Forms/Applications
Food and Nutrition
CalFresh (formerly 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 (626) 569-1399, (818) 701-8200, (310) 258-7400, (866) 613-3777 and a home visit will be scheduled to assist you with the application process.
Location of Department of Public Social Services Offices

Download CalFresh (formerly Food Stamps) Application
Child and Family Resources
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 (626) 569-1399, (818) 701-8200, (310) 258-7400, (866) 613-3777 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
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.
California Children's Services Download California Children's Services Application
Income Support for Adults
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.
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 (626) 569-1399, (818) 701-8200, (310) 258-7400, (866) 613-3777 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
Medi-Cal

The Medi-Cal application is comprised of three parts: Introduction, Application, and Instructions. Please download all three documents.

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 (626) 569-1399, (818) 701-8200, (310) 258-7400, (866) 613-3777 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
County Health Clinics

Under the Ability to Pay (ATP) plan, 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 this plan at any County medical center. The information for ATP is offered here to inform you about the information required for this plan. Visit a County hospital or clinic to obtain medical services.
Contact Information: dhs.lacounty.gov

Download Information
Senior and Disabled Services
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 (626) 569-1399, (818) 701-8200, (310) 258-7400, (866) 613-3777 and a home visit will be scheduled to assist you with the application process.
Contact Information: 1-866-613-3777

Download CAPI Application
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.
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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