Get 04-167 Date 06-16-2004 To: From: County Welfare Director Supply Clerk / Forms Coordinator Forms

This guide provides a clear and supportive approach to filling out the 04-167 form from the California Department of Social Services. It offers step-by-step instructions to ensure that users can effortlessly complete the necessary fields for their welfare case management.

Follow the steps to complete the form accurately and efficiently.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the current date at the top of the form in the designated 'DATE' field.
3. Fill in the 'TO:' field with the title 'County Welfare Director.' Ensure this is correctly labeled.
4. In the 'FROM:' section, write 'Supply Clerk / Forms Coordinator' as specified.
5. Locate the 'County' and 'Case Name' fields. Input the relevant information associated with your welfare case.
6. Proceed to complete the 'Other ID No.' and 'Case No.' fields, ensuring accurate identification of the case.
7. In the 'Worker Name' field, write the name of your assigned county worker for reference.
8. Follow the prompts regarding the exemption determinations, clearly indicating if the exemption is approved or denied. Provide detailed reasoning in the space provided, as this is critical for records.
9. Review your entries for accuracy before submitting. This is a vital step to ensure your information is correctly documented.
10. Once all necessary fields are filled out, save your changes. You can then download, print, or share the form as needed.

Complete your forms online to ensure timely and efficient processing of your welfare assistance.