Farsi/Dari

Farsi/Dari Translations

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For Farsi forms beginning with the following letters:

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |

Forms translated into FARSI

A Forms

• ABCD 478A (5/20) - Disqualification Consent Agreement California Work Opportunity And Responsibility To Kids (CalWORKs) Program
• AD 931 (2/20) - Independent Adoption Of A Foreign-Born Child - Statement Of Acknowledgment
• 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

C Forms

• CCP 4 (8/21) - Health And Safety Self-Certification (For license-exempt providers)
• 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
• 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 - Important - Please Read - Use Starting October 1, 2021
• CF 11 (9/22) - Notice To All CalFresh Recipients -  Important - Please Read - Use Starting October 1, 2022
• CF 18 (2/14) Eng/Farsi - Important Information
• CF 20 (2/14) - You Do Not Owe Anything For Receiving CalFresh Benefits
• CF 21 (3/14) - Release Form
• CF 23 CR (2/14) - CalFresh Benefits How To Report Household Changes
• 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 Initial 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 30 (2/18) - SAR 7 Reminder Notice
• CF 30 LP (2/18) - SAR 7 Reminder Notice - Large Print
• CF 31 (6/19) - CalFresh Supplemental Form For Special Medical Deductions
• CF 32 (6/13) - CalFresh Request For Contact
• 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 285 (4/21) - Application For CalFresh Benefits
• CF 285LP (4/21) - Application For CalFresh Benefits (20pt Font) - Use Starting June 1, 2019
• CF 285A (11/21) - Application For CalFresh Benefits
• CF 303 (8/19) – Replacement Or Disaster Supplement Affidavit
• CF 377.1 (5/20) - Notice Of Approval For CalFresh Benefits
• CF 377.1LP (5/20) - Notice Of Approval For CalFresh Benefits - Large Print 
• CF 377.1A (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 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 377.4A (2/14) - CalFresh Notice Of Change (Non-Citizen)
• CF 377.5 SAR (9/13) - CalFresh Mid-Certification Period Status Report
• 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
• 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 - Large Print
• CF 377.7B1 (10/17) - CalFresh Repayment Notice For Inadvertent Household Errors Only Final Notice
• CF 377.7B1 LP (2/18) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice - Large Print
• 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) - Large Print
• 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) - Large Print
• 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) - Large Print
• 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) - Large Print
• CF 377.7G (3/18) - CalFresh Intentional Program Violation (IPV) Notice - Due To Trafficking
• CF 377.9 (8/20) - Notice Of Back CalFresh Benefits
• CF 377.9LP (8/20) - Notice Of Back CalFresh Benefits - Large Print
• 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 478 (2/14) - Disqualifiction Consent Agreement CalFresh Program
• 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 (9/20) - Information For Households Applying For CalFresh With The Social Security Administration (20pt Font)
• CR 6181 (11/20) - Interpreter Services Statement And Confidentiality Agreement
• CTRI 01 (10/20) - California Tax Return Information (CTRI) Notification To Client
• 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 42 (10/21) - Statement of Facts - Homeless Assistance
• 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 63 (11/20) - Request For Income And/Or Resource Verification
• CW 80 (2/18) - Self-Certification Form For Motor Vehicles - CalWORKs
• CW 2166 (12/20) - Multilingual Work Really Pays! Here's How - Use Starting June 1, 2021
• CW 2166 (4/21) - Multilingual Work Really Pays! Here's How - Use Starting May 1, 2022
• CW 2166 (11/21) - Multilingual Work Really Pays! Here's How - Use Starting June 1, 2022
• CW 2184 (4/21) - CalWORKs 60-Month Time Limit - Use Starting May 1, 2022
• CW 2186A (4/21) - CalWORKs Exemption Request Form - Use Starting May 1, 2022
• CW 2186B (4/21) - CalWORKs Exemption Determination - Use Starting May 1, 2022
• CW 2187 (4/21) - Your CalWORKs 60-Month Time Limit - Use Starting May 1, 2022
• CW 2189B (9/20) – Notice Of Your CalWORKs Time Limit – 57TH Month On Aid (Use Starting May 1, 2022)
• CW 2190A (4/21) - CalWORKs 60-Month Time Limit Extender Request Form - Use Starting May 1, 2022
• CW 2190B (4/21) - CalWORKs 60-Month Time Limit Extender Determination Form - Use Starting May 1, 2022
• CW 2191 (4/21) - Time On Aid Verification For CalWORKs/TANF 60-Month Time Limits - Use Starting May 1, 2022
• CW 2192 (4/21) - Tracking Non-California TANF Assistance For Time Limits - Use Starting May 1, 2022
• CW 2200 (5/22) - Request For Verification​
• CW 2211 (11/14) - Your CalWORKs Reporting Rules Have Changed
• CW 2212 (11/14) - The Rules For Your CalWORKs Case Have Change
• CW 2213 (10/15) - Response To Request To Inspect Case Record CalWORKs, CalFresh, TCVAP, And Refugee Programs
• CW 2215 (10/20) - California Work Opportunity and Responsibility to Kids (CalWORKs) Important Information for Safety Net And Certain Child-Only Case
• CW 2218 (7/16) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-needy Caretaker Relative With Relative Foster Child)
• CW 2218 (6/21) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-Needy Caretaker Relative With Relative Foster Child) - Use Starting June 1, 2021
• CW 2218 (3/22) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-Needy Caretaker Relative With Relative Foster Child) - Use Starting June 1, 2022 

