California Department of Social Services Forms

This form is used for prelicensing entrance checklist for child care centers in California. It helps ensure that child care centers meet the necessary requirements before obtaining a license.

This form is used for the prelicensing entrance checklist for family child care homes in California.

This form is used for notifying the denial of the Assistance Dog Special Allowance (ADSA) in California.

This form is used for receiving notifications regarding changes to your CalFresh EBT account in California. It informs you about any actions taken or updates made to your account.

This form is used for imposing civil penalties in cases of death, serious injury, or physical abuse in child care facilities in California.

File this form if you are the physician of the applicant for admission to a Community Care Facility and have a thorough knowledge of the patient's medical issues. The goal of this document is to check if the patient can continue their residential treatment at the facility.

This Form is used for conducting facility inspections at adoption agencies in California. It helps ensure compliance with licensing requirements and standards.

This form is used for conducting facility inspections at crisis nurseries in California. It helps ensure that these organizations are providing a safe and suitable environment for children in times of crisis.

This form is used to apply for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs in California. It is available in Spanish.

This form is used for applying for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs in California.

This form is used for submitting an audited attendance and fiscal report for child development programs in California that include early childhood mental health consultation services.