Blank Application Forms

The below forms may be dropped at a secure drop box, at one of our offices, during regular business hours, 8:30 a.m. to 5:00 p.m or submitted by fax to 510-670-5095 or by mail at P.O. Box 12941, Oakland, CA 94604.

CalWORKs Initial Application and Redetermination:

SAWS 2 Plus: Application for CalFresh, Cash Aid, and/or Medi-Cal 
CambodianChinese,  FarsiSpanish, Tagalog, Vietnamese, Other languages

CalFresh Initial Application:

CF 285: Application for CalFresh Benefits
Cambodian, Chinese, Farsi, SpanishTagalog, Vietnamese, Other languages

CalFresh Renewal:

CF 37: Recertification for CalFresh Benefits
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese, Other languages

Medi-Cal Initial Application:

CCFRM604: State of California Health Insurance Application
CambodianChinese, Farsi, Spanish, Tagalog, Vietnamese, Other languages

General Assistance Initial Application and Renewal Application:

90-16:  Application  for General Assistance

Cash Assistance Program for Immigrants (CAPI)

SOC 814:  Statement of Facts Cash Assistance Program for Immigrants (CAPI)  
Chinese, Spanish, Other languages

Additional Forms for CalWORKs, CalFresh and General Assistance:

90-152GA Accomodation Request

SAR 7:  Eligibility Status Report
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese, Other languages

SAR 3Mid-Period Status Report For Cash Aid and CalFresh
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese,  Other languages

Authorized Representative Forms

CalWORKs, CalFresh, Refugee Cash Assistance, and General Assistance
CSF 14: Authorization for Release of Information - Authorized Representative

MC 382: Appointment of Authorized Representative
CambodianChinese​FarsiSpanishTagalog, Vietnamese

​MC 383: Authorized Representative Standard Agreement for Organizations

C-776: CAPI Authorized Representative Form

Additional Blank Forms to Complete During the Application Process

The following forms need to be completed during the application process. You do not need to print these forms as they will be mailed to you after you submit your initial application form.  However, you do not need to wait for these forms to be mailed and may complete and submit these forms electronically or through the mail with the initial application or at any time during the application process.

Application Forms

Printable blank application forms for all our services