalWORKs and CalFresh
- TEMP NA 1232 (8/08) - Food Stamp Notice of Action - EBT Account
- TEMP NA 1238 (7/04) - Required Form - Substitute Permitted
- TEMP QR 1 (8/03) - New Reporting Requirements For CalWORKs And Food Stamp Recipients
- TEMP SAR 1 (9/13) - Important Information - Please Read New Reporting Requirements For Cash Aid and CalFresh
- WTW 4 (7/99) - Notice to Other Parent
- WTW 5 (9/13) - Welfare-To-Work Program Notice - Tell The County If You Need Help Reading Or Understanding This Notice
- WTW 8 (7/99) - Student Financial Aid Statement
- WTW 10 (7/99) - Request for Welfare to Work Third Party Assessment
- WTW 15 (9/13) - Simplified CalFresh Program Unpaid Work Experience (WEX) And Unpaid Community Service Hours Worksheet
- WTW 17 9/13) - Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
- WTW 27 (10/03) - Request For Good Cause Determination
- WTW 29 (9/03) - Plan To Stop A Welfare To Work Sanction
- WTW 31 (10/06) - Request To Stop A Welfare To Work Sanction
- WTW 37 (7/09) - Permission To Release Domestic Abuse Information When Moving To Another County