Transcription of CALIFORNIA DEPARTMENT OF SOCIAL SERVICES …
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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES …
CA6 Does he/she presently live in CALIFORNIA and intend to continue living here? YES NO If NO , explain:CA3 Has he/she applied for or received benefits in the past, such as: cash aid, YES NOCFCalFresh, homeless assistance, Medi-Cal, Refugee Cash Assistance? If "YES", explain:WHENWHERE (County, State, or Country)TYPE OF BENEFITCA5 Has he/she been in the military service or the spouse, parent or child YES NO CFof a person who has been in the military service? If YES , explain:LIST NAME, BRANCH OF SERVICE, DISCHARGE YES NO CA4 Is he/she a child under age 19? If YES , complete below: YES NO PARENT OR CARETAKERR eason Other Parent Child Needs AidRELATIVE S NAMEOTHER PARENT S NAMEDoes Not LiveDue to Parent s( ) Lives in Home( ) Lives in Homein the Home(Check all boxes which apply) Yes Yes No NoCITIZEN/NONCITIZEN STATUS ( ) Citizen/National
CF 15 Does he/she get food from any of the following programs? YES NO Communal dining facility for the elderly or disabled Food distribution program operated by a Native American reservation
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