PD 25-01: Recently Obsoleted Forms For the Period of October, November, & December 2024

Date: 02/05/25
To: Eligibility and Clerical Staff
From: Elizabeth Garay, SSA BPIS
Reference: N/A

Changes

Due to the recent cleanup of the DEBS Forms Library, the following forms were obsoleted in the last quarter of 2024, which include the months of October, November, and December. These forms have been removed from the DEBS Forms Library and must no longer be used. If applicable, a replacement form is noted below and the county replacement forms have been added to the DEBS Forms Library where necessary. 

 

Form Number Form Name Replacement Form Number Replacement Form Name If Applicable, Obsolete History Noted Below
CSC 001 FC Approval with SCI N/A N/A N/A
CSC 002 FC Denial - Child Deceased  N/A N/A N/A
CSC 01 FC Approval N/A N/A N/A
CSC 02 FC Denial - No Jurisdiction N/A N/A N/A
CSC 03 FC Denial - Excess Income N/A N/A N/A
CSC 04 FC Denial - Excess Property N/A N/A N/A
CSC 05 FC Denial - Lump Sum N/A N/A N/A
CSC 09 FC Clothing Allowance Authorization N/A N/A N/A
CSC 12 FC Overpayment N/A N/A N/A
DL 207 Driver License Record Correction Request (Traffic Violations/Convictions Only) DL 207 Report of Incorrect Record Form (DL 207) accessed through the DMV website N/A
GA 8 Standar Failure to Respond Letter NA N/A N/A
GA 10 General Assistance Budget Worksheet N/A N/A N/A
GA 10H General Assistance Budget Worksheet - Homeless N/A N/A N/A
GA 1122 Assessment Referral Form N/A N/A N/A
GA 1122 RRC Assessment Referral Form N/A N/A N/A
GA 157 General Assistance Overpayment Computation Worksheet N/A N/A N/A
GA 18 B GA Partial Month Eligibility Proration Chart N/A N/A N/A
GA 22 GA Shelter Referral Script N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
GA 23 General Assistance Program Resource Guide N/A N/A N/A
GA 25 GA Sponsor Deem Budget N/A N/A N/A
GA 30 General Assistance Job Search Control VS 30 Vocational Services Schedule & Appointment (Refer to the updated version in VSAS) N/A
GA 3303 Important information for Completing the Form W9 N/A N/A N/A
GA 4 Screening Sheet - Persons over 65 N/A N/A N/A
GA 475 Employment History  N/A N/A N/A
GA 50 Notice N/A N/A N/A
GA 63 General Assistance/Vocational Services Information Sheet N/A N/A N/A
GA 66 Home Visit Request N/A N/A N/A
GA 68 Monthly Attendance Report VS 68 Vocational Services Program - Monthly Attendance Report (Refer to the updated version in VSAS) N/A
GA 8 Standard Failure to Respond Letter N/A N/A N/A
GA 9 Public Works Job Assignment and Time Sheet N/A N/A N/A
SCD 100 3 Month Warning N/A N/A N/A
SCD 101 Sworn Statement GEN 853

Sworn Statement

Note: For Medi-Cal, any signed and dated sworn statement containing the appropriate penalty of perjury declaration is acceptable.

 N/A
SCD 101 A Sworn Statement Continuation GEN 853

Sworn Statement

Note: For Medi-Cal, any signed and dated sworn statement containing the appropriate penalty of perjury declaration is acceptable.

