2014 Notice Of Forms Changes
14-141
SOC 851 (10/14) - In-Home Supportive Services Program Notice To Applicant Provider Of Provider Ineligibility Incomplete Provider Process
14-140
SOC 2266 (10/14) - In-Home Supportive Services Program Notice To Recipient Approval Of Exception To Exceed Weekly Hour
14-139
SOC 2265 (10/14) - In-Home Supportive Services Program Notice To Provider Reduction Of Total Violation Count
14-138
SOC 2264 (10/14) - In-Home Supportive Services Program Notice To Recipient Rescinding Provider Violation
14-137
SOC 2263 (10/14) - In-Home Supportive Services Program Notice To Provider Rescinding Violation
14-136
AD 67 (10/14) - Information About The Birth Mother
14-135
SOC 2255 (10/14) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
14-134
SOC 2255 (9/14) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement
14-133
SOC 2270 (11/14) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement
14-132
SOC 2270 (10/14) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement
14-131
SOC 855 (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process
14-130
SOC 2259 (12/14) - In-Home Supportive Services Program Notice To Provider Of Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limits
14-129
SOC 2258 (12/14) - In-Home Supportive Services Program Notice To Provider Of Third Violation And Three-Month Suspension For Exceeding Workweek And/Or Travel Time Limits
14-128
SOC 2257A (12/14) - In-Home Supportive Services Program Notice To Recipient Of Provider’s First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
14-127
SOC 2257 (12/14) - In-Home Supportive Services Program Notice To Provider Of First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
14-126
PUB 466 (12/14) - CDSS Employment Guide
14-125
PUB 467 (12/14) - Job Fair Flyer
14-124
M43-119H (11/14) - Missing SAR 72, Discontinue
14-123
M43-119G (11/14) - Missing SAR 72, Change
14-122
M42-769A (11/14) - Apply $100 Cal-Learn Penalty
14-121
M42-431A4 (11/14) - No Eligible Noncitizen Status/Proof of Eligible Noncitizen Status, Discontinue
14-120
M42-213A (11/14) - Restricted Account
14-119
M42-101C (11/14) - Age and School Requirements, Discontinue
14-118
M42-101B (11/14) - Age and School Requirements
14-117
M40-181E (11/14) - SAWS 2 PLUS Redetermination Immunizations/School Attendance, Change
14-116
M40-181A (11/14) - SAWS 2 Redetermination/Other Essential Information
14-115
M40-171A (11/14) - Failure to Cooperate, Deny
14-114
M40-129D5 (11/14) - Failed to Provide Proof of SSN Application, Deny
14-113
M40-129D1 (11/14) - Procedural Requirements, Deny
14-112
M40-105E (11/14) - Notice Of Action - School Attendance
14-111
M40-105C (11/14) - Notice Of Action - Immunizations
14-110
SOC 2259 (10/14) - In-Home Supportive Services Program Notice To Provider Of Fourth Violation And Termination For Exceeding Workweek And/Or Travel Time Limits
14-109
SOC 2258 (10/14) - In-Home Supportive Services Program Notice To Provider Of Third Violation And Three-Month Suspension For Exceeding Workweek And/Or Travel Time Limits
14-108
SOC 2257A (10/14) - In-Home Supportive Services Program Notice To Recipient Of Provider’s First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
14-107
SOC 2257 (10/14) - In-Home Supportive Services Program Notice To Provider Of First/Second Violation For Exceeding Workweek And/Or Travel Time Limits
14-106
M40-105A (11/14) - Failed to provide SSN or proof of completed SSN Application
14-105
M40-105 (11/14) - Failed to Provide SSN When Received or Failure to Cooperate
14-104
CF 11 (8/14) - Notice To All CalFresh Recipients
14-103
PUB 467 (8/14) - Job Fair Flyer
14-102
CF 11A (9/13) - Notice To All CalFresh Recipients
14-101
WTW 43 (9/14) - Notice Of Your Welfare-To-Work (WTW) 24-Month Time Clock Ending Soon
14-100
CF 215 (9/14) - CalFresh Notification Of Inter-County Transfer
14-099
AD 887B (7/14) - Statement of Understanding - Independent Adoptions Program
