Residents of Institutions

Good morning everyone,

Please see below some information on a new form for those of you who work with residence of institutions. Here is the full link to the information: https://files.mail-list.com/f/snap/96042840.html

Here is the info on two new recommended CalFresh forms, the Drug Addiction or Alcoholic Treatment and Rehabilitation Centers and Group Living Arrangements: Periodic Resident Report (CF 377.5A) and the Drug Addiction or Alcoholic Treatment Centers and Group Living Arrangements: Change Report for Residents (CF 377.5B).

Drug Addiction or Alcoholic Treatment and Rehabilitation Centers and Group Living Arrangements: Periodic Resident Report (CF 377.5A)

o A DAA Treatment Center and Group Living Agreements (GLA) must provide the CWD with a list of residents receiving CalFresh as well as a statement signed by a responsible facility official attesting to the validity of the list. For DAA Treatment Centers, the CWD must require submission of the resident list on a monthly or semimonthly basis. For GLAs, the resident list must be submitted on a periodic basis as determined by the CWD, regardless of if the resident has selected the GLA to act as an authorized representative (AR) or they applied on their own.

Drug Addiction or Alcoholic Treatment Centers and Group Living Arrangements: Change Report for Departing Residents (CF 377.5B)

o When a household leaves a DAA Treatment Center or GLA, the DAA Treatment Center or GLA must notify the CWD of the household’s departure by sending a completed change report form to the CWD with the household’s new address, if available, and a statement that the DAA Treatment Center or GLA designated employee no longer represents the household as an AR for their CalFresh case (if applicable). For GLAs that have residents who do not have an AR, this form is still required to be submitted when a CalFresh resident leaves.

o The CF 377.5B is a recommended form. The CF 377.5B serves as a change reporting document for a DAA Treatment Center or GLA to inform the CWD of a household change of address and provide the household’s new address, if available. Additionally, this form acts as a statement that the DAA Treatment Center or GLA and respective designated employee is no longer acting as the household’s AR (if applicable). While the CF 377.5B is not a mandatory form, CWDs who create an alternative form are required to collect from the DAA Centers and GLAs the same data elements that are captured in the attached sample form.

CalFresh Mid-Certification Period Status Report Form (CF 377.5 SAR)

o In addition to the two recommended forms mentioned above, DAA Treatment Centers and GLAs must provide the CalFresh Mid-Certification Period Status Report (CF 377.5 SAR) to residents who are leaving their facilities. Per ACL No. 19-51, a DAA Treatment Center or GLA facility must provide the household with a change report form as soon as it has knowledge that the household plans to leave the facility. They must also advise the household to return the CF 377.5 SAR to the CWD within 10 days of any change in the household’s circumstances that the household is required to report.

Implementation

o The new CF 377.5A and CF 377.5B and CF 377.5 SAR are posted on the CDSS website and currently available