CalFresh, known federally as the Supplemental Nutrition Assistance Program or SNAP, provides monthly food benefits to individuals and families with low … For Spanish forms beginning with the following letters click below: M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z, Copyright © 2021 California Department of Social Services, Translated Spanish Forms Beginning With Letters A Through L, M16-120B (6/11) - EBT Dormant Account: Suspend, M16_120C (7/02) - EBT Dormant Account - Reactivate, M16_325B (7/02) - EBT Incomplete Document, M16-325E (8/08) - Direct Deposit Cancellation, M16_505A (7/02) - Designated Alternate Cardholder, M16_505B (7/02) - Designated Alternate Cardholder - Need Additional Facts, M16_505D (7/02) - Designated Cardholder - Deny, M20 003 (7/01) - Duplicate Aid Match, Discontinue, M20 003A (7/01) - Duplicate Aid Match, Deny, M20_353C (6/98) - Fraud, Penalty Applied to AU, M20_353D (6/98) - Fraud, Penalty Applied to AU, M20_353F (6/98) - Fraud, Penalty Stops - Change, M40_105 (11/14) - Failed to Provide SSN When Received or Failure to Cooperate, M40_105A (11/14) - Failed to Provide SSN or proof of completed SSN Application, M40_105B (7/98) - Change: Required Documentation Received, Immunization, M40_105C (11/14) - Notice Of Action - Immunizations, M40_105D (7/98) - Change: Required Documentation Received, School Attendance, M40-105D1 (1/15) - Notice Of Action - School Attendance, M40_105E (2/15) - Notice Of Action - School Attendance, M40_105I (3/00) - Deny: SFIS Requirements, Failure to Cooperate, M40_105J (3/00) - Deny: SFIS Requirements, Refusal to Cooperate, M40-107 (6/11) - Addendum 1 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption, M40-107 (6/11) - Addendum 2 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption, M40_107A (11/02) - Other: CalWORKs 60-Month Time Limit, Time on Aid (no previous NOA issued), M40 107B (6/11) - Time on Aid at Redetermination, M40_107C (6/11) - Time on Aid Between 42nd and 46th, M40 107D (6/12) - Time On Aid To Former CalWORKs Recipients, M40_107E (4/04) - Change: CalWORKs 60-Month Time Limit, 60th month On Aid, M40_107F (6/11) - Extender Met After 48th Month, M40_107F1 (6/11) - Extender Beyond 60th month On Aid, M40_107G (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid, M40_107H (11/02) - Change: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only, M40_107I (11/02) - Discontinue: CalWORKs 60-Month Time Limit, 60th month on Aid MFG child only, M40_107J (11/02) - Partial Approval: CalWORKs 60-Month Time Limit, Time-Out Adult, M40_107J1 (6/11) - Approval After 48 Months on Aid, M40_107K (6/11) - Increase Grant due to TOA Adjustment, M40_118A (8/96) - Application Processing Deny, M40-125B SAR (4/16) - Restore After a SAR7 Discontinuance, M40-125C SAR (4/16) - Incomplete Semi-Annual Report (SAR7) Denial of Restoration, M40 129B (11/09) - Full Payment - Approve, M40 129C (12/90) - Immediate Need -Deny - Miscellaneous, M40-129D1 (11/14) - Procedural Requirements, Deny, M40_129D5 (11/14) - Failed to Provide Prove of SSN Application - Deny, M40_157A1 (5/91) - Incomplete Citizen/Alien Documentation: Approval, M40_171A (11/14) - Failure to Cooperate - Deny, M40_171B (1/97) - Refusal to Cooperate - Denial, M40_171C (6/98) - Approve: Application Processing, Basic Approval, M40_171M (7/87) - Denial: Application Processing, Not a California Resident, M40-181 (9/13) - SAWS 2 Redetermination Of Eligibility, M40-181A (11/14) - SAWS 2 Redetermination/Other Essential Information, M40-181C SAR (9/13) Notice Of Action - Balderas Reminder Notice, M40_181D (5/91) - Denial: Application Processing, Not a California Resident, M40_181E (11/14) - SAWS 2 PLUS Redetermination