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Forms & Documents > Participant Services > Non-Specific Program > Forms

Name Description
ABCDM 228 - Applicant's Authorization For Release Of Information ABCDM 228 - Applicant's Authorization For Release Of Information
ABCDM 228 - Applicant's Authorization For Release Of Information (Sp) ABCDM 228 - Applicant's Authorization For Release Of Information (Sp)
DSS-6-Sworn-Statement-of-Facts

DSS 6 Sworn Statement of Facts

DSS-6-Sworn-Statement-of-Facts-(Sp)

DSS 6 Sworn Statement of Facts (Sp)

DSS-72-Preferred-Language-Designation

DSS 72 - Preferred Language Designation

DSS-GEN-254-Self-Employment-Worksheet

DSS GEN 254 Self Employment Worksheet

DSS-GEN-254-Self-Employment-Worksheet-(Sp)

DSS GEN 254 Self Employment Worksheet (Sp)

DSS-GEN-254-B-Information-and-Expense-Deduction-Choice-for-Self-Employment

DSS GEN 254-B Information and Expense Deduction Choice for Self Employment

DSS-GEN-254-B-Information-and-Expense-Deduction-Choice-for-Self-Employment-(Sp)

DSS GEN 254-B Information and Expense Deduction Choice for Self Employment (Sp)

DSS-GEN-282-Verification-of-Job-Ending

DSS GEN 282 Verification of Job Ending

DSS-GEN-324-New-Job-Verification

DSS GEN 324 New Job Verification

DSS-GEN-360-Verification-of-Wages

DSS GEN 360 Verification of Wages

CW 2.1 NA Notice and Agreement for Child, Spousal and Medical Support CW 2.1 NA Notice and Agreement for Child, Spousal and Medical Support
CW 2.1 NA Notice and Agreement for Child, Spousal and Medical Support (Sp) CW 2.1 NA Notificación y acuerdo sobre el mantenimiento de hijos/esposa(o) y mantenimiento en relación al cuidado de la salud
CW 2.1Q Support Questionnaire CW 2.1Q Support Questionnaire
CW 2.1Q Support Questionnaire (Sp) CW 2.1Q Cuestionario sobre la manutención
CW 2223 Demographic Questionnaire for CalWORKs, RCA, ECA, TCVAP, and CalFresh CW 2223 Demographic Questionnaire for CalWORKs, RCA, ECA, TCVAP, and CalFresh Programs
CW 2223 Demographic Questionnaire for CalWORKs, RCA, ECA, TCVAP, and CalFresh (Sp) CW 2223 Cuestionario demográfico para los programas de CalWORKs, RCA, ECA, TCVAP y CalFresh
NA 1273 Electronic Notification Agreement NA 1273 Electronic Notification Agreement
NA 1273 Electronic Notification Agreement (Sp) NA 1273 Electronic Notification Agreement (Sp)
NVRA Voter Preference Form NVRA Voter Preference Form
NVRA Voter Preference Form (Sp) NVRA Formulario de preferencia del votante
SAR 7 Eligibility Status Report SAR 7 Eligibility Status Report
SAR 7 Eligibility Status Report (Sp) SAR 7 Eligibility Status Report (Sp)
SAWS 1 Initial Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs SAWS 1 Initial Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs
SAWS 1 Initial Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs (Sp) SAWS 1 Solicitud inicial para beneficios del programa de CalFresh, asistencia monetaria, y/o beneficios de Medi-Cal/otros programas para el cuidado de la salud
SAWS 2 Plus Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs SAWS 2 Plus Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs
SAWS 2 Plus Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs (Sp) SAWS 2 Plus Solicitud para beneficios del programa de CalFresh, asistencia monetaria, y/o beneficios de Medi-Cal/otros programas para el cuidado de la salud Plus Solicitud para beneficios del programa de CalFresh, asistencia monetaria, y/o beneficios de Medi-Cal…
SAWS 2A SAR Rights, Responsibilities and Other Important Information SAWS 2A SAR Rights, Responsibilities and Other Important Information
SAWS 2A SAR Rights, Responsibilities and Other Important Information (Sp) SAWS 2A SAR Derechos, responsabilidades y otra información importante
TEMP 2202 Cash Aid/Food Stamp EBT Service Request TEMP 2202 Cash Aid/Food Stamp EBT Service Request
TEMP 2202 Cash Aid/Food Stamp EBT Service Request (Sp) TEMP 2202 Asistencia monetaria/estampillas para comida – petición para servicios de EBT

Contact Social Services

Child Hotline Information:

  • If you suspect there is an emergency requiring immediate intervention, call 911
  • To report suspected child abuse or neglect call the 24 hour Child Abuse Hotline at (805) 781-KIDS (5437) or toll free 1-800-834-KIDS (5437)

Adult Hotline Information:

  • If you suspect there is an emergency requiring immediate intervention, call 911
  • To report suspected elder abuse or neglect call the Adult Services Hotline at (805) 781-1790 during regular business hours, or after business hours call (844) 729-8011
  • Mandated Reporter