D Forms

• DFA 377.1 (11/01) - Notice of Approval
• DFA 377.1A (3/02) - Notice Of Denial Or Pending Status
• DFA 377.7A (4/21) - Notice Of Administrative Disqualification
• 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 377.7G (5/02) - Food Stamp Repayment Agreement For An Intentional Program Violation (IPV) Only
• DFA 377.7F (6/18) - CalFresh Overissuance Notice - Intentional Program Violation (IPV)
• DFA 377.7F LP (6/18) - CalFresh Overissuance Notice - Intentional Program Violation (IPV) - Large Print
• DFA 377.7F1 (10/00) - Food Stamp Repayment Notice For An Intentional Program Violation (IPV) Only Final Notice
• DFA 377.10 (6/04) - Food Stamp Notice Of Discontinuance
• DPA 19 (6/22) - Appointment Of Authorized Representative
• DPA 435 (1/18) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification hearing)
• DPA 436B (8/18) - County Information Letter
• DPA 479 (12/17) - Administrative Disqualification Hearing Waiver - CalWORKs/CalFresh

E Forms

• EBT 1232 (6/22) - CalFresh Notice Of Action - EBT Account
• EBT 2216 (10/22) - EBT Surcharge Free - Direct Deposit Handout
• EBT 2259 (11/21) - Report Of Electronic Theft Of Benefits
• EBT 2259A (11/21) - EBT Scamming Acknowledgement
• EBT 2260 (8/21) - Excessive Card Replacement Warning Letter
• EFA 7 (7/21) - The Emergency Food Assistance Program (TEFAP) Certification Of Eligibility
• EFA 14 (6/22) - The Emergency Food Assistance Program (TEFAP) 2022 Income Guidelines
• EFA 15 (6/22) - Alternate Pick-Up Request Form The Emergency Food Assistance Program (TEFAP) 2022 Income Guidelines
• FSP 2 (1/21) - Family Stabilization Program Denial Notice - Use Starting May 1, 2022

G Forms

• GEN 100 (11/20) - Examples Of Verification
• GEN 102 (1/22) - Appointment Letter
• GEN 107 (8/20) - Message From The County
• GEN 111 (11/20) - Employer Statement Form
• GEN 1179 (5/18) - Complaint of Discrimination
• GEN 1390 (3/17) - Informing Notice - Regarding An Action Taken On Your Case
• HCS 100 (11/21) - Application For Home Care Aide Registration or Renewal

