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De Acci n (Completar 1A o 1B) 1. A. Solicitud de servicios Servicios aprobados para comenzar: Fecha 1. B. Beneficiario de los servicios Cambio en el servicio Terminaci n del servicio Servicios negados Si es apelado, fecha de la apelaci n: Fecha (Nota: Las instrucciones de esta apelaci n se encuentran al reverso de esta pagina) Notificaci n de cuotas pendientes de pago Fecha de acci n efectiva: Si es apelado, fech.

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How to fill out the Cd7617 Form Spanish online

Filling out the Cd7617 Form Spanish online is an essential process for individuals involved with child development services in California. This guide provides clear instructions on how to properly complete each section of the form to ensure that your information is accurately submitted.

Follow the steps to successfully complete the Cd7617 Form Spanish online.

  1. Click ‘Get Form’ button to obtain the form and access it for editing.
  2. Identify the type of action notification you are submitting by completing section 1A for application services or section 1B for recipient of services, including dates and relevant details.
  3. In section 2, provide the distribution of the notification by indicating when and how the notice was given or sent. Include initials of the parent or caretaker if applicable.
  4. Complete section 3 with the parent or caretaker's information, ensuring to include names, addresses, and phone numbers.
  5. In section 4, list all approved child care services for each child receiving services, including their names and the approved hours for each day of the week.
  6. Provide the basis for family eligibility for services in section 5 by marking applicable options, and include the estimated recertification date.
  7. Fill out section 6 detailing the necessity for services, and check all that apply based on the specific circumstances of the family.
  8. Clearly state the specific reason for the action in section 7, indicating if services were denied, changed, or terminated.
  9. Complete the agency representative's information in section 8-10, including signature and title, to finalize the form.
  10. After completing the form, you may save changes, download, print, or share the document as needed.

Start completing your documents online today for a more efficient process.

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Cd7617 Form Spanish
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2014 CA Form CD-7617
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