Immunizations/School Attendance, Change, M40-195B (11/17) - ICT Notice Of Transfer, Receiving, M41_401A (12/86) - Denial: Deprivation, No Deprivation, M41_440F (6/98) - Deny: Deprivation, CalWORKs-U, 100 Hours Work Rule, M41_450A (1/98) - Deprivation: Uniformed services - Deny, M42_101B (11/14) - Age and School Requirements, M42_101C (11/14) - Age and School Requirements, Discontinue, M42-207A (10/15) - Over Property Limit, Deny, M42_221K (4/99) - Suspend: Property, Transfer w/out Fair Consideration, M42_221L (4/00) - Suspend: Income, Transfer w/out Fair Consideration, M42-431A4 (11/14) - No Eligible Noncitizen Status/Proof of Eligible Noncitizen Status, Discontinue, M42-769A (11/14) - Apply $100 Cal-Learn Penalty, M43_119E (1/98) - Sponsored Non-Citizen: Some needs Met - Change, M43_119G (11/14) - Missing SAR 72, Change, M43-119H (11/14) - Missing SAR 72, Discontinue, M43_119I (7/98) - Change: Sponsored Alien, Deemed & Family Property, M43_119J (7/98) - Change: Sponsored Alien, Deemed Property, M43_119K (7/98) - Deny: Sponsored Alien, Deemed Property & Family Property, M43_119L (7/98) - Deny: Sponsored Alien, Deemed Property, M43_119M (1/98) - Sponsored non-Citizen: Deemed Income-Change, M44_113A (6/98) - Change: Income, Change in Income, M44_113G1 (6/98) - Change: Income, Change in Income, M44_133D (6/98) - Change: Income, Change in Income, M44_133Q (6/98) - Change: Income, Change in Income, M44_133S (10/02) - Minor Parent Financial Eligibility (Change), M44-133T (9/20) - Minor Parent, Financial Eligibility, Partial Approval, M44_133V (10/02) - Minor Parent Financial Eligibility (Suspend), M44-207I SAR (4/16) - Financial Eligibility, M44_207J (6/98) - Deny: Income, Financial Eligibility Test, M44-207K (5/20) – Financial Eligibility, Discontinue, M44-207K1 (5/20) - Minor Parent, Financial Eligibility, M44_207L (6/98) - Suspend: Income, Financial Eligibility Test, M44-211B (7/19) - Expanded Temporary HA For Applicants Fleeing DV, Approve, M44-211D (7/19) - Temporary Shelter and/or Permanent Housing, Deny, M44_211L (7/01) - Change: Special Needs - Pregnancy, M44_305 (9/97) - Minor Parent Change of Payee, M44_307A (11/15) - Voucher/Vendor Payment, Other, M44-315A (5/20) - $10 Minimum Payment, Change, M44_315B (9/98) - Change: Aid Payment Levels, ICT between Reg-2, M44 315C (4/09) - Notice of Action - Four Percent Grant Reduction, M44 316 (8/04) - No Change/Mid Quarter Reporting, M44-316A (9/13) - Notice Of Action - Not Yet Changed, M44-316B (9/13) - Notice Of Action - Change In Income Over IRT, M44-316C (8/19) - Notice Of Action - No Change/Mid-Period Report Of Property, M44-316 SAR (9/13) - No Change/Mid-Period Reporting, M44-316D SAR (9/13) - Notice Of Action - Change In Income, M44-316E (10/16) - Mid-Period Change Due To The Death Of A Child, M44_340 (4/00) - Approval: Underpayments, Underpayment Adjustment, M44 340C (8/12) - Underpayment Adjustment, M44_350A (11/11) - Overpayment Adjustment, M44_350E (11/11) - Excess Property O/P and Adjustment (W/O Good Faith), M44_350F (11/11) - Excess Prop O/P (W/O Good Faith), M44_350G (11/11) - Excess Prop O/P Adjustment (With Good Faith), M44_350H (11/11) - Excess Prop O/P (W/Good Faith), M44-350I SAR (9/13) - Notice Of Overpayment, M44-350J (3/12) - Overpayment To Be Stopped Effective February 1, 2012, M44-350K (12/18) - EBT Replacement Denial, M44 352A (11/11) - Notice of O/P and Demand, M44 352H (11/11) - Overpayment Adjustment, M44-352H SAR (9/13) Notice Of Action Overpayment Adjustment, M44_401A (6/98) - Approve: Hardship Supplement RISP - MFG, M44_401B (6/98) - Deny: Hardship Supplement RISP - MFG, M81_215A (6/98) - DENY: Aid Payments, Diversion payment provided, M81_215B (6/98) - DENY: Aid