L Forms

• LIC 01A (9/21) - Resource Family Application
• LIC 184B (3/22) - Notification Of Incomplete Application - Family Child Care Home
• LIC 184C (3/22) - Notification Of Incomplete Application (NOIA) Child Care Centers - Pre-30-Day NOIA
• LIC 184D (3/22) - Notification Of Incomplete Application (NOIA) Child Care Centers - 30-Day NOIA
• LIC 184E (3/22) - Notice Of Incomplete Application (NOIA) Changes To Corporate Status
• LIC 198 (1/22) - Child Abuse Central Index Check For County Licensed Facilities
• LIC 279B (1/22) - Current Children In Your Home - Application For A Family Child Care Home License
• LIC 300A (01/22) - Removal Confirmation - Exemption Needed
• LIC 311A (2/22) - Records To Be Maintained At The Facility - Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children
• LIC 311D (2/22) - Forms/Records To Keep In Your Family Child Care Home
• LIC 421A (6/22) - Civil Penalty Assessment (Unlicensed Facility)
• LIC 610A (01/22) - Emergency Disaster Plan For Family Child Care Homes
• LIC 700 (10/19) - Identification And Emergency Information Child Care Centers/Family Child Care Homes
• LIC 9052 (1/22) - Notice Employee Rights
• LIC 9058 (3/22) - Applicant/Licensee Rights
• LIC 9217 (5/22) - Pre-Licensing Readiness Guide - Family Child Care Home
• LIC 9224 (8/08) - Acknowledgement Of Receipt Of Licensing Reports

M Forms

• M40-107 (4/21) - Addendum 1 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107 (4/21) - Addendum 2 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107A (4/21) - Time On Aid (no previous NOa issued), Other - Use Starting May 1, 2022
• M40-107B (4/21) - Time On Aid at Redetermination - Use Starting May 1, 2022
• M40-107C1 (9/20) - Time on Aid Between 54th and 57th Month - Use Starting May 1, 2022
• M40-107D (4/21) - Time On Aid To Former CalWORKs Recipients - Use Starting May 1, 2022
• M40-107F (4/21) - Extended Beyond 60 Months of Aid - Use Starting May 1, 2022
• M40-107F1 (4/21) - Extender Met After 60th Month - Use Starting May 1, 2022
• M40-107F2 (4/21) - Extender Ended - Use Starting May 1, 2022
• M40-107G (4/21) - 60th Month On Aid, Discontinue - Use Starting May 1, 2022
• M40-107I (7/22) - 60th Month On Aid, No eligible child, Discontinue
• M40-107J (4/21) - Timed-Out Adult, Partial Approval - Use Starting May 1, 2022
• M40-107J1 (4/21) - Approval After 60 Months on Aid - Use Starting May 1, 2022
• M40-107K (4/21) - Increase Grant due to TOA Adjustment - Use Starting May 1, 2022
• M40-129B (11/09) - Full Payment - Approve
• M40-129B1 (12/90) - Approval after Immediate Need Payment, Approve
• M40-129C (12/90) - Miscellaneous, Deny
• M40-129D2 (12/90) - Procedural Requirements, Deny
• M40-129D3 (12/90) - Procedural Requirements, Deny
• M40-129D4 (9/00) - Procedural Requirements, Deny
• M40-129D5 (11/14) - Failed to Provide Proof of SSN Application, Deny  
• M40-129E1 (12/90) - No Emergency, Deny
• M40-129E2 (12/90) - No Emergency, Deny
• M40-129E4 (12/90) - No Emergency, Deny
• M40-129E5 (12/90) - No Emergency, Deny
• M40-129E6 (12/90) - No Emergency, Deny
• M40-181 (9/13) - SAWS 2 Redetermination Of Eligibility
• M40-181C SAR (9/13) - Notice Of Action - Balderas Reminder Notice
• M40-181F (7/22) - No Change at Redetermination
• M40-195A (8/22) - ICT Notice Of Transfer, Sending
• M40-195B (8/22) - ICT Notice Of Transfer, Receiving
• M44-133T (9/20) - Minor Parent, Financial Eligibility, Partial Approval
• M44-207K (5/20) – Financial Eligibility, Discontinue
• M44-207K1 (5/20) - Minor Parent, Financial Eligibility
• M44-207M (8/20) - Financial Eligibility, Deny
• M44-211D (10/21) - Temporary Shelter And/Or Permanent Housing
• M44-211N (9/21) - No Longer Pregnant, Change
• M44-315A (5/20) - $10 Minimum Payment, Change
• M44-315A (8/21) - $10 Minimum Payment, Change - Use Starting May 1, 2022
• 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
• M44-350K (11/21) - EBT Replacement Denial
• M44-350L (12/18) - Notice Of Overpayment
• M44-352H SAR (9/13) Notice Of Action Overpayment Adjustment
• M81-215E (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M81-215F (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M82-820A (9/21) - No Eligible Person, Deny
• M82-832H (10/20) - Child Does Not Meet Requirements (SB 380)