14-098
AD 861 (5/14) - Consent To Adoption Of Indian Child By Alleged Natural Father (In Or Out Of California)
14-097
AAP 6 (7/14) - Adoption Assistance Program Negotiated Benefit Amount And Approval
14-096
TEMP 3000 (9/14) - IHSS Program Overtime and Workweek Requirements Recipient Declaration
14-095 (not used)
14-094 (not used)
14-093 (not used)
14-092 (not used)
14-091
SOC 846 (9/14) - IHSS Program Provider Enrollment Agreement
14-090 (not used)
14-089 (not used)
14-088 (not used)
14-087 (not used)
14-086
SOC 426A (9/14) - English and Spanish - IHSS Program Recipient Designation of Provider
14-085
FSP 3 (8/14) - Family Stabilization Program Notice of Change in Program Status
14-084
FSP 2 (8/14) - Family Stabilization Program Denial Notice
14-083
FSP 1 (8/14) - Family Stabilization Program Evaluation Request
14-082
CF 1 (9/14) - Notice To All CalFresh Recipients
14-081
AAP 4 (9/13) - Eligibility Certification Adoption Assistance Program (Combines AAP4 And FC 9)
14-080
AD 501 ENG/SP (6/14) - Relinquishment In or Out-of-County (Birth Mother/Biological Father/Presumed Father in California)
14-079
AD 842 (7/14) - Consent To Adoptive Placement By Alleged Natural Father (Outside California In Armed Forces)
14-078
TEMP 2250 (8/14) - State Law Changes MAP Levels For Cash Aid Recipients
TM44-315H (9/14) - Law Change To MAP Levels
14-076
DPA 302 (8/11) Interpreter/Translator Billing
14-075
NA 1271 (5/14) - Notice Of Action - Denial Of Home Assessment/Approval
14-074
NA 816 (3/14) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan
14-073
NA 817 (3/14) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan
14-072
NA 1268 (4/13) - CalFresh Informing Notice Of Sending Intercounty Transfer
14-071
NA 840 (3/14) - Notice Of Action - Welfare To Work Plan
14-070
NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work
14-068
NA 1240 (4/13) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account
14-067
NA 845 (3/14) - Notice Of Action - Sanction and Removal Of The Other Parent's Needs
14-066
NA 1267 (4/13) - CalFresh Informing Notice Of Receiving Intercounty Transfer
14-065
NA 995 (5/13) - Food Stamp Notice of Denial/Disqualification For The California Food Assistance Program
14-064
CF 1239 (5/13) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits
14-063
NA 841 (3/14) - Notice Of Action - Welfare-To-Work Plan
14-062
PUB 463 (10/13) - Education Travel Reimbursement
14-061
NA 290 (2/14) - Notice of Action - Multi-purpose
14-060
CF 387 (5/14) - CalFresh Request For Information
14-059
List of Obsolete Forms - DFA 377.9, DFA 386, DFA 389, DFA 478, DFA 842
14-058
List Of Obsolete Forms - DFA 377.4A, DFA 377.7A1, DFA 377.7B, DFA 377.7B1, DFA 377.7C, DFA 377.7E1
14-057
AD 885 (3/14) - Mother Or A Biological/Presumed Father Of A Child Who Is Not Detained, A Juvenile Court Dependent In Out-of-home Care, Or The Ward Of A Legal Guardian
14-056
SAR 7A (5/14) - How To Fill Out Your SAR 7 Eligibility Status Report
14-055
SAR 7 (5/14) - SAR 7 Eligibility Status Report
14-054
EFA 14 (4/14) - Emergency Food Assistance Program (EFAP) 2014 Income Guidelines
14-053
FC 1637 (5/14) - 90-Day Transition Plan
14-052
AD 885A (4/14) - Mother or a Biological/Presumed Father of a Child Who is Detained, a Juvenile court Dependent in Out-of-home Care, or the Ward of a Legal Guardian
14-051
AD 887 (4/14) - Statement Of Understanding - Independent Adoptions Program
14-050
AD 594 (4/14) - Alleged Natural Father's Consent To Adoption (In Or Out Of California)
14-049
WINS 1 (5/14) - Notice To All CalFresh Recipients Work Incentive Nutritional Supplement (WINS) Benefit Important - Please Read
14-048
WINS 1239 (5/14) - CalFresh Notice Of Approval/Denial/Termination Work Incentive Nutritional Supplement (WINS) Benefit
1 4-047
CW 215 (4/14) - Notification Of Intercounty Transfer
14-046
CF 377.2A1 (4/14) - Important Information For Households In Which All Adults Are Elderly Or Disabled With No Earned Income
