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Case Record Forms
Mandatory Forms
The following forms must be imaged into each case as appropriate:
| Form Number | Form Name |
| CW 2200 | "Request for Verification" |
| SCD 41 | “Identification & Intake Record” |
| SAWS 2 Plus | “Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs” |
| GEN 1365 | “Notice of Language Services” |
| IEVS Abstract | Individual Inquiry Screen |
| SCD 103 | “Acknowledgment of the Limited Sharing of Information for the Administration of the CalWORKs Program” |
| WTW 5 | "Welfare to Work Informing Notice" |
Other Forms
The following forms may or may not be required in the case record: (This list is not intended to be all inclusive.)
| Form Number | Form Name |
| CW 2.1 N&A | "Child/Spousal and Medical Support Notice and Agreement” |
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CW 2.1Q CW 371 |
“Support Questionnaire” “Referral to DA for Action” Reminder: These forms MUST be completed and a referral made to the DCSS when a child's parents are unmarried, living together and paternity has never been established by court order. |
| CW 23 | “Statement of Facts - Senior Parent” |
| CW 25 | "Supplemental Statement of Facts - Minor Parent" |
| CW 25A | "Payee Agreement for Minor Parent" |
| CW 82 | “Agreement to Sell Property” |
| SCD 173 | "Time on Aid Screening Form" |
| SCD 298 | "Welfare to Work Core and Non-Core Activities" |
| SCD 549 | “Request for Information From Employer” (for ANY parent who has quit or lost a job within last 6 months) |
Related Topics
Verification Needed to Establish Eligibility
Loss of Contact/Whereabouts Unknown
Determining County of Responsibility
Client Resides in Another County