Payments, Diversion services provided, M81_215D (6/98) - Change: Aid Payments, Diversion Repayment Stops, M82 506 (6/98) - Change: Assignment of Support Rights, Failure to Cooperate, M82 506A (6/98) - Partial Approval: Assignment of Support Rights, Failure to Cooperate, M82 510 (6/02) - Failure to Cooperate, Change, M82 510A (6/98) - Change: Support Process/Assignment, Cooperate, M82 812 (4/04) - Family Reunification/Zero Grant, M82 -820A (3/15) - No Eligible Person, Deny, M82 832A (2/99) - Change: Aid Payments, Fleeing Felons, M82 832B (2/99) - Partial Approval: Application Processing, Fleeing Felons, M82 832E (4/15) - Eligible Person Leaving AU, Change, M82 832F (4/15) - Eligible Person Leaving AU, Discontinue, M82-832G (6/18) - Eligible/Mandatory/Optional Person Leaving AU, M82-832H (6/18) - Child Does Not Meet Requirements (SB 380), M82 836A (8/91) - Denial: Au Composition, Unborn not Eligible for Aid, M89 130 (1/02) - Restricted Account, Discontinue, M89_201 (11/96) - Minor Parent exemption: Deny, MT42_101.2D (11/04) - Fry vs Saenz Lawsuit Age Requirement - Change, MT42_101.2E (11/04) - Fry vs Saenz Lawsuit Age Requirement - Discontinue, NA Description Of Services L (3/15) - Description Of services, NA IHSS BACK L (3/15) - Your Hearing Rights, NA 200 (7/19) - Notice Of Action - Multipurpose - Include Budget - Use Starting June 1, 2020, M44-207M (8/20) - Financial Eligibility, Deny, NA 210 (5/20) - Discontinue, Suspend Financial Eligibility, NA 213A (8/20) – Notice Of Action – Deny – Financial Eligibility, NA 271 (7/19) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid - Use Starting June 1, 2020, NA 274E (6/11) - Notice Of Action Overpayment Computations For 1-1-98 to 6-30-2011, NA 274F (6/11) - Notice Of Action - Overpayment Amount Owed (For Overpayments Occurring on or after 7/1/2011), NA 274G (7/19) - Notice Of Action - Continuation Page - Overpayment Computations Occurring On Or After 10/1/2013 To 5/31/2020, NA 274H (5/20) - Notice Of Action - Continuation Page - Overpayment Computations For 6/1/2020, NA 275 (4/99) - Continuation Page - Overpayment Adjustment Computation - Cash Aid, NA 281 (6/11) - Notice Of Action Underpayment Amount Owed (For Underpayments Occurring on or After 1-1-98 thru 6-30-2011), NA 281A (6/11) - Notice Of Action Underpayment Amount Owed (For Underpayments Occurring On Or After 7/1/2011), NA 281C (7/19) - Notice Of Action - Continuation Page - Underpayment Computations Occurring On Or After 6/1/2020, NA 290 (2/14) - Notice of Action - Multipurpose, NA 300 (7/19) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Test - Use Starting June 1, 2020, NA 403 (4/17) Notice Of Action - For Resource Families, including homes certified by a Foster Family Agency, County, NA 403A (4/17) Notice Of Action – Change For Kinship - Guardians Only, NA 530 (4/11) - Notice of Action 48-Month Time Limit, NA 531 (7/19) - Notice Of Action - Continuation Page - 48-Month Time Limit - Use Starting June 1, 2020, NA 532 (7/19) - Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue - Use Starting June 1, 2020, NA 533 (5/11) - Notice Of Action - CalWORKs "Child-Only" Time On Aid Grant Cut, NA 534 (5/11) - Notice Of Action - CalWORKs "Child-Only" Time On Aid Grant Cut Continued, NA 691 (3/18) - Notice Of Denial - Cash Assistance Program For Immigrants (CAPI), NA 692 (12/17) - Notice Of Change Cash Assistance Program For Immigrants (Capi), NA 693 (4/99) - Notice Of Approval Cash Assistance Program For Immigrants (Capi), NA 791 (9/18) - Notice of Action - Approval/Denial/Change, NA 816 (3/14) - Notice of Action - Sanction Of Other Parent After Failed Compliance Plan, NA 817 (3/14) - Notice of Action - Sanction Of Participant After