14-045
CF 377.7B1 (2/14) CalFresh Repayment Notice For Inadvertent Household Errors Only Final Notice
14-044
CF 377.7A1 (2/14) Request For Restoration Of CalFresh Benefits After Administrative Disqualification
14-043
WINS 1 (4/14) Notice To All CalFresh - Work Incentive Nutritional Supplement (WINS) Benefit
14-042
AD 887 (4/14) - Statement Of Understanding - Independent Adoptions Program
14-041
CF 377.4 CR (1/14) CalFresh Notice Of Change For Change Reporting Households
14-040
SOC 2250 (3/14) Application For Qualified Agency Certification
14-039
SOC 2249 (3/14) Qualified Agency Certification Application Checklist
14-038
WINS 1239 (4/14) CalFresh Notice Of Approval/Denial/Termination Work Incentive Nutritional Supplemnt (WINS) Benefits
14-037
CF 285 (2/14) English and Spanish - Application For CalFresh Benefits
14-036
KG 5 (2/14) Kinship Guardianship Assistance Payment (Kin-GAP) Program - Nonrecurring Legal Guardianship Expenses Form
14-035
KG 4 (2/14) Kinship Guardianship Assistance Payment (Kin-GAP) Program - Nonrecurring Legal Guardianship Expense Agreement
14-033
CW 2200 (2/14) Request For Verification
14-032
AD 842 (10/13) - Consent To Adoptive Placement By Alleged Natural Father (Outside California In Armed Forces)
14-031
STO CA 0034 (3/14) Forged Endorsement Affidavit
14-030
CF 29C (2/14) CalFresh Recertification Appointment
14-029
CF 29B (2/14) CalFresh Initial Recertification On-Demand Appointment Letter
14-028
CF 29D (2/14) CalFresh Recertification On-Demand Appointment Letter
14-027
CF 29A (2/14) CalFresh Initial Appointment Letter
14-026
AD 512 (1/14) Psychosocial And Medical History Of Child
14-025
LIC 184D (1/14) Notification of Incomplete Application (NOIA) Child Care Centers 30-Day NOIA
14-024
LIC 184C (1/14) Notification Of Incomplete Application (NOIA) Child Care Centers - Pre-30-Day NOIA
14-023
LIC 184B (1/14) English and Spanish - Notification Of Incomplete Application - Family Child Care Home
14-022
DFA 303 (3/05) English and Spanish - Replacement Affidavit/Authorization (DFA 303)
14-021
WTW 40 (2/14) Assembly Bill (AB) 74 County Welfare Department Family Stabilization (FS) Plan
14-020
List Of Obsolete Forms - TEMP 2230 ENG/SP, TEMP 2227 ENG/SP, TEMP 2225 ENG/SP, TEMP 2224 ENG/SP, TEMP 2193 ENG/SP, TEMP 2193A ENG/SP, TEMP NA 1239 ENG/SP
14-019
QR 2104 (6/10) English and Spanish - Food Stamp Notice Of Restoration Approval
14-018
List Of Obsolete Forms - FS 11 ENG/SP, FS 29 ENG_SP, FS 11B ENG/SP, FS 11C ENG/SP, FS 17 ENG/SP, FS 25 ENG_SP, FS 31 ENG/SP, FS 23 QR ENG_SP
14-017
List Of Obsolete Forms - DFA 377.5, DFA 377.7D, DFA 377.7D1, DFA 377.7D3
14-016
CF 377.7D (1/14) CF 377.7D1 (1/14) and CF 377.7D3 (1/14)
14-015
SOC 2247 (1/14) IHSS UHV Findings Report
14-014
SOC 2251 (1/14) To Request Appeal Of Agency Certification Denial
14-013
SOC 2250 (1/14) Application For Qualified Agency Certification
14-012
SOC 2249 (1/14) Qualified Agency Certification Application Checklist
14-011
TEMP 2250 (1/14) State Law Changes MAP Levels For Cash Aid Recipients
TM44-315G (12/13) Law Change To MAP Levels
14-010
SOC 2245 (1/14) IHSS Fraud Data Reporting Form
14-009
AD 501 (11/13) Relinquishment In Or Out-of-County (Birth Mother/Biological Presumed Father In California)
14-008
CF 377.7D1 (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
14-007
CF 377.D3 (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
14-006
CF 377.7D (8/13) CalFresh Overissuance Notice For Administrative Errors (AE) Only
14-005
FS 22 QR (10/13) English and Spanish - Applying For Food Stamp Benefits
14-004
DFA 285-A2 (8/06) English and Spanish - Statement Of Facts
14-003
DFA 285-A1 (2/13) English and Spanish - CalFresh Benefits
14-002
DFA 285-A3 QR (6/13) English and Spanish - CalFresh Benefits Your Rights And Responsibilities
14-001
CW 80 (12/13) Self-Certification Form For Motor Vehicles - CalWORKs