CalSAWS Imaging Document Types and Form Names - 7/23/20

CalSAWS Imaging Document Types and Form Names - 7/23/20

Imaging Document Types Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Address/Residency Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP)

Imaging Form # PA 4024 CSF XXX CSF XXX DCFS 6044 CW 2104 MC 214 PA 1815 IMG 200 IMG 201 IMG 202 IMG 203 IMG 204 DCFS 6060 DCFS 6062 DCFS 6030 AAP 8 DCFS 6061 DCFS 6066 DCFS 6063 DCFS 6065 DCFS 6057 DCFS 6058 DCFS 6031 DCFS 6064 IMG 205 IMG 206 AD 4320 IMG 207 IMG 208 IMG 209

Imaging Form Names ADDRESS CHANGE - PLEASE HELP US HELP YOU Address Change/ Housing Costs California Residency Questionnaire DCFS Important Notice Address Change EBT Residence Verif Letter Important Info About Residency Important Notice about Mailing Address Mail Pick-Up Agreement Returned Mail Shelter Expense Utility Expense AAP - Budget or Worksheet AAP F1 Letter to Parent AAP Follow Up Letter AAP 3 AAP Intake Check List AAP Nonrecurring Adoption Expenses Agrmt AAP P1 Letter to Parent AAP P1 Letter to PAS AAP Phone Number and AAP3 Letter AAP Phone Number Letter AAP Rate Letter Verif AAP Rate Letter Verif to Ext to 21 AAP Reassessment Checklist AAP Social Security Card Request AAP Workers Checklist AAP/Placement Forms Adoption Assistance Agreement Adoption Documents Adoption Payment County Adoption Form

Case/Person Level Case Case Case Case Case Case Case Case Case Person Person Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case

Imaging Document Types Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Adoption Assistance Program (AAP) Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Imaging Form # DCFS 6022 AAP 4 IMG 210 IMG 211 IMG 212 FC 8 IMG 213 IMG 215 AAP 2 IMG 216 AAP 3 IMG 217 MC 371 SAWS 1 SAWS 2 PLUS CW 2219 IMG 218 CF 285 DFA 385 CF 385 MC 250A SAWS 2 PLUS - APPX C IMG 219 CD 9600 MC 250 IMG 220 WTW EOA 1 SAWS 2 PLUS APPENDIX D ABP 898-15 PA 5076

Imaging Form Names DCFS MEDS Letter to AAP Provider Eligibility Certification AAP Emer. Placement w/ Relative Agreement Extended AAP Family History Federal Eligibility Certification AAP ICAMA Licensing Forms Payment Instructions AAP Placement with a Relative Reassessment Info - AAP AAP Application Additional Family Members Requesting MC App for Cash Aid, CF, MC/34-County CMSP App for CF, Cash Aid, MC/Health Care Appl For CW-Non-Needy Caretaker w/Rel FC Application Clearance Sheet Application for CF Benefits Application for Disaster Application For Disaster CF Application for MC for Former FC Youth

Assistance with Completing This App Case Assignment and Tracking Child Care Application Child not w/Relative-Public Agency Resp Consult Guide CW EOA Program Application

Employment History GR Application - Non-Resident GR Intake Screening Form

Case/Person Level Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case

Case Case Case Case Case Case

Case Case Case

Imaging Document Types Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening Application, Intake, or Screening

Application, Intake, or Screening Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter

Imaging Form # CAPI 103 GR SAWS 2 PLUS SAWS 2 PLUS - APPX A PA 6091 IMG 221

Imaging Form Names GR Referral For SSI Application GR SAWS 2 PLUS

Health Coverage From Jobs Household Member Info Intake Checklist

MC 210 Mail In Instr MC 210 Mail In App MC 274 TB CW 10 DHCS 7075 IMG 222 MC 14 A SAWS 2 PLUS - APPX B RFTHI RFTHI FFY MC 325 GR RR SAWS 2 PLUS DHCS 7089 MC 4605 MC 210 A MC 223 C MC 210B SAWS 2 PLUS APPENDIX E CSF 105 CL 3 CL 1 FS 29 LA 1-B FS 29 LA 1-A

MC 210 Instructions MC 210 MC Mail-In Application MC Tuberculosis Program Application Notice of Withdrawn Application Pickle Needs Test Program Screening Sheet QMB/SLMB/QI Applications

