2012 Notice Of Forms Changes

12-102
PUB 429 (11/12) English and Spanish It's Your Money - Claim It And Save It - Flyer

12-101
PUB 428 (11/12) English and Spanish It's Your Money Claim It & Save It

12-100
SOC 833 (3/12) Grievance Procedures For Challenging Reference To The Child Abuse Central Index 

12-099
SOC 832 (3/12) Notice of Child Abuse Central Index Listing 

12-098
LIC 9140A  (12/12)  Request To Add Or Remove Instructor

12-097
LIC 9215 (12/12)  Application For Administrator Re-Certification

12-096
NA 1271 (12/12) Notice Of Action - Denial Of Home Assessment/Approval

12-095
CW 8 (7/01) English And Spanish Statement Of Facts For An Additional Person

12-094
SOC 838 through SOC 840 (10/12) New Forms

12-093
NA 1250 through SOC 1257 (5/09) New Forms

12-092
NA 1239 SAR (10/12) Notice Of Action Continuation Page - Semi-Annual Reporting Budget

12-091
NA 960Y SAR (10/12) Notice Of Action Stop Aid: Report Incomplete

12-090
NA 960X SAR (10/12) Notice Of Action Stop Aid; Report Not Received

12-089
SAR 7A (10/12) How To Fill Out Your SAR 7 Semi-Annual Eligibility/Status Report

12-088
SAR 7 (10/12) Report Month Eligibility/Status Semi-Annual For Cash Aid And CalFresh

12-087
SAR 2 (10/12) Reporting Changes For Cash Aid And CalFresh

12-086
TEMP SAR 1 (10/12) New Reporting Requirements For Cash Aid And CalFresh

12-085
List of Obsolete forms

12-084
DFA 1239 (9/12) CalFresh Notice Of Approval/Denial/Termination Transitional Benefits

12-083
PUB 458 (11/11)  Reporting Child Abuse and Neglect - Information About The Law And Training

12-082
PUB 337 (9/12) Statewide Fingerprint Imaging System Brochure

12-081
NA 1239 AR (9/12) Notice Of Action - Continuation Page - Annual Reporting Budget

12-080
TEMP AR 1 (9/12) Important Information - New Reporting Requirements For CalWORKs and CalFresh

12-079
AR 3 (9/12) Mid-Year Status Report For CalWORKs and CalFresh

12-078
AR 2 (9/12) Reporting Changes For CalWORKs and CalFresh

12-077
FS 11 (9/12) English and Spanish - Notice To All CalFresh Recipients - Important - Please Read

12-076
NA 960Y QR (7/12) English and Spanish - Notice Of Action - Stop Aid; Report Incomplete

12-075
NA 960X QR (7/12) English and Spanish - Notice Of Action - Stop Aid; Report Not Received

12-074
SOC 179 (8/12) Transitional Housing Program Plus Foster Care (THP+FC) - Non-Minor Dependent Rate Application

12-073
PUB 412 (3/11) (Multilingual) State Hearing Information (Print Letter Size)
PUB 412 (3/11) (Multilingual) State Hearing Information (Print Tabloid Size)

12-072
GE 1 (7/12) IHSS General Exception Approval -  Applicant Provider
GE 2 (7/12) IHSS General Exception Denial - Applicant Provider
GE 3 (7/12) IHSS General Exception Acknowledgement Of Appeal
GE 4 (7/12) IHSS General Exception Notice Of Late Appeal
GE 5 (7/12) IHSS General Exception Incomplete Request
GE 6 (7/12) IHSS General Exception Case Closure - Applicant Provider

12-071
SOC 877 (11/11) English and Spanish (All Languages) In-Home Supportive Services (IHSS) Program Application For Supplemental Care

12-070
LIC 9218 (2/05)  Application Checklist - Child Care Center

12-069
CW 74 (7/12) Permanent Housing Search Document

12-068
NA 1242 (4/11) Notice Of Action - Sanctions Budget

12-067
SOC 881 (6/12) In-Home Supportive Services Program Notice To Provider Of Inactivity

12-066
M40-107d (6/12) English and Spanish Time On Aid To Former CalWORKs Recpients

12-065
CF 24 (7/12) CalFresh (CF) Program Request For Policy/Regulation Interpretation

12-064
SOC 858 (12/11) English and Spanish - IHSS Provider Notification

12-063
DFA 377.7F (4/11) English and Spanish - CalFresh Overissuance Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IPV

12-062
DFA 377.7D1 (6/11) English and Spanish - CalFresh Overissuance Notice For Administrative Errors (AE) Only

12-061
DFA 377.7D (6/11) English and Spanish - CalFresh Overissuance Notice For Administrative Errors (AE) Only

12-060
DFA 377.7B (6/11) English and Spanish - CalFresh Overissuance Notice For Inadvertent Household Errors (IHE) Only

12-059
CW 51 (10/11) English and Spanish - Child Support - Good Cause Claim For Noncooperation

12-058
SOC 2244 (6/11) English and Spanish - IHSS Providers Notice Of New Timesheets

12-057
SOC 2243 (6/11) English and Spanish - IHSS Recipients Notice of New Timesheets

12-056
LIC 625 (6/12)  Appraisal/Needs And Services Plan

12-055
SOC 177 (5/12) Facility Evaluation Report - Transitional Housing Program-Plus-Foster Care Facility

12-054
SOC 171 (5/12) Transitional Housing Program-Plus-Foster Care (THP-Plus-FC) Application - Approval/Denial/Denial Pending Checklist

12-053
SOC 170 (5/12)  Application To Become A Transitional Housing Program (THP)-Plus-Foster Care Provider

