Thai

Thai Translations

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Forms translated into THAI

A | C | D | E | F | G | L | M | N | P | S | T | W |

A

• ABCDM 229 (1/23) - Applicant/Recipient’s Authorization For Release Of Information To Community-Based Organization (CBO) In BenefitsCal
• AD 1A (4/22) - Parental Consent To Adoption (In Or Out-Of-California)
• AD 65 (2/02) - Parent's Authorization For Medical And Surgical Care
• AD 67 (5/15) - Information About The Birth Mother - Agency And Independent Adoptions Program
• AD 100 (7/10) - Authorization For Use And/Or Disclosure Of Health Information Independent Adoption Program
• AD 918 (11/03) - Family Assessment Questionnaire II
• AD 590A (6/15) - Waiver Of Right To Further Notice Of Adoption Planning - Presumed Father In Or Out Of California - Agency And Independent Adoptions Program
• AD 880 (2/21) – Declaration Of Birth Parent - Agency And Independent Adoptions Program
• AD 887 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The Child To The Petitioner(s)
• AD 887A (4/14) - Statement Of Understanding - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The Child To The Petitioner(s) - Independent Adoptions Program
• AD 908 (5/22) - Adoptions Information Act Statement
• AD 918 (11/03) - Family Assessment Questionnaire II
• AD 925 (11/23) - Independent Adoption Placement Agreement - Indian Child - Independent Adoptions Program
• AD 4324 (10/03) - Adoption Questionnaire I

C

• 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
• 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 34 (12/20) – CalFresh Notice of Change: Semi-Annual Reporting Eliminated
• CF 285 (8/21) - Application For CalFresh Benefits
• CF 285A (11/21) - Application For CalFresh Benefits
• CF 389 (7/24) - Notice Of Denial Of Restoration
• 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 377.2B (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 377.4 SAR (9/23) - CalFresh Notice Of Change For Semi-Annual Reporting Households
• 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 377.7D2 (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 377.7H (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 377.10 (2/24) - CalFresh Notice Of Denial/Disqualification For Failure To Meet General CalFresh Work Rules
• 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 377.11E (12/23) – CalFresh Able-Bodied Adult Without Dependents (ABAWD) Time Limit Exemption Screening Form
• CF 385 (1/24) - Application For Disaster CalFresh
• CF 388 (7/24) - CalFresh Notice Of Restoration Approval
• 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
• 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 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 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 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

• DPA 19 (6/22) - Appointment Of Authorized Representative

E

• EBT 1232 (6/22) - CalFresh Notice Of Action - EBT Account
• EBT 2216 (4/23) - EBT Surcharge Free - Direct Deposit Handout
• EBT 2259 (3/24) - Report Of Electronic Theft Of Benefits
• EBT 2260 (8/21) - Excessive Card Replacement Warning Letter
• EFA 7 (7/21) - The Emergency Food Assistance Program (TEFAP) Certification Of Eligibility
• EFA 14 (3/24) - The Emergency Food Assistance Program (TEFAP) 2024 Income Guidelines
• EFA 15 (4/24) - Alternate Pick-Up Request Form The Emergency Food Assistance Program (TEFAP) 2024 Income Guidelines

F

• FDU 113 (7/22) - Civil Rights Annual Training Checklist For CSFP And TEFAP
• FSP 2 (1/21) - Family Stabilization Program Denial Notice - Use Starting May 1, 2022

G

• GEN 102 (1/22) - Appointment Letter
• GEN 1179 (5/18) - Complaint of Discrimination
• GEN 2101 (3/24) - Non-Work Social Security Number Request Form

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L

• LIC 613B (6/22) - Personal Rights Children’s Residential Facilities

M

• 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
• M40-107K (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
• M40-181F (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
• M44-207K1 (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
• M44-340 (2/23) - Underpayment Adjustment, Approval
• M44-350K (6/24) - EBT Replacement Denial
• M44-352H (2/23) - 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)

N

• 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 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 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 (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 (12/20) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring On Or After 6-1-2021)
• 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 816A (1/24) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan (FR)  - Use Starting January 1, 2025
• 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 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 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

P

• PUB 13 (5/22) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California
• PUB 13L (5/22) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California (Large Print)
• PUB 388 (2/24) - California Electronic Benefit Transfer (EBT) Card
• PUB 389 (2/24) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase
• PUB 428 (12/23) - It's Your Money - Get It - The State and Federal Earned Income Tax Credit (EITCs)
• PUB 429 (12/23) - California EITC is Here! Claim Your 2023 State And Federal Credits - You Earned It - It's Your Money
• PUB 470 (4/21) - Your Rights Under Adult Protective Services
• PUB 520 (11/21) - Great News! Based On Your Medi-Cal Eligibility Your Household May Be Eligible For CalFresh Food Benefits
• PUB 525 (11/23) - Protect Yourself From Electronic Theft By Downloading The ebtEDGE Mobile Application Today
• PUB 526 (12/23) - You May Be Eligible For Retroactive CalFresh Benefit Theft Replacements

S

• SAR 7 DA (12/23) - Domestic Abuse Addendum to the SAR 7