PD 24-17: Recently Obsoleted Forms For the Period of July, August, & September 2024

Date: 10/07/2024
To: Eligibility and Clerical Staff
From: Elizabeth Garay, SSA Business Policy Implementation Specialist
Reference: N/A

Changes

The following forms were obsoleted in the third quarter of 2024 which include the months of July, August, & September. These forms have been removed from the DEBS Forms Library and must no longer be used. If applicable, a replacement form is noted below. The county replacement forms have been added to the DEBS Forms Library. 

 

Form Number Form Name Replacement Form Number Replacement Form Name If Applicable, Obsolete History Noted Below
CF 37 Coversheet Coversheet for CF 37 N/A N/A N/A
DHCS 7077 A Notice Regarding Transfer of a Home for Both a Married and an Unmarried Applicant/Beneficiary N/A N/A N/A
FC 4 Paternity Affidavit N/A N/A N/A
MC 003 Early and Periodic Screening, Diagnosis, and Treatment Services N/A N/A N/A
MC 007 Medi-Cal Application Cover Letter N/A N/A N/A

SCD 93 A

SCD 93 B

SCD 93 C

 Medi-Cal Application Cover Letter N/A N/A N/A
SCD 2483 SCC SSA Online Privacy and Security Training Non-Disclosure Agreement N/A N/A N/A
SCD 2611 Non-Work Social Security Number Letter GEN 2101 Non-Work Social Security Number Request Form N/A