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Child Abuse Central Index Forms Child Abuse and Neglect Reporting Forms The following forms are for use by government agencies and mandated reporters pertaining to child abuse cases. Problems with downloading forms? 08/01/2011. Leccin 1 3 Temas | 1 Prueba . Forms. Program Summary The Child and Adult Food Care Program (CACFP) is a state and federally funded Child Nutrition Program (CNP) designed to provide nutritious meals and snacks served to infants, children, and adults. You can call Monday to Friday, 8 a.m. to 8 p.m., and Saturday, 8 a.m. to 6 p.m. Or visit CoveredCA.com. (916) 440-7370, 711 (California State Relay) Email: CivilRights@dhcs.ca.gov. 2022-2023 CACFP Capacitacin anual obligatoria (CDSS-110) Estado actual. Child Care Services Forms Annual Summary of Eleven- and Twelve-Year-Old Children in Early Learning and Care Division (ELCD) Child Care Programs CD-9608Bx (XLS) Attendance and Fiscal Reporting forms are available through the Child Development Fiscal Services website. Emergency Disaster Drill Log California Community Care Licensing (CCL) Requirements Licensed child care programs must conduct emergency drills at least once every 6 months. MC 300 Forms: MC 306 (11/15) - Appointment of Representative; Alt: Spanish (01/08) MC 322 (05/07) - Real and Personal Property - Supplement to Medi-Cal Mail-in Application Click the download button to access the Contract Data Summary Sheet for all other contract types (not Fire, Police or Schools). (This form is not to be sent home or given to parents to complete.) Multipurpose Senior Services Program. CDSS forms and publications are available only in Portable Document Format (PDF). How to complete the Get And Sign California lic 702 2008-2019 Form online: To get started on the form, use the Fill camp; Sign Online button or tick the preview image of the form. Termination of Service for . Medi-Cal Mail-In application: Single Streamline Application Farsi Hmong Korean Laotian Arabic Armenian Cambodian Chinese Russian Spanish Tagalog Vietnamese Welfare and Institutions Code section 10850. When completed per MPP Section 21-115.2, including Armenian, Chinese and Spanish forms, the translations will be posted on our website. $0. Welcome to the Statewide Forms Directory! 9.Local CHDP Provider Updates. : 20-22 Page 4 October 28, 2020 GEN 1365 Language Access Services for Limited-English Proficient and Non- Note, this form must be submitted within 10 days of your reported food-loss or your household may not be eligible to receive replacement benefits. Your Email address. Forms &. Energy Assistance Application. 5. Safeguarding Information for the Financial Assistance Programs - 45 CFR section 205.50. Coniugazione Documents Dizionario Dizionario collaborativo Grammatica Expressio Reverso Corporate. 01/28/2020. CDSS CDs Ca Form. The California Department of Social Services (CDSS) serves, aids and protects needy and vulnerable children and adults in ways that strengthen and preserve families, encourage personal . For more information, review the online CDSS Privacy Policy Statement. The call is free. 1.B. **Due to browser constraints please download forms for full functionality. Box) City State Zip EBT card was reported lost/stolen to the county or . Your Organization. Recipient of Services. *To order forms in braille, please contact program directly. LIC 279B (1/22) - Current Children In Your Home - Application For A Family Child Care Home License. Access forms used by the Department of Health Care Services. The letter must contain the complainant's name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. LIC 281 (9/04) - Application Instructions for A Facility License. Join to apply for the ASSOCIATE GOVERNMENTAL PROGRAM ANALYST role at California Department of Social ServicesASSOCIATE GOVERNMENTAL PROGRAM ANALYST role at 12.Provider Outreach and Education- Medi-Cal Learning Portal. Date: _____ Full Medi-Cal benefits were granted pending verification of immigration status. Contenido Curso . CHDP Provider Resources. Toma este curso. 1.ACEs Aware Toolkit. LIC 279 (2/23) - Application For A Family Child Care Home License. Background Policy Notary/Authentication Apostille Process Documents Needed for the 3 Packets Of Information. If appealed, appeal is due by: Date (Note: Appeal Instructions are on reverse side.) Sacramento, CA 95899-7413. Pasar al contenido principal LinkedIn. $0 . It is a trade that is more about possibilities than probabilities, and the people making them probably run a big fund with all sorts of positions, some speculative, in hopes that one or three actually work. Translated Spanish Forms Beginning With Letters A Through L Problems with downloading forms? Here's How, CW 2184 (8/16) - CalWORKS 48-month Time Limit, CW 2184 (4/21) - CalWORKs 60-Month Time Limit, CW 2186A (12/12) - CalWORKs Exemption Request Form, CW 2186A (4/21) - CalWORKs Exemption Request Form, CW 2186B (4/21) - CalWORKs Exemption Determination, CW 2187 (4/11) - Your CalWORKs 48-Month Time Limit, CW 2187 (4/21) - Your CalWORKs 60-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 2190B (4/21) - CalWORKs 60-Month Time Limit Extender Determination Form, CW 2191 (4/21) - Time On Aid Verification For CalWORKs/TANF 60-Month Time Limits, CW 2192 (4/21) - Tracking Non-California TANF Assistance For Time Limits, CW 2200 (5/22) - 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 (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 (12/20) - 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, 2021, CW 2218 (3/22) - 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), 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 (4/21) - 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, DPA 13 (7/99) - Request For State Hearing Before The State Department Of Social Services, DPA 19 (6/22) - Appointment OfAuthorized 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 1232 (6/22) - CalFresh Notice Of Action - EBT Account, EBT 2216 (10/22) - EBT Surcharge Free - Direct Deposit Handout, EBT 2259 (11/21) - Report Of Electronic Theft Of Benefits, EBT 2259A (11/21) - EBT Scamming Acknowledgement, EBT 2260 (8/21) - Excessive Card Replacement Warning Letter, EFA 7 (7/21) - The Emergency Food Assistance Program (TEFAP) Certification Of Eligibility, EFA 7A ENG/SP (3/11) - Emergency Food Assistance Program (EFAP) Certification Of Eligibility, EFA 14 (6/22) - The Emergency Food Assistance Program (TEFAP) 2022Income Guidelines, EFA 15 (6/22) - Alternate Pick-Up Request Form The Emergency Food Assistance Program (TEFAP) 2022 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 31 (8/16) Accreditation Reimbursement Request. That's what a next generation of #cdss look like. March XX, 2010ALL-COUNTY LETTER (ACL) NO. Visit the CDSS CACFP web page or call 1-833-559-2420 for more information. The adverbs before take the feminine form of the adjective. . Complaint forms are available here: DHCS-1044-DHCS-DISCRIMINATION-COMPLAINT-FORM.pdf. If you do not see the form you need, please check if it can be ordered through the Children's Medical Services (CMS) Catalog or contact us and we will try to accommodate your request. to EBT hotline and the county, or the EBT hotline Health and Safety Code section 1500 et seq. The completed AD-3027 form or letter must be submitted to USDA . 10.CHDP Program Trainings. FDU 113 (7/22) - Civil Rights Annual Training Checklist For CSFP And TEFAP, FS 31 ENG/SP (2/09) - Notice To All Food Stamp Recipients - Important-Please Read - Things You Need To Know, FSP 1 (8/14) - Family Stabilization Program Evaluation Request, FSP 2 (1/21) - Family Stabilization Program Denial Notice, FSP 3 (8/14)Family Stabilization Program Notice of Change in Program Status, GEN 1179 (5/18) - Complaint of Discrimination, GEN 1388 (9/15) - Language Accessibility Services Complaint Form, GEN 1390 (3/17) - Informing Notice - Regarding An Action Taken On Your Case, HCS 100 (11/21) - Application For Home Care Aide Registration or Renewal, IHSS-E 002 (1/17) - In-Home Supportive Services (IHSS) Program Notice To Provider For Discontinuance Of Exemption From Workweek Limitations For Extraordinary Circumstances, IHSS-E 003 (1/17) - In-Home Supportive Services (IHSS) Program Notice To Recipient For Discontinuance Of Exemption From Workweek Limitations For Extraordinary Circumstances, IHSS-E 004 (4/17) - In-Home Supportive Services Program Notice Of Non-Receipt Of Exemption From Workweek Limits Provider Agreement (APD 006), IHSS-E 005 (1/17) - In-Home Supportive Services Program Notice Of Ineligibility To Request Exemption From, IHSS-E 006 (4/17) - In-Home Supportive Services Program Notice To Provider Of Expiration Of Exemption From Workweek Limits, IHSS-E 007 (4/17) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Providers Expiration Of Exemption From Workweek Limits, KG 1 (12/11) - Kin-GAP Mutual Agreement For 18 Year Olds, KG 2 (1/11) - Statement Of Facts Supporting Eligibility For Kinship Guardianship Assistance Payment (KinGAP) Program, KG 3 (12/11) - Kin-GAP Mutual Agreement For Nonminor Former Dependents, KG 4 (2/14) - Kinship Guardianship Assistance Payment (Kin-GAP) Program - Nonrecurring Legal Guardianship Expenses Agreement, KG 5 (2/14) - Kinship Guardianship Assistance Payments (Kin-GAP) Program Nonrecurring Legal Guardianship Expenses Form, LIC 00 (8/17) - Conversion to Resource Family: Release of Information, LIC 00A (2/17) - Conversion - Resource Family Application, LIC 01A (9/21) - Resource Family Application, LIC 01C (7/16) - Resource Family Application-Confidential, LIC 03 (8/21) - Resource Family Home Health And Safety Assessment Checklist Document For Agency Use Only, LIC 05A (8/21) - Resource Family Approval Certificate, LIC 12 (8/21) - Resource Family Approval Document Alternative Plan (DAP), LIC 184A (1/08) - Notification Of Incomplete Foster Family Home Application, LIC 184B (3/22) - Notification Of Incomplete Application - Family Child Care Home, LIC 184C (3/22) - Notification