Qus American Indian/Alaskan Native Request for Tax Household Info (RFTHI) Request for Tax Household Info FFY Request For TMC Or 4 Month Continuing MC SAWS 2 PLUS w/GR Rights/Responsibilities SCREENING DISABLED WIDOW(ER) 50-64 Supp MC / Medicare Application Supp SOF for Retro Coverage/Restoration Supp SOF MC Child App Only-Under Age 18 Supp TO SOF (PICKLE ELIGIBILITY)

Vehicle Info & Self Cert of Equity Value Appointment Letter Cal-Learn Notice Participation Problem Cal-Learn Reg/Prog Info/Orientation Appt CF RE Appt Letter - No Phone on File CF RE Appt Letter - Phone Interview

Case/Person Level Case Case

Case Case Case

Case Case Case Case Case Case Case

Case Case Case Case Case Case Case Case Case Case

Case Case Case Case Case Case

Imaging Document Types Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Appointment Letter Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info Authorized Rep and Release of Info CalFresh (CF)

Imaging Form # CF 29 IMG 223 CSF XXX FS 29 LA 3-C FS 29 LA 3-B FS 29 LA 3-A WTW 46 IMG 224 GN 60102-A GN 6010 CL 4 CSF XXX CSF XXX ABCDM 228 MC 382 MC 306 PA 1857 MC 383 IMG 225 MC 220 CSF XXX MC 381 IMG 226 DHCS 7071 MC 380 IMG 227 CW 60 DHCS 7068 PA 6066 TELE_SIG_DEC IMG 228 IMG 229

Imaging Form Names CF Recertification Appointment Letter CFET Appointment Cure Sanction Appointment Letter CW/CF RE Appt Letter - Face-to-Face CW/CF RE Appt Letter - No Phone on File CW/CF RE Appt Letter - Phone Interview END WTW 24-MONTH TIME CLOCK REVIEW APPT GA/GR Appointment Letter GAIN Appointment Letter GAIN/REP Appointment Letter Info Parent/Legal Guard of Cal-Learn Pt WTW Appointment Letter WTW/REP Appointment Letter Applicants Auth. for Release of Info Appointment of Authorized Rep Appointment of Rep Auth Rep Designation CF/Cash Benefits Auth Rep Standard Agreement for Org Authorization for Contact Authorization for Release of Information Authorized Rep Designation Cancellation/Change to MC Auth Rep Appt County Authorized to Release Info MC Waiver Info and Authorization Notice of Appointment of Authorized Rep Other Agency Authorized to Release Info Release of Info - Financial Institution Resp Public Guard/Conser or Appl/Ben Rep Social Security Disclosure Form Telephonic Signature Declaration Video/Photo Release ABAWD

Case/Person Level Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case

Imaging Document Types CalFresh (CF)

CalFresh (CF) CalFresh (CF) CalFresh (CF)

CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) CalFresh (CF) Cal-Learn Cal-Learn

Imaging Form # IMG 230

Imaging Form Names CF - Budget or Worksheet

CalFresh Admin Set CalFresh IPV Set CSF XXX

CF Admin Set CF IPV Set CF Notification of Change

CF Potential IPV Set FS 26 CF 28 Coversheet PA 1820 PA 1893 CF 28A CF 28B PA 1866 PA 6174 CF 31 CF 377.11A CF 377.11 CF 377.11C IMG 231 CF 10 CF 478 CF 386 CF 1 RMFSBUS1 RMFSBUS2 CSF XXX PA 2486 CF 377.11B MCP IMG 232 IMG 233

CF Potential IPV Set CF Program Qualify Drug Felon Addendum CF Program Restricted Account Agreement CF Repay Agreement Cover Notice CF Repayment Card CF Restricted Account Agreement Part A CF Restricted Account Agreement Part B CF Shared Housing/Utility Costs Supp Qu CF Solicitation Letter CF Suppl Form for Special Med Deduction CF Time Limit Exp 3 Consec Mnth ABAWD CF Time Limit Fail Meet ABAWD Work Req CF Time Limit for ABAWDs CF Workers Checklist Dependent Care Cost Affidavit Disqualification Consent Agreement - CF Notice of Missed Interview Notice to CF Recipients Important RMP CF NOA Change Benefit Usage 1 RMP CF NOA Change Benefit Usage 2 RMP CF Notification SSI/SSP-IFDS PARTICIPANT CONTACT LETTER Use of Countable Month for ABAWD WIC Supp. Nutrition Program Cal-Learn Agreement Cal-Learn Assessment

Case/Person Level Case

Case Case Case

Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case Case

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