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FINANCIAL SERVICES BUREAU
AUTOMATED ASSISTANCE CLAIMS



This website provides information for the CDSS Automated Assistance Claiming Process. Please use the applicable claim forms on this page and submit them to CDSS by way of email to assistance.claims@dss.ca.gov.

All assistance claim forms and respective procedures are accessible on this page. Claim forms and addendums are contained in an Excel Workbook format. The CA 800 FC FED ADJ - Adjustment Worksheet for Aid Code 42, is not contained in a workbook so will need to be submitted separately (if applicable) by email.

 

Claim Forms
NOTE: Please download these Excel spreadsheets to your computer prior to using them. Please follow the instructions for downloading Excel spreadsheets prior to entering your data into them.

CA800 Automated Assistance Claims (Updated 1/26/10)
CA800 Tribal Automated Assistance Claims (Updated 1/22/09)
CA800FC IV-E Waiver Demonstration Project Addendum
CA 800 FC FED ADJ - Adjustment Worksheet for Aid Code 42