Of Incomplete Application (NOIA) Child Care Centers -Pre-30-Day NOIA, LIC 184D (3/22) - Notification Of Incomplete Application (NOIA) Child Care Centers - 30-Day NOIA, LIC 184E (3/22) - Notice Of Incomplete Application (NOIA) Changes To Corporate Status, LIC 192 (7/03) - Notiification Of Initial Application Denial, LIC 198 (1/22) - Child Abuse Central Index Check For County Licensed Facilities, LIC 198B (8/21) - Out-Of-State Child Abuse/Neglect Report Request, LIC 200 (2/11) - Application For A Community Care Facility or Residential Care Facility For The Elderly License, LIC 200A (2/17) - Application For A Child Care Center License, LIC 215 (7/04) - Applicant Information - Facility License, LIC 279 (2/09) - Application For A Family Child Care Home License, LIC 279A (5/17) - License Application And Instructions For Family Child Care Homes, LIC 279B (1/22) - Current Children In Your Home - Application For A Family Child Care Home License, LIC 281A (1/07) - License Application And Instructions For Child Care Centers, LIC 281D (1/17) - Application And Supporting Documentation Checklist Foster Family Agency, LIC 281E (1/17) Application And Supporting documentation Checklist Short - Term Residential Therapeutic Program, LIC 282 (8/08) - Affidavit Regarding Liability Insurance For Family Child Care Home, LIC 283 (4/10) - Foster Family Home Application, LIC 283A (12/07) - Foster Family Home Application Instructions, LIC 300A (01/22) - Removal Confirmation - Exemption Needed, LIC 301E (6/22) - Reference Request - Exemption, LIC 308 (11/02) - Designation of Facility Responsibility, LIC 309 (6/01) - Administrative Organization, LIC 311A (2/22) - Records To Be Maintained At The Facility - Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children, LIC 311D (2/22) - Forms/Records To Keep In Your Family Child Care Home, LIC 401 (3/01) - Monthly Operating Statement, LIC 401A (3/99) - Supplemental Financial Information, LIC 403A (9/11) - Balance Sheet Supplemental Schedule, LIC 404 (7/99) - Financial Information Release And Verification, LIC 405 (8/01) - Record Of Client's/Resident's Safeguarded Cash Resources, LIC 421A (6/22) - Civil Penalty Assessment (Unlicensed Facility), LIC 421BG (5/19) - Civil Penalty Assessment Caregiver Background Check, LIC 421CC (6/22) - Civil Penalty Assessment Child Care, LIC 421D (CC) (8/22) - Civil Penalty Assessment Death/Serious Injury/Physical Abuse (Child Care), LIC 421FC (7/17) - Civil Penalty Assessment Failure To Correct And Repeat Violations, LIC 421IM (7/17) - Civil Penalty Assessment Immediate $500 And Repeat Violations, LIC 503 (3/99) - Health Screening Report - Facility Personnel, LIC 508 (7/21) - Criminal Record Statement & Out-Of-State Disclosure, LIC 508A (3/11) - Criminal Record Statement - Adoption Facilitator, LIC 508B (3/11) - Criminal Record Statement - Long-Term Ombudsman Program, LIC 508D (8/17) - Out-Of-State Disclosure And Criminal Record Statement, LIC 601 (8/08) - Identification And Emergency Information, LIC 602 (7/22) - Physician's Report For Community Care Facilities, LIC 603 (6/22) - Preplacement Appraisal Information, LIC 605A (7/22) - Release Of Client/Resident Medical Information, LIC 610 (10/03) - Emergency Disaster Plan For Child Care Centers, LIC 610A (01/22) - Emergency Disaster Plan For Family Child Care Homes, LIC 610B (6/02) - Emergency Plan For Foster Family Homes, LIC 610C (10/03) - Emergency Disaster Plan For Children's Residential Facilities (Except Foster Family Homes), LIC 610D (12/21) - Emergency Disaster Plan For Adult Day Programs, Adult Residential Facilities, Residential Care Facilities For The Chronically Ill And Social Rehabilitation Facilities, LIC 610E (3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly, LIC 613 (12/02) - Personal Rights Adult Residentail Care Facilities, LIC 613A (8/08) - Personal Rights - Child Care Centers, LIC 613B (6/22) - Personal Rights Childrens Residential Facilities, LIC 613C (1/19) - Personal Rights Residential Care Facilities for The Elderly, LIC 613C-2 (1/19) - Personal Rights Of Residents In Privately Operated Residential Care Facilities For The Elderly, LIC 621 (4/99) - Client/Resident Personal Property And Valuables, LIC 622 (9/19) - Centrally Stored Medication and Destruction Record, LIC 623 (5/01) - Group Planned Activities, LIC 624 (4/99) - Unusual Incident/Injury Report, LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home, LIC 624-LE (4/17) - Law Enforcement Contact Report, LIC 625 (11/19) Appraisal/Needs and Services Plan, LIC 627 (9/08) - Consent for Medical Treatment - Child Care Centers Or Family Child Care Homes, LIC 627A (9/08) - Consent To A Medical Examination, LIC 627B (9/08) - Consent For Emergency Medical Treatment - Children's Residential Facilities, LIC 627C (4/00) - Consent For Emergency Medical Treatment - Adult And Elderly Residential Facilities, LIC 700 (10/19) - Identification And Emergency Information Child Care Centers/Family Child Care Homes, LIC 701 (8/08) - Physician's