ABCDM 228 |
CF, MC, CW |
Authorization for Release of Information |
PDF (CDSS) |
English |
Spanish |
CCFRM 604 |
MC |
Application for Health Insurance |
PDF (CDSS) |
English |
Spanish |
CCP 2145 |
WTW |
CalWORKs Childcare Reimbursement Report |
PDF (CDSS) |
English |
Spanish |
CF 10 |
CF |
Dependent Care Cost Affidavit |
PDF (CDSS) |
English |
Spanish |
CF 285 |
CF |
Application for CalFresh |
PDF (CDSS) |
English |
Spanish |
CF 37 |
CF |
Recertification for CalFresh Benefits |
PDF (CDSS) |
English |
Spanish |
CSF 2 |
CF, CW |
General Affidavit |
PDF (local) |
English |
Spanish |
CSF 22 |
CW |
Employment Questionnaire |
PDF (local) |
English |
Spanish |
CSF 23 |
CF, CW |
Statement of Gift/Loan |
PDF (local) |
English |
Spanish |
CSF 33 |
CW |
Notice to Self-Employed Individuals |
PDF (local) |
English |
Spanish |
CSF 35 |
CF, CW |
Self-Employment Sworn Statement |
PDF (local) |
English |
Spanish |
CW 2.1 NA |
MC, CW |
Notice and Agreement for Child, Spousal and Medical Support |
PDF (CDSS) |
English |
Spanish |
CW 2.1 Q |
MC, CW |
Support Questionnaire |
PDF (CDSS) |
English |
Spanish |
CW 2186A |
CW, WTW |
CalWORKs Exemption Request Form |
PDF (CDSS) |
English |
Spanish |
CW 2209 |
CW |
Immunization Good Cause Request Form |
PDF (CDSS) |
English |
Spanish |
CW 42 |
CW |
Statement of Facts - Homeless Assistance |
PDF (CDSS) |
English |
Spanish |
CW 61 |
CW, WTW |
Health Care Provider - Authorization to Release Medical Information |
PDF (CDSS) |
English |
Spanish |
CW 8 |
CW |
Statement of Facts for an Additional Person |
PDF (CDSS) |
English |
Spanish |
CW 8 A |
CW |
Statement of Facts to Add a Child Under Age 16 |
PDF (CDSS) |
English |
Spanish |
E-81 Mileage |
WTW |
Mileage Record for WTW Activities |
PDF (local) |
English |
- |
MC 382 |
MC |
Authorized Representative Form |
PDF (CDSS) |
English |
Spanish |
SAR 7 |
CF, CW |
Eligibility Status Report |
PDF (CDSS) |
English |
Spanish |
SAWS 1 |
CF, MC, CW |
Application for CalFresh, Cash Aid, and/or MediCal/Health Care Programs |
PDF (CDSS) |
English |
Spanish |
TEMP 2201 |
CF, CW |
Request for DAC/AR |
PDF (CDSS) |
English |
Spanish |
TNB 4 |
CF |
Notice of Recertification for Transitional Nutrition Program |
PDF (CDSS) |
English |
Spanish |
W 323 |
CW |
Non Needy Relative Statement |
PDF (local) |
English |
Spanish |
W-73 |
CF, MC, CW |
Employer Letter English/Spanish |
PDF (local) |
English/Spanish |
W-402 |
CW |
Employment History Form |
PDF (local) |
English |
Spanish |
W-459 |
CF, MC, CW |
Electronic Communication Consent Form |
PDF (local) |
English |
Spanish |
W-497 |
CW |
Caretaker Relatives for the AFDC Child |
PDF (local) |
English |
- |
W-521 |
CF, MC, CW |
Authorization for Release of Information (CBO) English/Spanish |
PDF (local) |
English/Spanish |
W-664 |
CF, MC, CW |
Verification of Gross Pay English/Spanish |
Word (local) |
English/Spanish |