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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.  It is natural to feel overwhelmed because there are many new things to remember.  In a matter of time, all of this will be second nature to you, so hang in there! 

 

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 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)

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

 

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

Job Search Contact Log--06-117 (PDF) 

 

For more State of California HHSA forms visit:  www.cdss.ca.gov/cdssweb/PG169.htm

Last updated: 3/12/2015 7:13:12 AM