California Department of Social Services Forms

This form is used for social workers in California to disclose information related to their professional background and any disciplinary actions taken against them.

This form is used for notifying recipients of the In-Home Supportive Services (IHSS) program in California about the denial of their request for an in-home reassessment based on a state law change. It provides information about why the request was denied and any available options for further action.

This Form is used for requesting to deactivate or reactivate a user in the County Cmips II system in California.

This form is used for the In-home Supportive Services Program in California to notify providers of inactivity.

This form is used for reporting a safely surrendered baby to the California Department of Social Services.

This Form is used for preparing a checklist of facts for the In-Home Supportive Services (IHSS) Program Caregiver Background Check Bureau (CBBC) in California. It is used by the General Exception Unit (GEU) to ensure all necessary information is provided for the background check process.

This form is used for summarizing the statement of facts for the IHSS Program Caregiver Background Check Bureau (CBCB), specifically for the General Exception Unit (GEU) in California.

This form is used for the In-home Supportive Services Program in California. It is a notice to the provider regarding their eligibility and acknowledgement of receiving a waiver.

This form is used for requesting a reference for the applicant of In-Home Supportive Services (IHSS) in California.

This form is used for California's In-home Supportive Services (IHSS) program recipients to request a waiver for their provider.

This form is used for completing the medical questionnaire for the "Safely Surrendered Baby" program in California.

This form is used for notifying recipients of the In-Home Supportive Services Program in California about the ineligibility of their provider due to Tier 2 crimes and subsequent convictions.

This form is used for informing recipients of the In-home Supportive Services Program in California about the ineligibility of their provider due to a subsequent conviction for Tier 1 crimes.

This form is used for sending a notice to the provider in the In-home Supportive Services program in California who is found to be ineligible due to a subsequent conviction for Tier 2 crimes.

This form is used for providing a notice to the provider of the In-Home Supportive Services Program in California regarding their ineligibility due to Tier 1 crimes or subsequent convictions.

This Form is used for acknowledging the receipt of an invalid request for a provider waiver in the In-home Supportive Services Program in California.

This form is used for the In-home Supportive Services Program in California. It is a notice to the recipient of the provider eligibility acknowledgment and receipt of waiver.

This form is used for notifying recipients of the In-home Supportive Services Program in California about the ineligibility of their provider due to Tier 2 crimes such as serious/violent felonies, sex offender felonies, and fraud against government agencies.

This form is used for notifying recipients of the In-home Supportive Services Program in California about the provider's ineligibility due to Tier I crimes such as elder or dependent adult abuse, child abuse, and fraud against a government health care or supportive services program.

This form is used for notifying recipients of the In-home Supportive Services Program in California about the eligibility of their service provider.

This form is used for notifying providers in California's In-Home Supportive Services Program about their ineligibility.

This form is used for notifying the provider applicant of their ineligibility for the In-home Supportive Services Program due to Tier 2 crimes such as serious/violent felonies, sex offender felonies, and fraud against government agencies. It is specific to California.

This form is used for notifying an applicant provider of their ineligibility for the In-home Supportive Services Program due to tier I crimes such as elder or dependent adult abuse, child abuse, or fraud against a government healthcare or supportive services program. The form is specific to the state of California.

This form is used for notifying an applicant provider in California about their ineligibility for a provider process due to incomplete information.

This form is used for the In-home Supportive Services Program in California. It is used to notify providers of their ineligibility for the program.

This form is used as a supplementary document to the Rate Questionnaire in California.

This form is used for supplementing the Rate Eligibility Form in the state of California.

This form is used for providing supplemental information related to the dual agency rate for real estate transactions in California.

This form is used to request a grievance hearing in the state of California.

This form is used for reporting and documenting cases of child abuse in California. It is used to list individuals who have been identified as perpetrators of child abuse in the state's central index.

This Form is used for verifying the county of residence in California for the Conlan II program.

This form is used for reporting child near fatality cases in California. It documents the services provided and actions taken by the county to address the situation.