Get Form Adsa 1a - Cdss - State Of California - Cdss Ca

This guide provides a thorough and supportive overview for users seeking to complete the Form ADSA 1A online. The form is essential for those applying for the assistance dog special allowance program in California, ensuring that all necessary information is accurately submitted.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering your Social Security Number in the designated field, ensuring accuracy as it is required for processing your application.
3. Provide the date of filling out the form in the specified format so that your application timeline is clear.
4. Indicate whether you are receiving any of the listed benefits by checking the appropriate boxes: SSI/SSP, IHSS, CAPI, or Social Security Disability Insurance. If receiving SSDI, attach a copy of your current award certificate.
5. Answer if your assistance dog is still in active service by selecting 'Yes' or 'No.' If 'No,' please enter the date they ceased service.
6. If you have obtained a new trained assistance dog, answer 'Yes' or 'No' as applicable. If 'Yes,' provide the name and acquisition date of the new dog.
7. In the next fields, detail the name of the individual or school that trained your dog, along with their contact number.
8. Describe what service your dog provides, offering as much detail as necessary to clarify their role.
9. Sign the form with your signature or mark where indicated, affirming the truthfulness of your statement under penalty of perjury.
10. List your area code and phone number for any follow-up communication.
11. If applicable, provide the name and phone number of a witness to your signature.
12. Complete the change of name and/or address section if needed, providing new information as required.
13. If there is a different address for receiving checks, fill out that section with accurate details for the payee.
14. You may opt to receive your next renewal application on a floppy disk by selecting 'Yes' or 'No'.
15. Finally, save your changes, and download, print, or share the completed form as necessary.

Start filling out your documents online today to ensure timely submission.