Pasar al contenido principal LinkedIn. Complete child's name and address information section, or ask parent or guardian to complete this section only. Health and Safety Code section 1500 et seq. The adverbs before take the feminine form of the adjective. lento, lenta lenta (mente), silencioso silenciosamente. (916) 440-7370, 711 (California State Relay) Email: CivilRights@dhcs.ca.gov. Safeguarding Information for the Financial Assistance Programs - 45 CFR section 205.50. 2824-EL. Services Denied . Sacramento, CA 95899-7413. Press Done after you complete the form. 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!

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