PD 25-06: Recently Obsoleted Forms for the Period of January, February, & March 2025

Date: 05/05/2025
To: Eligibility and Clerical Staff
From: Elizabeth Garay, SSA Business Policy Implementation Specialist
Reference: N/A

Changes

Due to the continued cleanup of the DEBS Forms Library, the following forms were obsoleted in the first quarter of 2025, which includes the months of January, February, and March. 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
SCD 17 Refugee Information Sheet N/A N/A N/A
SCD 1212 (QR30) CW Scratch Budget N/A N/A N/A
SCD 1225 Medi-Cal Notice of Action - Approval/Termination of One-Month Medi-Cal N/A N/A N/A
SCD 1383 Caretaker Relative Documentation Chart CW 790 Statement of Relationship N/A
SCD 2175 Asset Match - BEER Review N/A N/A N/A
SCD 2176 IRS-FTB Asset Match Beneficiary Earning Exchange Record Resource Verification Questionnaire N/A N/A N/A
SCD 2177 Notice (IEVS) N/A N/A N/A
SCD 2340 Medi-Cal Early Fraud Detection Program MC 609 Confidential Medi-Cal Complaint Report N/A
SCD 2350 Request for Tax Household Information (RFTHI) N/A Use the RFTHI form in CalSAWS

N/A
SCD 2350 Supplemental Request for Tax Household Information (RFTHI) Supplemental N/A Use the RFTHI form in CalSAWS N/A
SCD 2352 CA Counties N/A N/A N/A

SCD 2358

 SSI Attorney Referrals – Quarterly Report N/A N/A N/A
SCD 2394 MCE Determination Flow Chart for NACF N/A N/A Moved to the Scripts drop-down in Reference Materials (RM) on Program Bureau homepage
SCD 2424 My BCW Mobile App Flyer N/A N/A N/A
SCD 2425 Santa Clara County Public Health Department N/A N/A N/A
SCD 2427 DEBS Brochure N/A N/A N/A
SCD 2440 Telephone Greetings N/A N/A N/A
SCD 2447 Non-Magi Medi-Cal Brochure N/A N/A N/A
SCD 2448 APTC and CSR Brochure N/A N/A N/A
SCD 2454 Request for CalWIN Release Changes N/A N/A N/A
SCD 2480 CalWORKs - GA Application Guidelines N/A N/A N/A
SCD 2496 CalFresh Employment Services Orientation Appointment Notice N/A N/A N/A
SCD 2498 ABAWD Cover Letter N/A N/A N/A
SCD 2502 ABAWD Screening Script N/A N/A N/A
SCD 2506 CFET Partnership N/A N/A N/A
SCD 2507 CalFresh Employment Services ABAWD Bus Token Log N/A N/A N/A
SCD 2515 CalFresh Three-Month Time Limit for Able-Bodied Adults Without Dependents (ABAWD) N/A N/A N/A
SCD 292 DMV & Legal Information Request N/A N/A N/A
SCD 32 Wraparound Budget Worksheet N/A N/A N/A
SCD 957 CalWORKs Stage II Screener N/A N/A N/A

 

Implementation

Effective 05/05/2025.