Forms

NA 991 - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
NA 992 - RCA Application Approval
Refugee Cash Assistance (RCA) and Refugee Services (RS) forms:
RCA 43 - Refugee Cash Assistance (RCA) Notice Of A Participation Problem
RCA 44 - Refugee Cash Assistance (RCA) Notice Of No Good Cause Determination And Compliance Plan Appointment
RS 1 - Refugee Settlement Program Services Application And Assessment Information
RS 3 - Service Provider Referral/Notification Form
RS 3A - Client Tracking
RS 18 - Refugee Services - Information Transmittal
RS 36 - Employment And Training Requirements For Refugee Cash Assistance (RCA)
RS 52 - Claim for Reimbursement

Please contact your county analyst for the latest reporting forms or if you have any questions regarding these forms. For the County Operations & Performance Unit staff responsible for your county, either call (916) 654-4356 or email. Some documents are in Adobe Portable Document Format (PDF). Please see Tips for Using Adobe PDF Files for details.

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Refugee Programs Bureau
P.O. Box 944243, MS 9-6-646
Sacramento, CA 94244-2430
(916) 654-4356
RPB@dss.ca.gov

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