 N/A
SCD 1110 Welfare Reform Review Worksheet N/A N/A N/A
SCD 1121 FC Eligibility Verification Checklist N/A N/A N/A
SCD 1192 Clients Permission for Case Review N/A N/A N/A
SCD 1194 A Instructions for the State Review QC Finding N/A N/A N/A
SCD 1318 Papers Needed at Your Appointment N/A N/A N/A
SCD 1347 Important Information for Applicants N/A N/A N/A
SCD 1357 Advance Payment Responsibilities N/A N/A N/A
SCD 1460 A 1st Notice of Reinvestigation Due N/A N/A N/A
SCD 1460 B 2nd Notice of Reinvestigation Due N/A N/A N/A
SCD 1460 C 3rd Notice of Reinvestigation Due N/A N/A N/A
SCD 1460 D 2nd RV Appointment Notice N/A N/A N/A
SCD 1461 Foster Care Redetermination Appointment N/A N/A N/A
SCD 1503 Immunization Verification Form CW 107 Immunization Verification N/A
SCD 1518 Final Medi-Cal Checkout for VMC Patients N/A N/A N/A
SCD 1614 Affidavit for Designated Burial Funds N/A N/A N/A
SCD 1615 Student Income Budget N/A N/A N/A
SCD 1624 VSD Daily Sign In Roster N/A N/A N/A
SCD 163 GO Contact Action Summary Group Orientation N/A N/A N/A
SCD 1657 Emergency Medical Procedures Checklist N/A N/A N/A
SCD 1713 Alternative Payment Program/CalWORKs Employment Services Referral Update N/A N/A N/A
SCD 1715 SSI Plus Referral Form N/A N/A N/A
SCD 1723 A Cal-Learn Service/Information Form N/A N/A N/A
SCD 174 GA Repayment Agreement N/A N/A N/A
SCD 1750 Family Conference Referral CalWORKs N/A N/A N/A
SCD 176 QMB SSI Elig. Qualified Medi-Care Beneficiary Referral N/A N/A N/A
SCD 1798 CWES Overpayment/Underpayment Worksheet and Referral N/A N/A N/A
SCD 1802 SCC Works Participant Guidebook N/A N/A N/A
SCD 1803 SCC Works Brochure N/A N/A N/A
SCD 1807 SCC Works Participant Worksite Agreement N/A N/A N/A
SCD 183 IDM Change Request     N/A
SCD 1834 Incomplete Child Care Registration N/A N/A N/A
SCD 186 CalWIN User Registration for Employment Services Community Partners N/A N/A N/A
SCD 193 Collateral Contact Affidavit N/A N/A N/A
SCD 2205 SSI Denial/Medi-Cal Application Coverletter N/A N/A N/A
SCD 2221 All Bill Wilson Applicants N/A N/A N/A
SCD 2222 Federal Emergency Assistance N/A N/A N/A
SCD 2257 SSI Advocacy Data Form N/A Use SSI Advocacy System N/A
SCD 2262 Facsimile Transmittal N/A N/A N/A
SCD 2267 Summer Jobs for Youth: Work 2 Future Flyer N/A N/A N/A
SCD 2268 Summer Jobs for Youth: NOVA Flyer N/A N/A N/A
SCD 2271 Orientation Roster N/A N/A N/A
SCD 2280 Obtain Benefit & Case Information at the Touch of a Button N/A N/A N/A
SCD 2290 Benefits CalWIN Med-Cal Supplemental Questions N/A N/A N/A
SCD 2292 Case Tracking Request N/A N/A N/A
SCD 2300 A Proof Needed N/A N/A N/A
SCD 2305 Benefits CalWIN CBO Technical Issue Form N/A N/A N/A
SCD 2309 Progress Rating Form N/A N/A N/A
SCD 2312 Orientation N/A N/A N/A
SCD 2318 Automated Phone Service PIN Guide PUB 388 California Electronic Benefit Transfer (EBT) Card N/A
SCD 2319 Refugee Transitions Referral & Outcome N/A N/A N/A
SCD 2329 Good News for Seniors Receiving Social Security Benefits N/A N/A N/A
SCD 2351 Valley Care Flyer N/A N/A N/A
SCD 2356 CalHEERS Verification Transmittal Coversheet N/A N/A N/A
SCD 2374 Triage Tracking Sheet N/A N/A N/A
SCD 2376 A State Appeal Case Review N/A N/A N/A
SCD 2376 B Appeals Case Review N/A N/A N/A
SCD 2377 Personal Information Registration N/A N/A N/A
SCD 2382 Electronic Notification Option N/A N/A N/A
SCD 2383 Request for CalWORKs and/or CalFresh Benefits N/A N/A N/A
SCD 2468 GA Intake Telephonic Signature Intake Script for GA and GA/CF N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage and replaced with Interview Script for GA and GA/CF N/A
SCD 2468 GA RE Telephonic Signature Re-evaluation Script for GA and GA/CF N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
SCD 2468 MCI MC Telephonic Signature Intake Script N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
SCD 2468 TS Intake Telephonic Signature Intake Script N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
SCD 2514 GCF-SAR7 Flyer N/A N/A N/A
SCD 2568 CWCFI CalWORKs/CalFresh Intake Script (F2F) N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
SCD 2568 MCI MC Intake Script (F2F) N/A N/A N/A
SCD 2574 Telephonic Signature Script for SSP 14 N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage N/A
SCD 270 NSDI Entry Request N/A N/A N/A
SCD 30 A AAP Budget Worksheet N/A N/A N/A
SCD 31 Health Care Options Referral N/A N/A N/A
SCD 320 Verification of CalWORKs Employment Services Status N/A N/A N/A
SCD 321 Supplement Healthy Kids Supplemental Enrollment Application N/A N/A N/A
SCD 46 One Time Exemption for a Caretaker of a Child Under Six Months (6 months) CW 2186 B CalWORKs Exemption Determination N/A
SCD 523 U GA Cooperation Agreement N/A N/A N/A
SCD 532 Trustline/Child Care Approval (NA 832) Notice of Action N/A N/A N/A
SCD 548 Validation Summary by Quality Control N/A N/A N/A
SCD 557 Report of Fair Hearing in Another County N/A N/A N/A
SCD 558 Statement of Need for Mental Health Services Medi-Cal Minor Consent N/A N/A N/A
SCD 833 CalWORKs Immunization Rules CW 101 CalWORKs Immunization Rules N/A
SCD 84 Trustline N/A N/A N/A
SCD 86 Executive Office of Immigration Review Fax N/A N/A N/A
SCD 87 Santa Clara Social Services Family Conferencing N/A N/A N/A
SCD 930 Supervisory Summary Report N/A N/A N/A
SCD 94 6 Month Warning CW 2189 A Notice of Your CalWORKs Time Limit - 54th Month on Aid N/A
SCF 1258 Information Sheet N/A N/A N/A
SPLTR 918 Speed Letter 918 GA/G/R Verify SSI/SSP Application Status  N/A N/A N/A

 

Implementation

Effective 02/05/2025.