| Forms/Applications | |
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| Food and Nutrition | |
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Food Stamps You can submit this application by mail to the nearest Department of Public Social Services office of the County of Los Angeles, or you can go to the nearest Department of Public Social Services office of the County of Los Angeles to submit your application. If you are disabled and unable to go to a Department of Public Social Services office of the County of Los Angeles, you may call 1 (877) 481-1044 and a home visit will be scheduled to assist you with the application process. |
Location of Department of Public Social Services Offices Download Food Stamps Application |
| Child and Family Resources | |
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CalWORKs In order to meet requirements for the application process, you must go to a Department of Public Social Services office of the County of Los Angeles for a full intake interview. This application may not be submitted by mail. To assist you in preparing for the process, you may fill out the application ahead of time and bring it with you to the Department of Public Social Services office of the County of Los Angeles. If you are disabled and unable to go to a Department of Public Social Services office of the County of Los Angeles, you may call 1 (877) 481-1044 and a home visit will be scheduled to assist you with the application process. |
Location of Department of Public Social Services Offices Download CalWORKs Application |
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Los Angeles County Office of Education Head Start-State Preschool Questions regarding application forms will be answered at your local Head Start agency. Call (877)PRE-K-Kid or (877)773-5543. |
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| California Children's Services |
Download California Children's Services Application |
| Income Support for Adults | |
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Earned Income Tax Credit (EITC) Read the full list of eligibility requirements, detailed examples, and learn about the Advanced EITC – Publication 596. To apply for the Federal EITC, one must file an income tax return. This can be done by completing IRS Form 1040a and Schedule EIC. |
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General Relief In order to meet requirements for the application process, you must go to a Department of Public Social Services office of the County of Los Angeles for a full intake interview. This application may not be submitted by mail. To assist you in preparing for the process, you may fill out the application ahead of time and bring it with you to the Department of Public Social Services office of the County of Los Angeles. If you are disabled and unable to go to a Department of Public Social Services office of the County of Los Angeles, you may call 1 (877) 481-1044 and a home visit will be scheduled to assist you with the application process. |
Location of Department of Public Social Services Offices Download General Relief Application |
| Medical | |
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Medi-Cal The Medi-Cal application is comprised of three parts: Introduction, Application, and Instructions. Please download all three documents. You can submit this application by mail to: Northridge Regional Medi-Cal District P.O. Box 10810 Canoga Park, CA 91309 Or you can go to the nearest Department of Public Social Services office of the County of Los Angeles to submit your application. If you are disabled and unable to go to a Department of Public Social Services office of the County of Los Angeles, you may call 1 (877) 481-1044 and a home visit will be scheduled to assist you with the application process. |
Location of Department of Public Social Services Offices Download Medi-Cal Introduction Download Medi-Cal Application Download Medi-Cal App. Instructions |
| Medi-Cal Presumptive Eligibility for Pregnant Women | Presumptive Eligibility Patient Fact Sheet |
| Child Health and Disability Prevention |
CHDP Pre-Enrollment Application |
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County Health Clinics Under the Ability to Pay (ATP) and Outpatient Reduced-Cost Simplified Application (ORSA) plans, persons without insurance and/or who do not qualify for full-scope Medi-Cal, can get medical care at County hospitals and clinics at no cost or low cost. You may get these plans at any County medical center. The applications for ORSA and ATP are offered here to inform you about the information required for these plans. Visit a County hospital or clinic to obtain medical services. |
Contact Information: (800) 427-8700 Download ORSA Plan Application Download ATP Plan Application |
| Senior and Disabled Services | |
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Cash Assistance Program for Immigrants (CAPI) In order to meet requirements for the application process, you must go to a Department of Public Social Services office of the County of Los Angeles for a full intake interview. This application may not be submitted by mail. To assist you in preparing for the process, you may fill out the application ahead of time and bring it with you to the Department of Public Social Services office of the County of Los Angeles. If you are disabled and unable to go to a Department of Public Social Services office of the County of Los Angeles, you may call 1 (877) 481-1044 and a home visit will be scheduled to assist you with the application process. |
Contact Information: (877) 481-1044 Download CAPI Application |
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Deaf and Disabled Telecommunications Program (DDTP), A Program of the California Public Utilities Commission (CPUC) Application: Disability must be certified by an authorized health provider or other professional. Forms are available from the DDTP website (http://www.ddtp.org) or by calling the Call Center at 800-806-1191. *Please Note: Applications may be found in the back of your local yellow pages in the Coupon Section. |
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California Relay Service (CRS), A Program of the California Public Utilities Commission (CPUC) Application: Disability must be certified by an authorized health provider or other professional. Forms are available from the DDTP website (http://www.ddtp.org), Eligibility for CTAP Equipment, or by calling the Call Center at 800-806-1191. *Please Note: Applications may be found in the back of your local yellow pages in the Coupon Section. |
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