- NA 991 - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration)
- NA 992 - RCA Application Approval
- RCA and Refugee Services (RS) forms
- RCA 43 - Refugee Cash Assistance (RCA) Notice Of A Participation Problem
- RCA 44 - Refugee Cash Assistance (RCA) Notice Of No Good Cause Determination And Compliance Plan Appointment
- RS 1 - Refugee Settlement Program Services Application And Assessment Information
- RS 3 - Service Provider Referral/Notification Form
- RS 3A - Client Tracking
- RS 18 - Refugee Services - Information Transmittal
- RS 36 - Employment And Training Requirements For Refugee Cash Assistance (RCA)
- RS 50: Exhibit C - Services Report: Employment Services (Schedule C) **(Not to be used for county reporting), Instructions (Exhibit C-1) and Narrative form (Schedule A)
- Due to the RS 50 form not being ADA accessible, please email RPB Reports for a mailed copy.
- RS 51: Exhibit C-2 - Caseload Movement Report (Schedule B) **(Not to be used for county reporting)
- Due to the RS 51 form not being ADA accessible, please email RPB Reports for a mailed copy.
- RS 52 - Claim for Reimbursement (see ACIN I-42-09 for reporting details)
- Additional CDSS Forms and Translations
Please contact your county analyst for the latest reporting forms or if you have any questions regarding these forms. For the County Operations & Performance Unit staff responsible for your county, either call (916) 654-4356 or email. Some documents are in Adobe Portable Document Format (PDF). Please see Tips for Using Adobe PDF Files for details.