Frequently Used Forms

  • Forms are organized alphabetically by form number. You can also search for a keyword or form name using your device's Find function, e.g. CTRL+F or COMMAND+F.
  • The programs that each form applies to are listed in the Program column: CF=CalFresh, MC=Medi-Cal, CW=CalWORKs.
  • Many of these forms are fillable, meaning you can type into them before printing. If you want to type into a form, download the free Adobe Acrobat Reader first for a desktop or laptop computer, or download the free Adobe Fill & Sign app first for a mobile device. 
NUMBER PROGRAM NAME TYPE LINK
ABCDM 228 CF Authorization for Release of Information PDF (CDSS) English Spanish
CF 10 CF Dependent Care Cost Affidavit PDF (CDSS) English Spanish
CF 37 CF Recertification for CalFresh Benefits PDF (CDSS) English Spanish
CF 285 CF Application for CalFresh PDF (CDSS) English Spanish
CSF 2 CF General Affidavit PDF (local) English Spanish
CSF 23 CF Statement of Gift/Loan PDF (local) English Spanish
CSF 35 CF Self-Employment Self-Sworn Statement PDF (local) English Spanish
SAR 7 CF Eligibility Status Report PDF (CDSS) English Spanish
TEMP 2201 CF Request for DAC/AR PDF (CDSS) English Spanish
TNB 4 CF Notice of Recertification for Transitional Nutrition Program PDF (CDSS) English Spanish
W-73 CF Employer Letter English/Spanish Word (local) English/Spanish
W-459 CF Electronic Communication Consent Form Word (local) English Spanish
W-521 CF Authorization for Release of Information (CBO) English/Spanish Word (local) English/Spanish
W-664 CF Verification of Gross Pay English/Spanish Word (local) English/Spanish