12-052
SOC 157A (4/12)  Supervised Independent Living Placement (SILP) Approval And Placement Agreement 

12-051
SOC 341 (12/06) English and Spanish - Report Of Suspected Dependent Adult/Elder Abuse

12-050
CF 24 (4/12) CalFresh (CF) Program Request For Policy Regulation Interpretation

12-049
FS 24 (8/08) English and Spanish Food Stamp Program Request For Regulation Interpretation

12-048
PUB 387 (5/09) EBT Publication - All Languages
PUB 390 (5/09) EBT Publication - All Languages

12-047
GEN 1031 (3/12) Annual County Training Plan - Annual County Training Plan Due Date:  August 1, 2012

12-046
SOC 2245 (4/12) IHSS Fraud Data Reporting Form

12-045
SOC 862 (4/12) IHSS Recipient Request For Provider Waiver

12-044
SOC 857A (4/12) IHSS Program Notice To Recipient Of Provider Ineligibility Acknowledgement Of Receipt Of Invalid Request For Provider Waiver

12-043
SOC 847 (4/12) Important Information For Prospective Providers About The IHSS Program Provider Enrollment Process

12-042
SOC 426A (4/12) English and Spanish - IHSS Program Recipient Designation Of Provider

12-041
SOC 426 (4/12) English and Spanish - IHSS Program Provider Enrollment Form

12-040
AD 862 (3/12) Relinquishment Of An Indian Child - Out Of State (Alleged Natural Father)

12-039
DPA 19 (12/10)  Authorized Representative

12-038
PUB 325 (3/12)  Your Right To Make Decisions About Medical Treatment

12-037
SOC 157B (3/12) SILP Inspection:  Checklist Of Facility Health And Safety Standards

12-036
SOC 157A (3/12)  Supervised Independent Living Placement (SILP) Approval And Placement Agreement

12-035
AD 924 (2/12) English and Spanish - Independent Adoption Placement Agreement

12-034
NA 832 (3/10) English and Spanish - Notice Of Action Child Care Services

12-033
NA 533 (5/11) English and Spanish - Notice Of Action CalWORKs "Child-Only" Time On Aid Grant Cut
NA 534 (5/11) English and Spanish - Notice Of Action CalWORKs "Child-Only" Time On Aid Grant Cut (Continued)

12-032
FC 2 NM (2/12)  Statement Of Facts Supporting Eligibility For AFDC-Extended Foster Care (EFC)

12-031
LIC 9163B (7/11) Request For Live Scan Service - Long Term Care Ombudsman

12-030
QR 2103 (11/11) English and Spanish Reminder For Teens Turning 18 Years Old

12-029
NA 1270 (11/11) English and Spanish Notice Of Action - Discontinue Non-Minor Dependent

12-028
NA 1269 (11/11) English and Spanish Notice Of Action - Approve Non-Minor Dependent

12-027
SOC 154A (12/11) Placement Agency -  Foster Family  Agency Agreement - Child Placed by Agency in Foster Family Agency

12-026
SOC 870 (1/12) IHSS Notice To Provider Of Provider Eligibility Acknowledgement of Receipt Of Waiver

12-025
KG 3 (12/11)  Kin-GAP Mutual Agreement For Nonminor Former Dependents

12-024
DFA 377.7A1 (1/12) Request For Restoration Of CalFresh Benefits After Administrative Disqualification

12-023
DFA 377.7A (1/12) Notice Of Adminstrative Disqualification

12-022
SOC 856 (1/12) To Request Appeal Of Provider Enrollment Denial

12-021
AD 880 (12/11) Declaration Of Mother

12-020
AD 924 (4/08) English and Spanish Independent Adoption Placement Agreement

12-019
AD 4320 (11/11) Adoption Assistance Program (AAP) Agreement

12-018
AAP 7 (10/10) Adoption Assistance Program Statement Of Acknowledgement

12-017
AAP 8 (11/11) Adoption Assistance Program Nonrecurring Adoption Expenses Agreement

12-016
AAP 6 (11/11) Adoption Assistance Program Negotiated Benefit Amount And Approval

12-015
AAP 4 (11/11) Eligibility Certification Adoption Assistance Program 

12-014
SOC 157B (12/11)  SILP Inspection:  Checklist Of Facility Health And Safety Standards 

12-013
SOC 157A (1/12)  Supervised Independent Living Plan (SILP) Approval And Placement Agreement

12-012
SOC 156A (1/12)  Agency - Foster Parents Placement Agreement Nonminor Dependent Placed By Agency in Foster Home

12-011
SOC 156 (12/11)  Agency - Foster Parents Agreement - Child Placed By Agency In Foster Home

12-010
SOC 154B (1/12)  Agency - Group Home Agreement Nonminor Dependent Placed By Agency in Group Home

12-009
SOC 153 (1/12) Placement Agency - Foster Family Agency Agreement

12-008
SOC 152 (1/12)  Placement Agency - THP Plus Foster Care Provider Agreement

12-007
LIC 422A (10/11) Civil Penalty Ledger

12-006
FC 8 (10/11)  Federal Eligibility Certification For Adoption Assistance Program

12-005
LIC 403A (9/11) Balance Sheet Supplemental Schedule

12-004
LIC 9223 (1/12) Child Care Advocate Program

12-003
SOC 818 NMD (1/12)  Relative or Non-Relative Extended Family Member Caregiver

12-002
SOC 817 NMD (1/12)  Checklist of Health and Safety Standards for Approval of Family Caregiver Home

12-001  
SOC 815 (1/12) Approval Of Family Caregiver Home