Formularios de solicitud
Formularios de solicitud en blanco imprimibles para todos nuestros servicios
Formularios de solicitud en blanco
Los formularios a continuación se pueden dejar en un buzón seguro, en una de nuestras oficinas , durante el horario comercial habitual, de 8:30 a.m. a 5:00 p.m. O enviar por fax al 510-670-5095 o por correo postal a PO Box 12941, Oakland, CA 94604.
CalWORKs Initial Application and Redetermination:
SAWS 2 Plus: Application for CalFresh, Cash Aid, and/or Medi-Cal
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese, Other languages
CalFresh Initial Application:
CF 285: Application for CalFresh Benefits
Cambodian, Chinese, Farsi, Spanish, Tagalog, 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
Cambodian, Chinese, 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:
90-152: GA Accomodation Request
Spanish, Cambodian, Chinese, Farsi, Vietnamese
SAR 7: Eligibility Status Report
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese, Other languages
SAR 3: Mid-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
Medi-Cal
MC 382: Appointment of Authorized Representative
Cambodian, Chinese, Farsi, Spanish, Tagalog, Vietnamese
MC 383: Authorized Representative Standard Agreement for Organizations
CAPI
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.