N Forms

• NA Back 9 (5/22) - Your Hearing Rights (Full Rights Are Listed in CDSS PUB 412)
• NA 200 (12/20) - Notice Of Action - Multipurpose - Include Budget - Use Starting June 1, 2021
• NA 200 (7/21) - Notice Of Action - Multipurpose - Include Budget - Use Starting June 1, 2022
• NA 210 (5/20) - Discontinue, Suspend Financial Eligibility - Use Starting June 1, 2020
• NA 213 (10/21) - Deny - Financial Eligibility
• NA 213A (12/20) – Notice Of Action – Deny – Financial Eligibility - Use Starting June 1, 2021
• NA 213A (7/21) – Notice Of Action – Deny – Financial Eligibility - Use Starting June 1, 2022
• NA 271 (12/20) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid - Use Starting June 1, 2021
• NA 271 (7/21) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid - Use Starting June 1, 2022
• NA 274G (7/19) - Notice Of Action - Continuation Page - Overpayment Computations Occurring On Or After 10/1/2013 To 5/31/2020
• NA 274H (12/20) - Notice Of Action - Continuation Page - Overpayment Computations Between 6/1/2020 and 05/31/2021
• NA 274I (7/21) - Notice Of Action - Continued - Overpayment Amount Owed For Overpayments Occurring Between 6-1-2021 and 5-31-2022
• NA 274J (7/21) - Notice of Action – Continued - Overpayment Amount Owed For Overpayments Occurring On or after 6-1-2022
• NA 281C (7/19) - Notice Of Action - Continuation Page - Underpayment Computations Occurring On Or After 6/1/2020
• NA 281C (12/20) - Notice Of Action Continuation Page - Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2020 and 5-31-2021) – Use Starting June 1, 2021
• NA 281D (7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2021 and 5-31-2022)
• NA 281E (7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring On Or After 6-1-2022)
• NA 290 (2/14) -Notice of Action - Multipurpose
• NA 300 (7/19) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Test - Use Until May 31, 2021
• NA 300 (10/21) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Tests - Use Starting June 1, 2021
• NA 301 (10/21) - Continuation Page - Applicant Financial Eligibility Test
• NA 530 (4/21) - Notice Of Action - 60-Month Time Limit - Use Starting May 1, 2022
• NA 531 (12/20) - Notice Of Action - Continuation Page - 48-Month Time Limit - Includes Budget - Use Starting June 1, 2021
• NA 531 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget - Use Starting May 1, 2022
• NA 531 (7/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget - Use Starting June 1, 2022
• NA 532 (12/20) - Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue - Includes Budget - Use Starting June 1, 2021
• NA 532 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit Discontinue - Includes Budget - Use Starting May 1, 2022
• NA 532 (11/21) - Notice Of Action - Continuation Page - 60-Month Time Limit Discontinue - Includes Budget - Use Starting June 1, 2022
• NA 816 (3/14) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan
• NA 817 (3/14) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan
• NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work
• NA 821 (1/01) - Notice Of Action - Transportation Approval/Denial
• NA 823 (8/00) - Notice Of Action - Ancillary Expenses Approval/Denial
• NA 824 (4/99) - Notice Of Action
• NA 832 (3/20) - Notice of Action - Child Care Services
• NA 833 (4/20) - Notice of Action - Child Care Services Change
• NA 834 (3/20) - Notice of Action - Child Care Services Denial
• NA 835 (3/20) - Notice of Action - Child Care Services Discontinuance
• NA 841 (3/14) - Notice Of Action - Welfare-To-Work Plan
• NA 845 (3/14) - Notice Of Action - Sanction and Removal Of The Other Parent's Needs
• NA 960X SAR (9/13) - Notice Of Action - Stop Aid;Report Not Received
• NA 960Y SAR (10/14) - Notice Of Action - Stop Aid;Report Incomplete
• NA 995 (5/13) - Food Stamp Notice of Denial/Disqualification For The California Food Assistance Program
• NA 1239 AR (12/20) - Notice Of Action - Continuation Page - Annual Report Budget - Use Starting June 1, 2021
• NA 1239 AR (8/21) - Notice Of Action - Continuation Page - Annual Reporting Budget- Use Starting June 1, 2022
• NA 1239 SAR (12/20) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget - Use Starting June 1, 2021
• NA 1239 SAR (8/21) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget - Use Starting June 1, 2022
• NA 1240 (4/13) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account
• NA 1263 (8/11) - Notice of Action - Overissuance Budget Worksheet
• NA 1267 (4/13) - CalFresh Informing Notice Of Receiving Intercounty Transfer
• NA 1268 (4/13) - 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
• NA 1276 (1/15) - Notice Of Action - Welfare-to-Work 24-Month Time Clock Limit Notice