Failed Compliance Plan, NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work, NA 820 (1/01) - Notice of Action - Transportation Approval, NA 821 (1/01) - Notice of Action - Transportation Approval/Denial, NA 822 (7/16) - Notice of Action - Transportation Change, NA 823 (8/00) - Ancillary Approval/ Denial, NA 825 (8/00) - Notice Of Action - Payment Adjust Transportation, NA 827 (7/99) - Notice of Action - Recoupment of Unused Advance Payment, NA 828 (7/99) - Notice of Action - Transportation and Ancillary Exp Overpayment, NA 832 (3/20) - Notice of Action - Child Care Services, NA 833 (4/20) - Notice of Action - Child Care Services Change, NA 834 (3/20) - Notice of Action - Child Care Services Denial, NA 835 (3/20) - Notice of Action - Child Care Services Discontinuance, NA 840 (12/16) - Notice Of Action - Welfare To Work Plan, NA 840A (10/03) - Notice Of Action - Cash Aid, NA 841 (3/14) - Notice Of Action - Welfare-To-Work Plan, NA 843 (6/99) - Notice of Action - Inelegible, NA 844 (8/99) - Notice of Action - Adequate Progress, NA 845 (3/14) - Notice Of Action - Sanction And Removal Of The Other Parent's Needs, NA 960X SAR (9/13) - Notice Of Action - Stop Aid;Report Not Received, NA 960Y SAR (10/14) - Notice Of Action - Stop Aid;Report Incomplete, NA 991 (10/03) - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration), NA 992 (5/03) - Refugee Cash Assistance (RCA) Application Approval, NA 995 (5/13) - Food Stamp Notice Of Denial/Disqualification For The California Food Assistance Program, NA 1208 (2/00) - Notice Of Action - Basic Approval, NA 1209 (2/02) - Notice of Action - Change In The Amount Of Kin-Gap Payment, NA 1210 (4/02) - Notice Of Action - Discontinue, NA 1211 (2/00) - Notice Of Action - Denial, NA 1212 (2/00) - Notice Of Action - Discontinue Property, NA 1213 (2/00) - Notice Of Action - Discontinue Restricted Account, NA 1214 (2/00) - Notice Of Action - Change Under/Overpayment, NA 1217 (9/06) - Notice Of Action - Cash Assistance Program For Immigrants - Notice of Overpayment, NA 1218 (9/06) - Notice Of Action - Cash Assistance Program For Immigrants - Notice Of Underpayment, NA 1230 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Approval, NA 1231 (7/01) - Cash Assistance Program for Immigrants Notice of Overpayment - Partial Waiver Approval, NA 1239 (9/11) - Notice of Action (Continued) Quarterly Reporting Budget, NA 1239 AR (7/19) - Notice Of Action - Continuation Page - Annual Report Budget - Use Starting June 1, 2020, NA 1239 SAR (7/19) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget - Use Starting June 1, 2020, NA 1240 (4/13) - Notice of Action - Food Stamp Overissuance & Dormant EBT Account, NA 1250 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Approval, NA 1250L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval, NA 1251 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Approval Continuation, NA 1251L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval Continuation, NA 1252 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Denial, NA 1252L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Denial, NA 1253 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Change, NA 1253L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change, NA 1254 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Change Continuation, NA 1254L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change Continuation, NA 1255 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Termination, NA 1255L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Termination, NA 1256 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Share Of Cost, NA 1256L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Share