Report - Child Care Centers, LIC 702 (10/19) - Child's Preadmission Health History - Parent/Authorized Representative Report, LIC 860C (12/02) - Facility Review Index Foster Family Homes, LIC 861 (1/03) - Prelicensing In-Home Interview, LIC 973 (4/03) - Documented Alternative Plan - Foster Family Homes (Bedrooms), LIC 974 (4/03) - Documented Alternative Plan - Foster Family Homes (Telephones), LIC 995 (9/08) - Child Care Center - Notification Of Parents' Rights, LIC 995A (8/08) - Family Child Care Home - Notification Of Parents' Rights, LIC 995B (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Removal/Exclusion), LIC 995C (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Reinstatement), LIC 995D (5/03) - Family Child Care Home Explanation Of Exclusions And Reinstatement, LIC 995E (10/09) - Caregiver Background Check Process, LIC 995F (10/09) - Caregiver Background Check Information, LIC 999 (3/99) - Facility Sketch Floor Plan/Yard Plan, LIC 999A (2/05) - Facility Sketch (Floor Plan) - Family Child Care Home, LIC 9031 (11/99) - Notice Of Temporary Suspension Order Of License, LIC 9040 (10/05) - Child Care Facility Roster, LIC 9054 (3/99) - Local Fire Inspection Authority Information, LIC 9058 (3/22) - Applicant/Licensee Rights, LIC 9108 (3/05) - Statement Acknowledging Requirement To Report Suspected Child Abuse, LIC 9111 (12/99) - Noncompliance Conference Summary, LIC 9148 (9/00) - Earthquake Preparedness Checklist (EPC), LIC 9149 (8/14) - Family Child Care Home Property Owner/Landlord Consent Form, LIC 9150 (8/14) - Parent Notification - Additional Children In Care, LIC 9151 (8/14) - Property Owner/Landlord Notification Family Child Care Home, LIC 9158 (7/22) - Telecommunications Device Notification, LIC 9163 (3/21) - Request Live Scan Service - Community Care, LIC 9166 (2/01) - Consent/Verification for Nebulizer Care, LIC 9182 (11/15) - Criminal Background Clearance Transfer Request, LIC 9188 (11/15) - Criminal Record Exemption Transfer Request, LIC 9211 (9/21) - Request For Inactive Child Care License Status, LIC 9212 (10/05) - Consumer Awareness Information - Family Child Care, LIC 9213 (1/04) - Notice Of Site Visit By A Child Care Licensing Office Representative, LIC 9217 (5/22) - Pre-Licensing Readiness Guide - Family Child Care Home, LIC 9221 (5/22) - Parent Consent For Administration Of Medications And Medication Chart, LIC 9222 (9/05) - Blood Glucose Testing Consent/Verification Child Care Facilities, LIC 9223 (4/17) - Child Care Advocate Program, LIC 9224 (8/08) - Acknowledgement Of Receipt Of Licensing Reports, LIC 9225 (4/10) - Pre-Placement Questionnaire, LIC 9227 (8/20) - Individual Infant Sleeping Plan, LIC 9281 (01/22)- Small Family Home Risk Assessment. All County Welfare Directors Letter No. The information collected will not be shared with any other government agencies, unless required or allowed by law to administer programs. Fernando Uzuelli Ampliar bsqueda. Traduzione Context Correttore Sinonimi Coniugazione. La visita tambin verificar que los Cuando se ampla, se proporciona una lista de opciones de bsqueda para que los resultados . Any fields in the application or form with unrestricted text are intended for the requested information only. Person referred to INS to obtain replacement documents. CDSS forms and publications are available only in Portable Document Format (PDF). #OpenAI Microsoft ChatGPT Healthcare #digitalhealth #saude5ponto0 Mailing Address (Number, Street, P.O. El propsito de las visitas y las cartas es asegurar que los requisitos del Programa se estn cumpliendo y que los servicios autorizados sean necesarios para que usted permanezca en su hogar de una manera segura. If you suspect a case of child abuse in your neighborhood, you should contact your county child welfare agency or local law enforcement agency. Copies of the translated notices can be . For Spanish forms beginning with the following letters click below: A | B | C | D | E | F | G | H | I | J | K | L, Copyright 2023 California Department of Social Services, Spanish forms beginning with the letters M through Z, AAP 1 (9/09) - Request For Adoption Assistance Program Benefit, AAP 3 (2/22) - Reassessment Information - Adoption Assistance Program, AAP 5 (9/18) - Adoptions Assistance Program Independent Adoptions Program, AAP 6 (9/18) - Adoption Assistance Program Negotiated Benefit Amount and Approval, AAP 7 (12/17) - Adoptions Assistance Program Statement Of Acknowledgement, AAP 8 (9/18) - Adoption Assistance Program Nonrecurring Adoption Expenses Agreement, AAP 9A (5/21) - Adoption Assistance Program (AAP)Level Of Care Rate Determination Protocol Matrix, AAP 10 (10/21) -Prospective Or Adoptive Parent(s) Level Of Care (LOC) Reporting Tool, ABCDM 228 (6/99) - Applicant's Authorization For Release Of Information, ABCD 239.7A (8/01) - Notice Of Administrative Disqualification California Work Opportunity And Responsibility To Kids (CalWORKs) Program, ABCD 478A (5/20) - Disqualification Consent Agreement California Work Opportunity