STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ALTERNATE PICK-UP REQUEST FORM Emergency Food Assistance Program (EFAP) 2016 Income Guidelines Date: EFAP MAXIMUM INCOME MONTHLY ANNUAL HOUSEHOLD HOUSEHOLD HOUSEHOLD SIZE INCOME INCOME 1 $1,485.00 $17,820 2 $2,002.50 $24,030 Authorization: I hereby authorize, to pick up my United States Department of Agriculture Em.
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How to fill out the CA EFA 15 online
The CA EFA 15 form is used to request an alternate pick-up for food assistance under the Emergency Food Assistance Program. This guide provides step-by-step instructions for effectively completing the form online.
Follow the steps to accurately complete the CA EFA 15 form online.
- Press the ‘Get Form’ button to access the CA EFA 15 online and open it for editing.
- Fill in the date at the top of the form to indicate when you are completing the document.
- Identify and enter the number of people in your household in the designated field.
- Review the EFAP maximum income guidelines provided in the form to ensure your household qualifies. Fill in your household income based on the relevant income limit, either monthly or annual.
- In the authorization section, clearly state the name of the person you authorize to pick up your EFAP commodities. Make sure this information is accurate.
- Complete the certification section by affirming your household income and size. This statement confirms that the information provided is truthful and that the commodities are for personal use only.
- Sign the form to validate your application. This signature is essential for processing your request.
- Fill in your address and zip code accurately to ensure proper delivery of services.
- After completing all sections, review the form for any errors, then save your changes, download, print, or share the form as needed.
Complete your CA EFA 15 form online today to access food assistance easily.
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