Of Cost, NA 1257 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Multi, NA 1257L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Multi, NA 1261 (1/16) - Notice Of Action - Form and Instructions - For Group Homes, Short-Term Residential Treatment Centers, Foster Family Agencies, Transitional Housing Placement-Plus Foster Care and Transitional Housing Placement Program, NA 1261A (3/20) - Notice Of Action – For Approved Relatives, Non-Relative Extended Family Members, Foster Family Homes, Non-Related Legal Guardians or Non-Minor Dependents Residing In A Supervised Independent Living Setting, NA 1261B (1/16) - Notice of Action - Form And Instructions - For Kinship-Guardians Only, NA 1263 (8/11) - Notice of Action - Overissuance Budget Worksheet, NA 1267 (4/13) - CalFresh Informing Notice Of Receiving Intercounty Transfer, NA 1268 (4/13) - CalFresh Informing Notice Of Sending Intercounty Transfer, NA 1269 (11/11) - Notice of Action - Approve Non-Minor Dependent, NA 1270 (11/11) - Notice of Action - Discontinue Non-Minor Dependent, NA 1271 (5/14) - Notice Of Action - Denial Of Home Assessment/Approval, NA 1273 (7/13) - Electronic Notification Agreement, NA 1274 (7/13) - Electronic Notification Notice, NA 1275 (7/13) - Electronic Notification Cancellation Notice, NA 1276 (1/15) - Notice Of Action - Welfare-to-Work 24-Month Time Clock Limit Notice, NA 1277 (1/16) - Notice Of Action - Approved Relative Caregiver (ARC) Overpayment, NA 1278 (11/16) - Notice Of Action - Approve Approved Relative Caregiver (ARC) Payment, NA 1279 (11/16) - Notice Of Action - Deny Approved Relative Caregiver (ARC) Payment, NA 1280 (11/16) - Notice of Action - Discontinue Approved Relative Caregiver (ARC) Payment, NA 1281 (11/16) Notice Of Action - Change Approved Relative Caregiver (ARC) Payment, NA 1282 (12/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay, NA 1282L (12/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay, PUB 13 (8/20) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California, PUB 56 (12/06) - The In-Home Supportive Services Program, PUB 104 (12/06) - In-Home Supportive Services Individual Provider Benefits and Services Information, PUB 190 (8/06) - How To Hire And Supervise Your In-Home Supportive Services (IHSS) Provider, PUB 203 (1/04) - In-Home Supportive Services - Guide to Workers' Compensation Benefits for Individual Providers, PUB 269 (2/18) - California Child Passenger Safety Law - (8.5" x 11"), PUB 269 (2/18) - California Child Passenger Safety Law - (8.5" x 14"), PUB 271 (2/17) - Never Shake a Baby Brochure, PUB 271 (2/17) - Never Shake a Baby Brochure (Black & White), PUB 273-A2 (1/17) Shaken Baby Syndrome Poster - ( 24" x 36"), PUB 275 (4/07) - Family Planning...Making the Commitment for a Healthy Future, PUB 294 (7/11) - Assistance Dog Special Allowance (ADSA) Program Fact Sheet, PUB 325 (12/16) - Your Right To Make Decisions About Medical Treatment (Print 8 1/2 X 14), PUB 337 (9/12) - Statewide Fingerprint Imaging System (SFIS), PUB 339 (7/13) - Foster Care Ombudsman Brochure, PUB 367 (4/13) - Reach For Your Dreams With Cal-Learn, PUB 370 (4/19) - Public Assistance Benefits For Asylees In California, PUB 373 (Print 8.5 X 11) (5/07) - Important Food Stamp Information For Noncitizens, PUB 373 (Print 11 X 17) (5/07) - Important Food Stamp Information For Noncitizens, PUB 388 (10/20) - California Electronic Benefit Transfer (EBT) Card, PUB 393 (12/06) - Notification of Parents' Rights - Child Care Center, PUB 394 (12/06) - Notification of Parents' Rights - Family Child Care Home, PUB 400 (8/17) - Safely Surrendered Baby Campaign Brochure, PUB 400C (6/17) Safely Surrendered Baby Know Your Rights, PUB 