And Responsibility To Kids (CalWORKs) Program, ABCDM 229 (1/23) -Applicant/Recipients Authorization For Release Of Information To Community-Based Organization (CBO) In BenefitsCal, AD 1A (4/22) - Parental Consent To Adoption(In Or Out-Of-California), AD 1F (4/15) - Parental Consent To Adoption Outside California In Armed Forces - Independent Adoption Program, AD 2A/2B (5/11) - Stepparent Adoption (Consent to Adoption by a Parent in or outside of California Giving Custody to Husband or Wife or Domestic Partner of Other Parent), AD 2D (3/08) - Stepparent Adoption Consent To Adoption By Parent Outside California In Armed Forces Giving Custody To Husband Or Wife Or Domestic Partner Of Other Parent, AD 9 (11/07) - Independent Adoption Questionnaire, AD 20 (4/15) - Refusal To Give Parental Consent To Adoption - Independent Adoptions Program, AD 20B (5/15) - Refusal To Give Consent To Adoption - Alleged Natural Father, Independent Adoption Program, AD 22 (7/02) - Health Facility Minor Release Report, AD 65 (2/02) - Parent's Authorization For Medical And Surgical Care, AD 67 (5/15) - Information about The Birth Mother - Agency And Independent Adoptions Program, AD 67A (7/15) - Information About The Birth Father - Agency And Independent Adoptions Program, AD 72 (4/22) - Adoption Facilitator Complaint Form, AD 90 (6/13) - Supporting Information For Issuance Of California Department Of Social Services Acknowledgement And Confirmation Of Receipt Of Child Freeing Documents, AD 100 (7/10) - Authorization For Use And/Or Disclosure of Health Information Independent Adoption Program, AD 100A (3/08) - Authorization For Use And/Or Disclosure Of Health Information Agency Adoption Program, AD 165 (3/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father (In or Out-of-California), AD 501 (6/14) - Relinquishment In or Out-of-County (Birth Mother/Biological Father/Presumed Father in California), AD 501A ENG/SP (9/14) - Relinquishment Out-of-State (Birth Mother/Biological Father/Presumed Father), AD 504 (5/15) - Relinquishment Out of State In Armed Forces (Birth Mother/Biological Father/Presumed Father), AD 508 (7/13) - Rescission Request/Rescission Of Relinquishment, AD 512 (1/14) - Psychosocial And Medical History Of Child, AD 521 (8/11) - Application For Adoption Of A Child, AD 583 ENG/SP (5/15) - Relinquishment In Or Out Of County - Presumed Father Denies He Is The Birth Father, AD 584 ENG/SP (8/12) - Relinquishment Out of State - Presumed Father Denies He is the Birth Father, AD 586 (7/14) - Relinquishment In or Out-of-County (Alleged Natural Father In California), AD 588 (4/15) - Denial Of Paternity By Alleged Natural Father - In Or Out Of California - Agency And Independent Adoptions Program, AD 590 (4/15) - Waiver Of Right To Further Notice Of Adoption Planning (Alleged Natural Father In Or Out Of California) - Agency And Independent Adoptions Program, AD 590A (6/15) - Waiver Of Right To Further Notice Of Adoption Planning - Presumed Father In Or Out Of California - Agency And Independent Adoptions Program, AD 591 (12/14) - Relinquishment Out-of-State (Alleged Natural Father), AD 593 (5/22) - Relinquishment Out of State in Armed Forces (Alleged Natural Parent), AD 594 (3/15) - Alleged Natural Father's Consent To Adoption (In Or Out Of California), AD 842 (3/17) - Alleged Father's Consent To Adoption (Outside California In The Armed Forces), AD 859 (8/15) - Parental Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program, AD 860 (8/15) - Presumed Father's Consent To Adoption Of Indian Child (In Or Out-Of-California) - Independent Adoptions Program, AD 861 (8/15) - Consent To Adoption Of Indian Child By Alleged Father (In Or Out Of California) - Independent Adoption Program, AD 862 (3/12) - Relinquishment Of An Indian Child Out-Of-State (Alleged Natural Father), AD 863 (9/12) - Relinquishment Of Indian Child Out of State - Birth Mother/Presumed Father, AD 864 (3/08) - Relinquishment Of An Indian Child In Or Out-Of-County - Birth Mother/Presumed Father In California, AD 866 (10/14) - Relinquishment Of An Indian Child In Or Out-of-County - Presumed Father Denies He Is The Birth Father In California, AD 867 (3/08) - Relinquishment of an Indian Child - Out-of-State - Presumed Father Denies He is the Birth Father, AD 868 (8/14) - Relinquishment Of Indian Child - In/Out of County - Alleged Natural Father In California, AD 880 (1/21) Declaration Of Birth Parent - Agency And Independent Adoptions Program, AD 885 (3/14) - Mother Or A Biological/Presumed Father Of A Child Who Is Not Detained, A Juvenile Court Dependent In Out-of-home Care, Or The Ward Of A Legal Guardian, AD 885A (11/21) -Statement of Understanding - Parent or a Presumed Parent of a Child Who Is Detained, a Juvenile Court Dependent in Out-of-Home Care, or The Ward of a Legal Guardian, AD 885C (2/15) - Statement of Understanding Agency Adoptions Program - Alleged Natural Father Of The Child Who Is Not Detained, A Juvenile Court Dependent In Out-Of-Home Care, Or The Ward Of A