P Forms

• PUB 13 (5/22) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California
• PUB 273-A2 (2/21) - Shaken Baby Syndrome Poster - ( 24" x 36")
• PUB 370 (4/19) - Public Assistance Benefits For Asylees In California
• 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 (8/17) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits.
  Single Column | Double Columns .
• PUB 388 (8/17) - California Electronic Benefit Transfer (EBT) Card​
• PUB 389 (8/17) - 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.)
  Single Column | Double Columns
• 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 400 (08/17) - Safely Surrendered Baby Campaign Brochure
• PUB 400C (6/17) Safely Surrendered Baby Know Your Rights
• PUB 400C-1 (6/17) - Safely Surrendered Baby Law - Know Your Rights Poster
• PUB 412 (4/04) - State Hearing Information
• PUB 470 (4/21) - Your Rights Under Adult Protective Services
• PUB 470L (1/19) - Your Rights Under Adult Protective Services
• PUB 484 (7/15) - Keep More Of Your Money - Poster
• PUB 515 (10/19) - Risks and Effects of Lead Poisoning
• PUB 516 (9/19) - You May Be Eligible For 12 Months Of Child Care
• PUB 520 (11/21) - Great News! Based On Your Medi-Cal Eligibility Your Household May Be Eligible For CalFresh Food Benefits

Q Forms

• 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

R Forms

• RAD 03 (2/21) – Suspected Unemployment Insurance Fraud And identity Theft Information
• RFA 07 (2/18) - Resource Family Approval (RFA) Health Questionnaire

