California Department of Social Services Forms

This Form is used for canceling the Live-In Self-certification for the In-home Supportive Services (IHSS) Program and Waiver Personal Care Services (WPCS) Program in California.

This form is used for providing notice of actions taken by the California government.

This form is used for requesting a State Administrative Review for an exemption from workweek limits for extraordinary circumstances in the In-Home Supportive Services (IHSS) Program in California.

This Form is used for submitting a Notice of Action in California.

This form is used for notifying the provider of the In-home Supportive Services Program in California about the non-acceptance of a subsequent request for exemption from workweek limits due to extraordinary circumstances (Exemption 2).

This form is used for the Franchise Tax Board (FTB) to provide an annual pre-offset notice in California.

This document is used for individuals in California who are part of the In-Home Supportive Services program and want to hire a provider. The form includes a request for a background check using the person's name with the Department of Justice.

This form is used for receiving a pre-offset notice from the California Franchise Tax Board (FTB).

This form is used for reporting changes in income or household information for CalFresh (California's food assistance program) recipients.

This form is used for notifying the IRS of a change in the underpayment computation for California taxpayers.

This form is used for notifying individuals in California of a specific action that has been taken.

This document is used to notify individuals of an action being taken in the state of California.

This form is used for providing notice of action regarding the CalFresh EBT account in California.

This Form is used for notifying individuals in California about overpayments or underpayments of welfare to work or Cal-Learn supportive services.

This Form is used for providing a pre-offset notice to California residents regarding the Treasury Offset Program (Top).

This form is used for notifying individuals in California that their welfare-to-work 24-month time clock is ending soon.

This form is used for determining the extension of the 24-month time clock for Welfare-To-Work (WTW) program participants in California.

This form is used when an individual has decided to place an adult or elderly person who is unable to care for themself in assisted care to evaluate their needs and level of competency.

This form is used for relinquishing parental rights or establishing paternity outside of the birth county for birth mothers, biological fathers, or presumed fathers in California.

This form is used for the Private Adoption Agency Reimbursement Program (PAARP) in California. It is used to request reimbursement for expenses related to private adoptions.

This form is used for notifying individuals about the approval of their application for the CalFresh Water Pilot program in California.

This form is used for providing notice of discontinuance for the CalFresh Water Pilot program in California.

This form is used for applying for CalFresh benefits and is specifically for individuals who have excess medical deductions. It is provided in a large print format and is for residents of California.

This form is used for verifying school financial aid and expenses in the state of California. It is used to ensure accurate and up-to-date information regarding a student's financial situation when applying for financial aid.

This form is used for verifying pregnancy in the state of California. It may be required for various purposes such as filing for maternity leave or accessing certain benefits.

This form is used for completing the AFDC-FG/U Worksheet in California as a supplement to the Form FC3A.

This form is used to determine eligibility for federal AFDC-FC (Aid to Families with Dependent Children-Foster Care) in California.

This document provides a guide for financial screening of individuals applying for Supplemental Security Income (SSI) in California. It helps determine eligibility based on financial criteria.

This form is used for requesting a balance letter in the state of California. A balance letter shows the current amount owed on a financial account.

This form is used for approving a new direct deposit letter in California.

This form is used for notifying individuals in California enrolled in the Family Stabilization Program about changes in program status.