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IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ...
GO ON TO THE NEXT PAGE SOC 426 (6/16) PAGE 3 OF 5 . IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT FORM INSTRUCTIONS: • Use black or blue ink to fill out. Print information clearly. • Fill out, sign and return this form in person to the office or location designated by the county.
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Applying for Cash Aid (Apps-Forms) Eng1
dpss.lacounty.govNote: If you are interested in applying for Refugee Cash Assistance (RCA), access the RCA webpage. to get details on how to apply for RCA. CalWORKs Forms . There are various forms that may be needed when applying for CalWORKs. Below is a description as to when each form is needed as well as a link to access the form .
CW 42 Statement of Facts - Homeless Assistance
dpss.lacounty.govCW 42 (9/19) Required Form - Substitutes Permitted Page 3 of 3. 13. What day did you get a pay rent or quit notice? 14. How many months of back rent do you owe? 15. How much is your monthly rent? 16. Why didn’t you pay your rent? 17. Is your Landlord evicting you? Why?
INFORMATION SHEET GENERAL RELIEF
dpss.lacounty.govIf you are eligible for GR, you may be able to get emergency aid while your application is being processed. Emergency Aid can include: o Payments* to prevent eviction or utility shut-off. o Payments* to restore utilities. o Meal and housing vouchers if you are homeless. o Transportation funds for seeking jobs and for verified medical appointments.
SOC 873 (Rev 10-2016) EN - Los Angeles County, California
dpss.lacounty.govTitle: SOC 873 (Rev 10-2016) EN.xps Created Date: 2/9/2017 4:02:52 PM
APPLICATION FOR IN-HOME SUPPORTIVE SERVICES
dpss.lacounty.govthe County in which I receive services. The purpose of the visits and letters is to ensure that program requirements are being followed and that the authorized services are necessary for you to remain safely in your home. The visit will also verify that the authorized services are being provided, that the
SOC 426A - Los Angeles County, California
dpss.lacounty.govTitle: SOC 426A.pdf Created Date: 5/4/2016 10:31:25 AM
County of Los Angeles Department of Public Social Services ...
dpss.lacounty.govCalWORKs is a public assistanceprogram that gives cash aid and services to eligible families. If a family has little or no cash and needs housing, food, utilities, clothing or , medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for
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DOH CHRC 103 (9/06) Page 1 NYS Department of Health ...
www.stallionnursing.com2. Please obtain subject individual information and complete all sections on page 2 of this form prior to or at the time of fingerprinting. This information will be used to conduct both a Federal and State criminal history record check pursuant to State law. 3.
ALCOHOLIC BEVERAGE LICENSE INFORMATION & …
www.gwinnettcounty.comobtain fingerprinting . Alcoholic Beverage License Information & Checklist (Except Wholesaler) (Revised 02-27-19) Page 2 of 2 PRIMARY CHECKLIST FOR ATTACHMENTS ... (Revised 02/27/19 ) Page 1 of 6 . GWINNETT COUNTY DEPARTMENT OF PLANNING & DEVELOPMENT LICENSING AND REVENUE SECTION . ALCOHOL BEVERAGE UNIT P. O. …
FINGERPRINTING SERVICE INFORMATION
www.psp.pa.gov(Continued page 2) REASON FINGERPRINTING PROVIDED BY: PROVIDER or AGENCY CONTACT INFORMATION WEBSITE . Adoption 3M Cogent Systems 1-800-692-7462 www.pa.cogentid.com Criminal Justice Employment (Non-PSP) Hiring agency N/A N/A Department of Aging 3M Cogent Systems 717-265-7887 www.pa.cogentid.com ...
BE A SCHOOL VOLUNTEER (For Parents and Community …
ehandbooks.dadeschools.netLevel activities will require fingerprinting. Parent Portal - Services and Sites From the Parent Portal page, Click Services/Sites tab The Parent Portal Services/Sites page will display. Note: Name, Address, and Date of Birth must be accurate or clearance process will be delayed. From the Volunteer Registration page,
Change of Name Information Guide
cfr.forms.gov.ab.caDVS 3 132G Rev. 2 0- 4 Page of 5 Classification: Protected A Change of Name Information Guide IMPORTANT INFORMATION • The applicant must be a resident and must remain a resident of Alberta until the name change is complete …
Fingerprinting in Indiana Professional Licensing Agency
www.in.gov11. Complete your payment process and click “Send Payment Information”. 12. Print your confirmation page. If you provided an email address, you will receive an email confirmation as well. 13. Bring one of the following with you to your fingerprinting appointment: valid driver license, valid state
TEXAS DEPARTMENT OF PUBLIC SAFETY
www.dps.texas.govf) Sign the authorization letter and fill in contact information. Telephone Registration: a) You may contact the fingerprinting vendor at 1- 888-467-2080. b) The fingerprinting vendor will prompt you for the Service Code. c) The service code for a personal review is 11FT12.