S Forms

• SAR 2 (6/19) - Reporting Changes For Cash Aid And CalFresh
• SAR 2LP (6/19) - Reporting Changes For Cash Aid and CalFresh (20pt Font)
• SAR 3 (2/15) - Mid-Period Status Report For Cash Aid And CalFresh
• SAR 7 (12/14) - SAR 7 Eligibility Status Report
• SAR 7 Addendum (4/13) - Instructions And Penalties SAR 7 Eligibility Status Report - For Cash Aid and CalFresh
• SAR 7A (12/14) - 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 (8/13) - Initial Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
• SAWS 2 PLUS (4/15) - Application For CalFresh, Cash Aid, And/Or Medi-Cal/Health Care Programs
• SAWS 2A SAR (4/15) - Rights and Responsibilities And Other Important Information For The Cash Aid And CalFresh Programs, And/Or Medi-Cal/34-County Medical Services Program (CMSP)
• SAWS 30 (3/19) - Notification Of New Employment
• SNB 1 (8/18) - Notice To CalFresh Recipients Supplemental Nutrition Benefit (SNB) Program
• SNB 2 (8/18) - Notice Of Approval For Supplemental Nutrition Benefit (SNB) Program
• SNB 3 (8/18) - Notice Of Change For Supplemental Nutrition Benefit (SNB) Program
• SNB 4 (8/18) - Notice Of Expiration Of Certification For Supplemental Nutrition Benefit (SNB) Program
• SNB 5 (8/18) - Notice Of Discontinuance For Supplemental Nutrition Benefit (SNB) Program
• SNB 7 (6/19) - CalFresh And Supplemental Nutrition Benefit (SNB) Informing Notice Of Receiving Intercounty Transfer
• SNB 8 (6/19) - CalFresh And Supplemental Nutrition Benefit (SNB) Informing Notice Of Sending Intercounty Transfer
• SOC 829 (10/18) - In-Home Supportive Services (IHSS) / Waiver Personal Care Services (WPCS) Provider Direct Deposit Enrollment/Change/Cancellation Form
• SOC 831 (10/18) - IHSS Provider Letter
• SOC 832 (1/13) - Notice of Child Abuse Central Index Listing

T Forms

• 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 Electronic Benefit Transfer (EBT)
• TEMP 2250 (8/21) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients
• TEMP 2252 (12/20) - State Law Changes The CalWORKs Earned Income Disregard - Use Starting June 1, 2021
• TEMP 2252 (3/22) - State Law Changes The CalWORKs Earned Income Disregard - Use Starting June 1, 2022
• TEMP 3005 (12/14) - Changes For People With A Prior Felony Drug Conviction
• TEMP 3011 (12/21) – Child and Family Team (CFT) & Child and Adolescent Needs and Strengths Tool (CANS) - For Parents
• TEMP 3012 (12/21) – Child and Family Team CFT and CANS - For Youth
• TEMP 3013 (12/21) – Child and Family Team (CFT) & Child and Adolescent Needs and Strengths Tool (CANS) - For Professionals
• TEMP 3014 - (9/19) Treasury Offset Program (TOP) Pre-Offset Notice
• TEMP 3014 - (2/20) Treasury Offset Program (TOP) Pre-Offset Notice - Do Not Use Until 12/20
• TEMP 3015 - (2/20) Franchise Tax Board (FTB) Pre-Offset Notice - Do Not Use Until 12/20
• TEMP 3015A (2/20) - Franchise Tax Board (FTB) Annual Pre-Offset Notice - Do Not Use Until 12/20
• TEMP 3016 - Farsi
• TEMP 3017 - (2/20) - Treasury Offset Program Notification Of Offset
• TEMP 3022 - (8/21) - Important Information For CalWORKs Families -State Law Increases The CalWORKs Time Limit To 60 Months
• TEMP CF 1468 (2/15) - CalFresh Notice Of Change
• TEMP CW 2225 (10/20) - Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Disregard/Pass-Through Rules
• TEMP NA 1232 (8/08) - Food Stamp Notice of Action - EBT Account
• TEMP NA 1238 (7/04) - Required Form - Substitute Permitted
• TEMP WI 10072 (8/13) - EBT Replacement Approval
• TEMP WI 10072A (8/13) - EBT Replacement Review
• TM44-315H (9/14) - Law Change To MAP Levels
• TM44-315K (7/19) - Law Change To MAP Levels
• TM44-315M (7/22) - Law Change To MAP Levels
• TM82-832 (12/14) - Basic Approval
• TNB 1 (8/18) - Notice To CalFresh Recipients Transitional Nutrition Benefit (TNB) Program
• TNB 2 (8/18) - Notice Of Approval For Transitional Nutrition Benefit (TNB) Program
• TNB 3 (8/18) - Notice Of Change For Transitional Nutrition Benefit (TNB) Program
• TNB 4 (8/20) - Notice Of Recertification For Transitional Nutrition Benefit (TNB) Program
• TNB 5 (8/18) - Recertification Reminder Notice For Transitional Nutrition Benefit (TNB) Program Recertification Form Not Received Or Incomplete
• TNB 6 (8/18) - Notice Of Discontinuance For Transitional Nutrition Benefit (TNB) Program
• TNB 7 (6/19) - Transitional Nutrition Benefit (TNB) Informing Notice Of Receiving Intercounty Transfer
• TNB 8 (6/19) - Transitional Nutrition Benefit (TNB) Informing Notice Of Sending Intercounty Transfer

