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FOOD STAMP HANDBOOK

Handbook FORMS AND INSTRUCTIONS 63-1211 (Cont.} t- 63-1210 FORM INDEX 63-1210 ' 63-1211 ACTIVE STATE FOOD STAMP FORMS 63-1211 Form Form and Modification Current Form instruction Policy Form No. Title Version Designation* Provided Provided CA-1 Application for Public Assistance 8-78 R-NS No No CA-6 Alien Status Verification 1-82 R-NS No No CA-7 Monthly Eligibility Report 2-84 R-NS Form Only Yes CA-8 Statement of Facts For ; Additional Persons 2-84 R-NS _ Yes Yes CA-331/333 = Notice of Actions 11-80 R-NS No No DE 8435 FS Food Stamp Work Registration 3-81 R-NS No No DFA 285-A1 Application for Food Stamps — Part i 11-83 R-NS Yes Yes DFA 285-A2_ — Application for Food Stamps — ; Part 2 12-83 R-NS Yes Yes DFA 285-B Food Stamp Budget Worksheet 12-83 R-SP Yes Yes DFA 285-C Application for Food Stamps — Special Medical Deductions 11-83 R-NS Yes Yes DFA 285-D Food Stamp Budget Worksheet — Special Medical/Shelter Deductions 12-83 R-SP Yes Yes DFA 285.1 Income From Farm Operations and Other Self-Employment Sheet 8-73 R-SP No No DFA 286 Household Issuance Record (HIR Card) 4-79 R-SP No No DFA 287 Food Stamp Program Identification Card 4-80 R-SP Yes Yes DFA 288 Notice of Change to Authorization to Participate Master File or Household Issuance Record 5-79 R-SP No No

*Form Designation

R-NS Required Form — No Substitutes

R-SP Required Form -—- Substitutes Permitted Rec. Recommended Form

+ Designation Pending

CALIFORNIA-DSS-MANUAL-SS Rev. 1341 replaces Issue 2163 Effective 2/15/84

(MANUAL LETTER NO. 84.13) tei?