As a CalWORKs participant, you are introduced to County requirements, new forms, different representatives and agencies.  You will find yourself spending a lot of time filling out and requesting forms. 


For your convenience, we have provided you with access to a few of the CalWORKs forms you will need on a monthly, quarterly or possibly on a one-time basis.  Further, below you will find a blank fax cover sheet.  You are welcome to use the Southwestern College CalWORKs Program fax machine for any welfare-to-work correspondence to your ETA/ECM or child care case manager.


Fax Cover Sheet--Blank (PDF)


County of San Diego—Health & Human Services Agency (HHSA)

Monthly Attendance Verification (ENGLISH)--116 HHSA (PDF)

Monthly Attendance Verification (SPANISH)--116 HHSA (PDF)

Monthly Attendance Verification (ARABIC)--116 HHSA (PDF)

Mileage Reimbursement Log--HHSA 27-347 (PDF)

WTW Activity Attendance Verification--HHSA 27-340 (PDF)--used for employment and/or related training, community service and miscellaneous activities.


State of California—Health & Human Services Agency (HHSA)

Job Search Contact Log--06-117 (PDF) 


For more State of California HHSA forms visit:

Last updated: 3/16/2016 8:40:37 AM