400C-1 (6/17) - Safely Surrendered Baby Law - Know Your Rights Poster, PUB 401 (3/10) - Safely Surrendered Baby Campaign Poster - poster size, PUB 401A (11/10) - Safely Surrendered Baby Campaign Poster - 10" x 12", PUB 403 (6/05) - We Gladly Accept EBT (Poster size 11" x 17"), PUB 411 (8/11) - 20 Facts About Child Abuse and Neglect, PUB 420 (10/08) - Supplemental Security Income (SSI) Information for Transitioning Foster Youth, PUB 421 (10/08) - Supplemental Security Income (SSI) for Youth with Disabilities, PUB 422 (10/08) - Supplemental Security Income (SSI) for Foster Youth with Disabilities, PUB 428 (10/19) - It's Your Money - Get It - The State and Federal Earned Income Tax Credit (EITCs), PUB 429 (10/19) - California EITC is Here! Spanish Farsi Hmong Russian Spanish, Tagalog Hmong Japanese Spanish DPA 19. Problems with downloading forms? Title/Position: Employee. PUB 388 (8/17) - California Electronic Benefit Transfer (EBT) Card - The easy, safe, and convenient way to receive your food stamp and cash benefits. SOC 2279 (Spanish) Live In Family Care Provider Overtime Exemption Link SOC 2302 In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form Download Fillable Form Soc2298 In Pdf - The Latest Version Applicable For 2021. If you use this form, you may complete or … Translated Spanish Forms Beginning With Letters A Through L Click on one of the following links to view forms whose form number begins with the corresponding A - D | E - H| I - L | M - P | Q - T | U - Z. All completed forms must be returned in one of the following ways: a. Ukrainian Japanese Korean Tagalog 12 10, Vietnamese Korean Lao Ukrainian Armenian. Spanish Farsi Hmong Russian Spanish, Tagalog Hmong Japanese Spanish DPA 19. Download Fillable Form Soc2298 In Pdf - The Latest Version Applicable For 2021. Tips for Using Adobe PDF Files. Information Resources Guide Letters/Regulations Forms/Brochures Fiscal/Financial Data Portal Disaster Services Branch CDSS Programs CalFresh. Find out what is the full meaning of CDSS on Abbreviations.com! ). Spanish forms beginning with the letters M through Z NVRA voter registration agencies should ensure that the voter preference forms remain confidential. Translated Spanish Forms Beginning With Letters A Through L For Spanish forms beginning with the following letters click below: 3. As of May 2020, changes were made in how child support payments are distributed. NVRA voter registration agencies should ensure that the voter preference forms remain confidential. indicate which format you would prefer, if applicable. PUB 389 (8/17) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase. Department of Justice Form SS8572 (Suspected Child Abuse Reporting Form/Mandated Reporters) Foster Youth Rights. Here's How - Use Starting June 1, 2020, CW 2184 (8/16) - CalWORKS 48-month Time Limit, CW 2186A (12/12) - CalWORKs Exemption Request Form, CW2186B (12/12) - CalWORKs Exemption Determination, CW 2187 (4/11) - Your CalWORKs 48-Month Time Limit, CW 2188 (4/02) - Verification Of Aid For The Temporary Assistance For Needy Families (TANF) Program, CW 2189 (3/15) - Notice of Your CalWORKs Time Limit - 42nd Month On Aid, CW 2189A (9/20) – Notice Of Your CalWORKs Time Limit – 54TH Month On Aid (Use Starting May 1, 2022), CW 2189B (9/20) – Notice Of Your CalWORKs Time Limit – 57TH Month On Aid (Use Starting May 1, 2022), CW2190A (4/16) - CalWORKs 48-Month Time Limit Extender Request Form, CW2190B (5/16) - CalWORKs 48-Month Time Limit Extender Determination Denial Form, CW 2200 (6/19) - Request For Verification, CW 2200LP (6/19) - Request For Verification, CW 2201 (6/09) - Unemployment Insurance Benefits Referral Form, CW 2203 (11/09) - Request