Legal Guardian, AD 885D (11/21) -Statement of Understanding - Alleged Parent of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian, AD 887 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The Child To The Petitioner(s), AD 887A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The Child To The Petitioner(s), AD 887B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father, AD 899 (3/08) - Statement of Understanding - Mother or a Presumed Father of the INDIAN Child Who is Not Detained, a Juvenile Court Dependent in Out-of-home Care, or a Ward of a Legal Guardian, AD 899A (11/21) - Statement of Understanding - Mother or a Presumed Father of an Indian Child Who is Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 899C (3/06) - Statement Of Understanding - Alleged Natural Father of the INDIAN Child Who is Not Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 899D (11/21) - Statement Of Understanding -Alleged Parent of an INDIAN Child Who is Detained, a Juvenile Court Dependent in Out-of-home Care, or the Ward of a Legal Guardian, AD 900 (8/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Gave Physical Custody (Custodial Parent) Of The INDIAN Child To The Petitioner(s), AD 900A (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (Non-Custodial Parent) Of The INDIAN Child To The Petitioner(s), AD 900B (3/18) - Statement Of Understanding Independent Adoptions Program - Alleged Father Of An INDIAN Child, AD 902 (2/22) - Consent For Arranging Contact, AD 904A (8/20) - Waiver Of Rights To Confidentiality For Siblings, AD 904B (9/20) - Waiver Of Rights To Confidentiality For Siblings Under The Age Of 18, AD 907 (7/10) - Adoptive Placement Agreement, AD 908 (5/22) - Adoptions Information Act Statement, AD 918 (11/03) - Family Assessment Questionnaire II, AD 924 (6/22) - Independent Adoption Placement Agreement - Independent Adoptions Program, AD 925 (8/15) - Independent Adoption Placement Agreement - Indian Child - Independent Adoptions Program, AD 926 (1/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Places The Child With The Prospective Adoptive Parent(s), AD 927 (3/18) - Statement Of Understanding Independent Adoptions Program - Parent Who Places The Indian Child With The Prospective Adoptive Parent(s, AD 928 (7/02) - Revocation Of Consent Independent Adoption Program, AD 929 (9/18) - Waiver Of Right To Revoke Consent Independent Adoption Program - Independent Adoptions Program, AD 929A (12/16) - Waiver Of Right To Revoke Relinquishment Agency Adoption Program, AD 931 (2/20) - Independent Adoption Of A Foreign-Born Child - Statement Of Acknowledgment, AD 933 (12/20) - Intercountry Readoption Acknowledgment, AD 4317 (3/20) - Revocation Of Relinquishment, AD 4310 (8/07) - Adoption Programs Notice Required By Information Practices Act, AD 4320 (6/22) - Adoption Assistance Program (AAP) Agreement, AD 4324 (2/21) - Adoption Questionnaire I, AD 4328 (3/06) - Authorization For Release Of Personal Items, AD 4336 (4/15) - Presumed Father's Consent To Adoption When Denying He Is The Biological Father (Outside California In Armed Forces) - Independent Adoption Program, AD 4337 (10/21) - Criminal Record Statement, AD 4339 (12/14) - Relinquishment Out of State (Birth Mother/Biological Father/Presumed Father), ADM 36 (6/99) - Medical Report Regarding Child To Be Adopted, ADSA 1 (3/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits, ADSA 1A (5/21) - Assistance Dog Special Allowance (ADSA) Application For Renewal Of Benefits, ADSA 1AL (11/21) - Assistance Dog Special Allowance (ADSA) Application For Renewal Of Benefits, ADSA 1B (6/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits For Recipients Of Social Security Disability Insurance (SSDI) Benefits, ADSA 1BL (7/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits For Recipients Of Social Security Disability Insurance (SSDI) Benefits, ADSA 1L (5/21) - Assistance Dog Special Allowance (ADSA) Program Application For Benefits, ADSA 2 (10/21) Your Hearing Rights Under The Assistance Dog Special Allowance (ADSA) Program, ADSA 2L (12/21) Your Hearing Rights Under The Assistance Dog Special Allowance (ADSA) Program, ADSA 3 (10/21) - Assistance Dog Special Allowance (ADSA) Enclosure, ADSA 3L (11/21) - Assistance Dog Special Allowance (ADSA) Enclosure, AR 2 (11/13) - Reporting Changes For CalWORKs And CalFresh, AR 2 SAR (3/15) - Reporting Changes For CalWORKs And CalFresh, AR 3 (2/15) - Mid-Year Status Report For CalWORKs and CalFresh, ARC 1 (4/22) - Statement Of Facts Supporting Eligibility For The Approved Relative Caregiver (ARC) Funding Option Program, ARC 1A (11/16) Rights, Responsibilities, And Other Important Information, ARC 2 (11/16) - Redetermination: Statement Of Facts Supporting Eligibility For The Approved, CAS 854 (4/15) - Agency Adoption Fee - Reduction Request, CCD 21 (8/22) - Parent Plan For Seeking Employment (PPSE), CCD 27 (8/22) - Statement Of Parental Incapacitation, CCD 35 (8/22) - Educational Programs or Vocational Training Verification for