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Aid Program Forms

Application Forms
  Food Stamp Program: click here the application to sign-up for the Food Stamp program. Please complete the form as much as you can. If you have questions, visit or call and speak to our helpful and multi-lingual Human Services Agency staff to learn more. You can also mail the completed application to your local office.  Note: completing this application does not automatically grant you benefits. The Human Services Agency staff will contact you about your eligibility and any related benefits.

Medi-Cal Program: click here to download the application to sign-up for the Medi-Cal program. Please complete the form as much as you can. If you have questions, visit or call and speak to our helpful and multi-lingual Human Services Agency staff to learn more. You can also mail the completed application to your local office.  Note: completing this application does not automatically grant you benefits. The Human Services Agency staff will contact you about your eligibility and any related benefits.
Change Forms
  Below are some forms that you can download onto your computer, fill them out at home, and take with you or mail to your local Human Services Agency (HSA) office. These forms are to report any changes in your case management status.

Number
         
CW-7   Monthly Income Report
CA-61   Medi-Cal Verification
C-340   Statement of Living Arrangement
CW 2.1   Questionnaire - Absent Parent
CW 2.1   N+A Notice and Agreement of Child Support
CW8A   Statement of Facts to add a child under 16 to cash aid and food stamps
C-481   Financial Aid Verification
C-501   Voluntary Quit Questionnaire
DFA-377.5   Change Report Form
C-215   Household Determination Sheet
C-423   Statement of Child Care Costs
DHS-6155   Other Health Insurance Information
MC-13   Statement of Citizenship, Alienage, and Immigration Status
Trustline Registry   CA Registry of In-Home Child Care Providers Subsidized Application


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