W Forms

• WI 10072A (11/21) - EBT Replacement Approval
• WI 10072B (11/21) - EBT Replacement Review
• WINS 1 (5/14) - Notice To All CalFresh Recipients Work Incentive Nutritional Supplement (WINS) Benefit Important - Please Read
• WINS 1239 (5/14) - CalFresh Notice Of Approval/Denial/Termination Work Incentive Nutritional Supplement (WINS) Benefits
• WTW 2 (5/21) - Welfare To Work Plan Activity Assignment - Use Starting May 1, 2022
• WTW 5 (9/13) - Welfare-To-Work Program Notice - Tell The County If You Need Help Reading Or Understanding This Notice
• WTW 5 (1/21) - WelFare-To-Work Program Notice - Tell The County If You Need Help Reading Or Understanding This Notice - Use Starting May 1, 2022
• WTW 15 (9/13) - Simplified CalFresh Program Unpaid Work Experience (WEX) And Unpaid Community Service Hours Worksheet
• WTW 16A (7/19) - Grant Based OJT Income Examples For Region 1 - Use Starting June 1, 2020
• WTW 16A (3/22) - Grant-Based OJT Income Examples For Region 1 - Use Starting June 1, 2022
• WTW 16B (7/19) - Grant Based OJT Income Examples For Region 2 - Use Starting June 1, 2020
• WTW 16B (3/22) - Grant-Based OJT Income Examples For Region 2 - Use Starting June 1, 2022
• WTW 17 (12/15) - Waiver Of CalWORKs Learning Disabilities Screening And/Or Evaluation
• WTW 43 (9/14) - Notice Of Your Welfare-To-Work (WTW) 24-Month Time Clock Ending Soon
• WTW 44 (1/15) – Welfare To Work (WTW) 24-Month Time Clock Extension Request Form
• WTW 45 (1/15) – Welfare To Work (WTW) 24-Month Time Clock Extension Determination
• WTW 46 (1/15) - End Of Welfare-To-Work 24-Month Time Clock Review Appointment Letter
• WTW 47 (3/15) - Online CalWORKs Appraisal Tool Rights And Privacy
• WTW 51 (1/21) - Welfare To Work Noncompliance Checklist Tool - Use Starting May 1, 2022
• WTW 100 (9/20) - Good Cause/Exemption Letter
• WTW 111 (9/20) - Work Experience And/Or Community Services Hours Of Participation Notice
• WTW 112 (3/21) - Care Of A Household Member Verification
• WTW 246 (11/20) - Employment Workshop & Job Search Notice
• WTW 2490 (11/20) - Non-Receipt Of WTW Attendance/Progress Report