Parent or Caretaker Attending Educational Programs or Receiving Vocational Training, CCP 1 (3/15) - Declaration of Exemption from Trustline Registration and Health and Safety Self-Certification, CCP 4 (8/21) - Health And Safety Self-Certification (For license-exempt providers), CCP 6 (8/99) - Health And Safety Checklist, CCP 7 (10/19) - CalWORKs Child Care Request Form And Child Care Payment Rules, CCP 8 (10/19) - CalWORKs Stage One Child Care Authorization Form, CCP 2145 (5/04) - CalWORKs Child Care Reimbursement Report, CD 9600 (12/99) - Confidential Application For Child Development Services And Certification Of Eligibility, CF 1 (10/14) - Notice To All CalFresh Recipients - Important Please Read, CF 10 (12/13) - Dependent Care Cost Affidavit, CF 11 (9/21) - Notice To All CalFresh Recipients- Important - Please Read - Use Starting October 1, 2021, CF 11 (9/22) - Notice To All CalFresh Recipients, CF 18 ENG/SP (2/14) - Important Information, CF 20 (2/14) - You Do Not Owe Anything For Receiving CalFresh Benefits, CF 28 Coversheet (2/14) - CalFresh Program Restricted Account Coversheet - Important To Know, CF 28A (2/14) - CalFresh Program Restricted Account Agreement Part A, CF 28B (2/14) - CalFresh Program Restricted Accounting Agreement part B, CF 29 (10/13) - CalFresh Recertification Appointment Letter, CF 29A (2/14) - CalFresh Initial Appointment Letter, CF 29B (2/14) - CalFresh Initial On-Demand Appointment Letter, CF 29C (2/14) - CalFresh Recertification Appointment Letter, CF 29D (2/14) - CalFresh Recertification On-Demand Appointment Letter, CF 31 (6/19) - CalFresh Supplemental Form For Special Medical Deductions, CF 32 (6/13) - CalFresh Request For Contact, CF 34 (12/20) CalFresh Notice of Change: Semi-Annual Reporting Eliminated, CF 37 (11/16) - Recertification For CalFresh Benefits, CF 100 (11/20) - CalFresh Request For Authorized Representative Drug Or Alcohol Treatment Center Resident, CF 101 (11/20) - CalFresh Request For Authorized Representative, CF 285 (4/21) - Application For CalFresh Benefits, CF 285A (11/21) - Application For CalFresh Benefits, CF 285LP (4/21) - Application For CalFresh Benefits, CF 303 (8/19) - Replacement Or Supplement Affidavit/Authorization, CF 304A (9/20) - Important Information About Your CalFresh Benefits - CalFresh Water Pilot, CF 304B (9/20) -Notice Of Approval For The CalFresh Water Pilot, CF 304C (9/20) -Notice Of Discontinuance For The CalFresh Water Pilot, CF 304D (10/22) - Notice Of CalFresh Water Pilot Extension, CF 377.1 (5/20) - Notice Of Approval For CalFresh Benefits, CF 377.1A (8/21) - Notice Of Denial Or Pending Status, CF 377.1A LP (8/21) - Notice Of Denial Or Pending Status, CF 377.1LP (5/20) - Notice Of Approval For CalFresh Benefits, CF 377.11 (6/18) - CalFresh Time Limit Notice - Failure To Meet The Able-Bodied Adults Without Dependents (ABAWDs) Work Requirement, CF 377.11A (6/18) - CalFresh Time Limit Notice - Expiration Of Three Consecutive Months For Able-Bodied Adults Without Dependents (ABAWDs), CF 377.11B (6/18) - CalFresh Countable Month Letter - Use Of Countable Month For Able-Bodied Adults Without Dependents (ABAWDs), CF 377.11C (1/20) - CalFresh Informational Notice - CalFresh Time Limit For Able-Bodied Adults without Dependents (ABAWDs), CF 377.11E (1/20) CalFresh Able-Bodied Adult Without Dependents (ABAWD) Time Limit Exemption Screening Form, CF 377.2 (9/18) - CalFresh Notice Of Expiration Of Certification, CF 377.2B (10/20) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members, CF 377.2C (12/20) - CalFresh Notice Of Expiration Of Certification For Households With Only Elderly And/Or Disabled Members, CF 377.2D (3/18) - CalFresh Notice Of Status Change For Households With Only Elderly And/Or Disabled Members, CF 377.4 CR (1/14) - CalFresh Notice Of Change For Change Reporting Households, CF 377.4 SAR (6/13) - CalFresh Notice Of Change For Semi-Annual Reporting Households, CF 377.4A (2/14) - CalFresh Notice Of Change (Non-Citizen), CF 377.5 SAR (9/13) - CalFresh Mid-Certification Period Status Report, CF 377.6 (8/13) - Information/Verification Needed, CF 377.7A (2/14) - Notice Of Administrative Disqualification, CF 377.7A1 (2/14) - Request For Restoration Of CalFresh Benefits After Administrative, CF 377.7B (4/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only, CF 377.7B LP (2/18) - CalFresh Overissuance Notice - Inadvertent Household Errors (IHE) Only, CF 377.7B1 (10/17) - CalFresh Repayment Notice For Inadvertent Household Errors Only Final Notice, CF 377.7B1 LP (2/18) - CalFresh Repayment Notice - Inadvertent Household Errors Only Final Notice - Large Print, CF 377.7C (2/14) - CalFresh Repayment Agreement For Inadvertent Household Errors Only, CF 377.7D (1/14) - CalFresh Overissuance Notice For Administrative Errors (AE) Only, CF 377.7D1 (1/14) - CalFresh Overissuance Notice For Administrative Errors (AE) Only, CF 377.7D2 (10/17) - CalFresh Repayment Final Notice - County Administrative Error (AE), CF 377.7D2 LP (2/18) - CalFresh