Hmong
Hmong Translations
Problems with downloading forms? CDSS forms and publications are available only in Portable Document Format (PDF). Tips for Using Adobe PDF Files
For Hmong 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
- CCP 4 (8/21) - Health And Safety Self-Certification (For license-exempt providers)
- CCP 7 (5/24) - 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 (9/22) - Notice To All CalFresh Recipients - Important - Please Read - Use Starting October 1, 2022
- CF 11 (8/23) - Notice To All CalFresh Recipients - Use Starting October 1, 2023
- CF 12 (6/23) - Notice to CalFresh Recipients
- CF 12 LP (6/23) - Notice to CalFresh Recipients - Large Print
- CF 18 (2/14) Eng/Hmong - Important Information
- CF 20 (2/14) - You Do Not Owe Anything For Receiving CalFresh Benefits
- CF 21 (3/14) - Release Form
- 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 (8/21) - 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 (7/24) – 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 377.10 (2/24) - CalFresh Notice Of Denial/Disqualification For Failure To Meet General CalFresh Work Rules
- CF 377.11 (6/18) - CalFresh Time Limit Notice - Failure To Meet The Able-Bodied Adults Without Dependents (ABAWDs) Work Requirement
- CF 377.11A (11/23) - CalFresh Time Limit Notice - Expiration Of Three Consecutive Months For Able-Bodied Adults Without Dependents (ABAWDs)
- CF 377.11B (9/23) - 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 (12/23) – 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 (6/17) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members
- 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 (9/23) - CalFresh Notice Of Change For Semi-Annual Reporting Households
- 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 (6/22) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only
- CF 377.7B LP (6/22) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only - Large Print
- CF 377.7B1 (6/22) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice
- CF 377.7B1 LP (6/22) - 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 (6/22) - CalFresh Repayment Final Notice - County Administrative Error (AE)
- CF 377.7D2 LP (6/22) - CalFresh Repayment Final Notice - County Administrative Error (AE) - Large Print
- CF 377.7D3 (6/22) - 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 377.7H (2/23) - CalFresh Informational Notice - Potential Intentional Program Violation (IPV)
- CF 377.9 (8/20) - Notice Of Back CalFresh Benefits
- CF 377.9LP (8/20) - Notice Of Back CalFresh Benefits - Large Print
- CF 385 (1/24) - Application For Disaster CalFresh
- CF 386 (2/14) - CalFresh Notice Of Missed Interview
- CF 387 (5/14) - CalFresh Request For Information
- CF 388 (7/24) - CalFresh Notice Of Restoration Approval
- CF 389 (7/24) - Notice Of Denial Of Restoration
- CF 478 (2/14) - Disqualifiction Consent Agreement CalFresh Program
- CF 485 (10/23) - CalFresh Elderly Simplified Application
- CF 485 LP (12/23) - CalFresh Elderly Simplified Application - Large Print
- CF 886 (11/23) - CalFresh Notice Of Work Rules
- CF 889 (12/23) - CalFresh Restaurant Meals Program Approval/Termination Notice of Action
- CF 1239 (12/20) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
- CF 6177 (10/22) - CalFresh Student Exemption Screening Form
- CF SSA 1 (9/20) - 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)
- CFAP 377.7B (8/23) – California Food Assistance Program (CFAP) - State CalFresh Overissuance Notice Inadvertent Household Error (IHE) - Use Starting October 1, 2025
- CR 6181 (11/20) - Interpreter Services Statement And Confidentiality Agreement
- CSFP 001 (7/22) - Commodity Supplemental Food Program (CSFP) Participant Application
- CSFP 006 (7/22) - Commodity Supplemental Food Program (CSFP) Notice Of Action
- 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 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 377 (12/23) - CalWORKs Informational Notice - Potential Intentional Program Violation (IPV)
- 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 (1/24) - CalWORKs 60-Month Time Limit - Use Starting October 1, 2024
- CW 2186A (1/24) - CalWORKs Exemption Request Form - Use Starting October 1, 2024
- 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 2189A (9/20) – Notice Of Your CalWORKs Time Limit – 54TH Month On Aid (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 (5/23) - 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 (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
- M16-505A (7/02) - Designated Alternate Cardholder
- M16-705 (6/23) - EBT Adjustment Denial
- 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 (1/22) - 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
- M40-129B (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
- M40-107K (4/21) - Increase Grant due to TOA Adjustment - Use Starting May 1, 2022
- 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
- M40-181G (10/23) - Redetermination Reminder Notice
- 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
- M44-211L (9/23) - Pregnancy Special Needs, Approve
- M44-211N (9/23) - Pregnancy Special Needs, Change
- M44-211O (9/23) - Discontinue Pregnancy Special Needs Payment for Pregnant Person Only Assistance Unit
- M44-315A (5/20) - $10 Minimum Payment, Change - Use Until April 30, 2022
- 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
- M44-340 (2/23) - Underpayment Adjustment, Approval
- M44-350I SAR (9/13) - Notice Of Overpayment
- M44-350K (6/24) - EBT Replacement Denial
- M44-350L (12/18) - Notice Of Overpayment
- M44-352H (2/23) - Overpayment Adjustment
- M44-352H SAR (9/13) - Notice Of Action Overpayment Adjustment
- M44-353 (2/24) - Notice Of Overpayment Discharge
- M81-215E (4/21) - Time Limit Diversion - Use Starting May 1, 2022
- M81-215F (4/21) - Time Limit Diversion - Use Starting May 1, 2022
- M82-812B (6/24) - End of Cash Aid Following Family Reunification Discontinuance - Child Returned to Home
- M82-820A (9/21) - No Eligible Person, Deny
- M82-820D (9/23) - No Longer Eligible, Discontinue
- M82-832H (10/20) - Child Does Not Meet Requirements (SB 380)
- NA Back 9 (5/22) - Your Hearing Rights (Full Rights Are Listed in CDSS PUB 412)
- NA Back 9 LP (5/22) - Your Hearing Rights (Full Rights Are Listed in CDSS PUB 412) (Large print)
- 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 210 (7/19) - 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 (7/19) - Notice Of Action - Continuation Page - 48-Month Time Limit - Use Starting June 1, 2020
- 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 816A (1/24) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan (FR) - Use Starting January 1, 2025
- NA 817 (3/14) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan
- NA 817A (6/24) - Notice Of Action - Disqualification After Failed Compliance (FR) - Use Starting January 1, 2025
- NA 817B (4/24) - Notice Of Action - Sanction Of Participant in Two-Parent AU After Failed Compliance Plan (FR) - Use Starting January 1, 2025
- NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work
- NA 820 (11/20) - Notice Of Action - Transportation Approval
- NA 821 (11/20) - Notice Of Action - Transportation Approval/Denial
- 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 840B (4/24) - Notice of Action - Welfare-To-Work Plan – Denial (FR) - Use Starting January 1, 2025
- NA 840C (5/24) - Notice Of Action - Welfare to Work Plan in a Two-Parent AU (FR) - Use Starting January 1, 2025
- NA 840D (4/24) - Notice of Action - Welfare To Work Plan Continuance/Discontinuance (FR) - Use Starting January 1, 2025
- 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 Reporting 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