For Supplemental Payment By Check Or Direct Deposit, CW 2205 (10/12) - New Rules For CalWORKs Welfare-To-Work Activities, CW 2208 (2/13) - Your Welfare-To-Work 24-Month Time Clock, CW 2209 (12/14) - Immunization Good Cause Request Form, CW 2211 (11/14) - Your CalWORKs Reporting Rules Have Changed, CW 2212 (11/14) - The Rules For Your CalWORKs Case Have Change, CW 2213 (10/15) - Response To Request To Inspect Case Record CalWORKs, CalFresh, TCVAP, And Refugee Programs, CW 2215 (9/15) - New Rules in California Work Opportunity and Responsibility to Kids (CalWORKs) for Safety Net and Certain Child-Only Case, CW 2215 (10/20) - California Work Opportunity and Responsibility to Kids (CalWORKs) Important Information for Safety Net And Certain Child-Only Case, CW 2217 (1/15) - CalWORKs Request For Voluntary Repayment, CW 2218 (7/19) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-Needy Caretaker Relative With Relative Foster Child) - Use Starting June 1, 2020, CW 2219 (5/16) Application For California Work Opportunity And Responsibility To Kids (CalWORKs) (Non-Needy Caretaker Relative With Relative Foster Child), CW 2223 (9/18) - Demographic Questionnaire For CalWORKs, Refugee Cash Assistance (RCA), Entrance Cash Assistance (ECA), Trafficking And Crime Victims Assistance Program (TCVAP) And CalFresh Programs, CW 2224 (2/20) - CalWORKs Home Visiting Initiative (HVI), DFA 377.1A (3/02) - Notice Of Denial Or Pending Status, DFA 377.7A (1/12) - Notice of Administrative Disqualification, DFA 377.7D2 (10/00) - Food Stamp Repayment Notice for Administrative Errors Only, Final Notice, DFA 377.7E (7/04) - Food Stamp Repayment Agreement For Administrative Errors Only, DFA 377.7F (6/18) - CalFresh Overissuance Notice For An Intentional Program Violation (IPV) Or Status Change From Inadvertent Household Error (IHE) To An IVP, DFA 377.7F LP (6/18) - CalFresh Overissuance Notice - Intentional Program Violation (IPV), DFA 377.7F1 (10/00) - Food Stamp Repayment Notice for an Intentional Program Violation (IPV)Only, Final Notice, DFA 377.7G (5/02) - Food Stamp Repayment Notice for an Intentional Program Violation (IPV) Only, DFA 377.10 (6/04) - Food Stamp Notice Of Discontinuance, DFA 390 (9/11) - Notice Of Approval/Denial For Disaster CalFresh, DPA 13 (7/99) - Request For State Hearing Before The State Department Of Social Services, DPA 19 (12/10) - Authorized Representative, DPA 315 (7/99) - Withdrawal/Conditional Withdrawals Of Request For Hearing, DPA 421 (7/99) - Notification Of Open Record And Waiver Of Time, DPA 435 (1/18) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification hearing), DPA 436B (8/18) - County Information Letter, DPA 479 (12/17) - Administrative Disqualification Hearing Waiver - CalWORKs/Food Stamps, EBT 2216 (4/15) - EBT Surcharge Free - Direct Deposit Handout, EBT 2259 (5/19) - Report Of Electronic Theft Of Cash Aid, EBT 2259A (12/18) - EBT Scamming Acknowledgement, EBT 2260 (3/15) - Excessive Card Replacement Warning Letter, EFA 7 (2/18) - EFAP Certification Of Eligibility And Receipt For USDA Commodities, EFA 7A ENG/SP (3/11) - Emergency Food Assistance Program (EFAP) Certification Of Eligibility, EFA 14 (4/20) - The Emergency Food Assistance Program (TEFAP) 2020 Income Guidelines, EFA 15 (4/20) - Alternate Pick-Up Request Form The Emergency Food Assistance Program (TEFAP) 2020 Income Guidelines, FC 2 (11/04) - Statement of Facts Supporting Eligibility For AFDC-Foster Care (FC), FC 2 NM (2/12) - Statement of Facts Supporting Eligibility For AFDC-Extended Foster Care (EFC), FC 4 (5/00) - AFDC Program Choice Indicator, FC 31 (8/16) Accreditation Reimbursement Request. 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