Repayment Final Notice - County Administrative Error (AE), CF 377.7D3 (10/17) - CalFresh Overissuance Notice For Administrative Errors (AE), CF 377.7D3 LP (6/18) - CalFresh Overissuance Notice For Administrative Errors (AE), CF 377.7E1 (1/14) - CalFresh Repayment Agreement For Administrative Errors Only, CF 377.7F (10/17) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV), CF 377.7F LP (2/18) - CalFresh Overissuance Notice - Change From Inadvertent Household Error (IHE) To Intentional Program Violation (IPV), CF 377.7F1 (10/17) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV), CF 377.7F1 LP (2/18) - CalFresh Repayment Final Notice - Intentional Program Violation (IPV), CF 377.7G (3/18) - CalFresh Intentional Program Violation (IPV) Notice - Due To Trafficking, CF 377.9 (8/20) - Notice Of Back CalFresh Benefits, CF 377.9LP (8/20) - Notice Of Back CalFresh Benefits, CF 377.11D (1/20) CalFresh Discretionary Exemption For Able-Bodied Adults Without Dependents (ABAWDs), CF 385 (10/15) - Application For Disaster CalFresh, CF 386 (2/14) - CalFresh Notice Of Missed Interview, CF 387 (5/14) - CalFresh Request For Information, CF 388 (8/13) - CalFresh Notice Of Restoration Approval, CF 389 (2/14) - Notice Of Denial Of Restoration, CF 390 (5/19) Notice of Approval/Denial For Disaster CalFresh, CF 478 (2/14) - Disqualifiction Consent Agreement CalFresh Program, CF 502 (2/23) -Notice To All CalFresh Recipients - End Of CalFresh Emergency Allotments, CF 886 (8/22) - CalFresh Notice Of Work Rules, CF 1239 (12/20) - CalFresh Notice Of Approval/Denial/Termination Transitional Benefits, CF 6177 (10/22) - CalFresh Student Exemption Screening Form, CF SSA 1 (9/20) - Information For Households Applying For CalFresh With The Social Security Administration, CF SSA 1LP (9/20) - Information For Households Applying For CalFresh With The Social Security Administration, CRF 01 (10/20) - Coronavirus Relief Fund (CRF) Certification Of Eligibility, CL 1 (4/99) - Cal-Learn Registration Program Information Orientation Appointment, CL 2 (4/99) - Cal-Learn PROGRAM REQUIREMENTS, CL 3 (4/99) - Cal-Learn Notice Of A Participation Problem, CL 4 (4/99) - Cal-Learn Notice To Parent/Legal Guardian Of Cal-Learn Participant, CL 8 (3/99) - Cal-Learn Notice Of Report Card Submittal Schedule, CL 9 (3/99) - Cal-Learn Notice Of Good Cause Determination, CL 10 (4/99) - Cal-Learn Notice Of Exemption/Deferral, CL 11 (4/99) - Cal-Learn Notice Of Incomplete Grades, CR 6181 (11/20) - Interpreter Services Statement And Confidentiality Agreement, CSFP 001 (7/22) - Commodity Supplemental Food Program (CSFP) Participant Application, CSFP 006 (7/22) - Commodity Supplemental Food Program (CSFP) Notice Of Action, CTRI 01 (10/20) - California Tax Return Information (CTRI) Notification To Client, CW 2.1 N A (8/04) - Notice And Agreement For Child, Spousal And Medical Support, CW 4 (6/02) - Immediate Need Payment Request, CW 5 (7/01) - Veterans Benefits Verification and Referral, CW 8 (11/14) - Statement of Facts For An Additional Person, CW 8A (12/14) - Statement Of Facts To Add A Child Under Age 16, CW 10 (7/01) - Notice of Withdrawn Application, CW 13 (9/02) - Caretaker Relative Agreement, CW 23 (3/00) - Senior Parent - Statement Of Facts, CW 25 (7/01) - Supplemental Statement Of Facts - Minor Parent, CW 25A (2/13) - Payee Agreement For Minor Parent, CW 42 (10/21) - Statement of Facts - Homeless Assistance, CW 43 (3/00) - CalWORKs Applicant Choice Form Immediate Need Payment/Expedited Grant, CW 51 (10/11) - Child Support - Good Cause Claim For Noncooperation, CW 52 (7/18) - Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Assistance Unit And Child Support Rules, CW 52 (10/20) California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Instead Of Cash Grant Option, CW 60 (5/01) - Release Of Information - Financial Institution, CW 61 (7/01) - Authorization to Release Medical Information, CW 63 (11/20) - Request For Income And/Or Resource Verification, CW 71 (3/00) - Statement Of Cash Aid Mother And Unrelated Adult Male (UAM), CW 74 (9/19) - Permanent Housing Search Document, CW 80 (2/18) - Self-Certification Form For Motor Vehicles - CalWORKs, CW 82 (3/00) - Important Information About This Agreement, CW 86 (10/21) - Agreement - Restricted Account California Work Opportunity And Responsibility To Kids (CalWORKs) Program, CW 87 (6/02) - Reinforming Letter/Add a Person(s) Program, CW 88 (6/11) - Diversion Services Agreement CalWORKs Program, CW 88 Coversheet (6/11) - You May Be Eligible For Diversion Services, CW 89 (2/03) - Application Withdrawl Request, CW 101 (7/17) - CalWORKs Immunization Rules, CW 103 (11/09) - Multilingual - Transitional Medi-Cal, CW 2103 (6/16) - Reminder For Teens Turning 18 Years Old, CW 2166 (12/20) - Multilingual Work Really Pays! william costello westport, ct, coral bay club membership fees, To 6 p.m. or visit CoveredCA.com of information next generation of # cdss look like unless required allowed! 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