Get Ca Cf 377.5a 2020-2025

This guide provides a clear and detailed overview of how to fill out the CA CF 377.5A form online. Follow these instructions carefully to ensure accurate completion and submission of the resident report.

Follow the steps to complete the CA CF 377.5A form online.

1. Press the ‘Get Form’ button to access the CA CF 377.5A form and open it in your preferred editor.
2. Begin by filling in the facility's name, address, and city/ZIP code in the designated fields at the top of the form.
3. Input the authorized representative's first name, last name, and phone number in the specified sections.
4. Enter the CalFresh case number and the status (e.g., active or pending) for each resident in the appropriate fields for all individuals listed.
5. For each resident, provide details such as their facility entrance date, exit date, and the date the county was notified of their exit.
6. Complete the amount of benefit refund, if applicable, in the provided section for each resident.
7. Review the declaration section where the authorized representative must sign and date the form, confirming the accuracy of the information provided.
8. Once all required fields are filled out and reviewed for accuracy, save your changes. You can choose to download, print, or share the form as needed.

Complete the CA CF 377.5A online today to ensure timely reporting of your residents.