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Forms

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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.         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 You can view, download, and print many documents from this web site in Adobe's Portable Document Format (PDF). You will need Adobe Acrobat Reader to view and print these documents.