Automated Assistance Claims

This website provides information for the CDSS Automated Assistance Claiming Process

Please use the applicable claim forms on this page and submit them to CDSS via the CECRIS portal beginning March 2019, for the claiming period ending February 28, 2019.

Claim Forms

NOTE: Please download these Excel spreadsheets to your computer prior to using them. Please follow the instructions for downloading Excel spreadsheets prior to entering your data into them.

CA 800 Automated Asst Claim (Updated 7/31/19)
CA 800 CCR Claim (Updated 7/31/19)
EFC 18+NMD Temp (Updated 7/31/19)
CA 800 ARC Claim Instructions (Updated 7/1/18)
Safety Net, Fleeing Felon and Long Term Sanction Claim (Updated 7/31/19)
LIHEAP/SUAS Claim Instructions
Reimbursement Claim for EBT Replacement Due to Electronic Theft (07/31/19)
Reimbursement Claim for EBT Replacement Due to Electronic Theft by Skimming Instructions (05/19)
Reimbursement Claim for EBT Replacement Due to Electronic Theft by Scams Instructions (05/19)
Emergency Child Care Bridge TEMP Instructions (7/1/18)
CalWORKs Apparent Eligibility Claim Instructions (New 11/1/18)

Instruction Forms

Privacy Notice On Collection

California Department of Social Services
Privacy Notice on Collection
Effective: June 2016

The California Department of Social Services (CDSS) Privacy Notice on Collection covers our practices regarding personal information collected when completing forms (online or hardcopy) for our various programs. Personal information may include: name, social security number, physical description, home address, home telephone number, education or financial, medical or employment history, etc. Any personal information collected is governed by the requirements of the following authorities and all other laws pertaining to personal information:

Government Code section 11015.5
Health and Safety Code section 1500 et seq.
Information Practices Act - Civil Code section 1798 et seq.
Public Records Act - Government Code section 6250 et seq.
Safeguarding Information for the Financial Assistance Programs - 45 CFR section 205.50
Statewide Administrative Manual (SAM) section Privacy 5310 et seq.
Statewide Information Management Manual (SIMM) 5310 - A & B.
Welfare and Institutions Code section 10850

CDSS collects personal information directly from individuals who volunteer to obtain some of our services. Collection of this information is required to deliver the specific services, but use of these services is voluntary. Failure to provide requested information may result in a denial of services.

The information collected will not be shared with any other government agencies, unless required or allowed by law to administer programs.

Please do not provide personal information that is not requested. Any fields in the form with unrestricted text are intended for the requested information only.

Individuals who provide personal information to CDSS have the right to review the information for accuracy and completeness and to request corrections or deletions. For information, review the online CDSS Privacy Policy Statement.

For personal information access requests, send an email to CDSS’ Public Inquiry and Response Unit piar@dss.ca.gov and/or call (916) 651-8848 who will then direct you to your program representative.

For more consumer information on security please see the California Department of Justice’s, “Security Awareness”.

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Instructions For Downloading Spreadsheets

Right click on the link to the spreadsheet. Do NOT open it at this time.
Choose "Save Target As..." from the pull-down menu. (Note: if you are using a MAC instead of a PC, choose "download to disk" The "Save As" window will appear. Note: It may take the "Save As" window awhile to appear if you are downloading a large spreadsheet or are using dial-up Internent access.
In the "Save In" box at the top of the "Save As" window, select a location to save the file on your computer that will be easy for you to remember. Your desktop or My Documents are the two most common locations. Click on "Save".
The spreadsheet will now download to your computer. After the download process is finished, navigate to the location where you saved the file and double click on it to open it. You should be able to open and enter your data into the file from this location without any problem.