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Personal information may include: name, social security number, physical description, home address, home telephone number, and educational, financial, medical, or employment information. Any personal information collected is governed by the requirements of the following authorities and all other laws pertaining to personal information: </p> <ul> <li>Government Code Section 11015.5</li> <li>Health and Safety Code Section 1500 et seq.</li> <li>Information Practices Act - Civil Code Section 1798 et seq.</li> <li>Public Records Act - Government Code Section 6250 et seq.</li> <li>Safeguarding Information for the Financial Assistance Programs - 45 CFR Section 205.50</li> <li>Statewide Administrative Manual (SAM) Section Privacy 5310 et seq.</li> <li>Statewide Information Management Manual (SIMM) 5310 - A & B.</li> <li>Welfare and Institutions Code Section 10850 et seq.</li> </ul> <p> CDSS collects personal information directly from individuals who opt to obtain some of our services. Collection of this information is required to deliver the specific services, however, use of these services is voluntary. Failure to provide required information for the service may result in a denial of services. </p> <p> The information collected will not be shared with any other government agency, unless required or allowed by law. In addition, CDSS will not commercially distribute or sell any personal information about individuals to any third-party entity without the individual’s written consent. </p> <p> Please do not provide personal information that is not requested. Any fields in the application or form are intended for the requested information only. </p> <p> Individuals who provide personal information to CDSS have the right to review the information for accuracy and completeness and to request corrections or deletions. For personal information access requests send an email to CDSS’ Public Inquiry and Response Unit at <a href="mailto:piar@dss.ca.gov">piar@dss.ca.gov</a> and/or call (916) 651-8848. PIAR will direct you to the program representative who can help with your request. </p> <p> For more consumer information on security, please see the California Department of Justice’s, “<a href="https://oag.ca.gov/privacy/online-privacy">Security Awareness</a>” website. </p> <p> <a href="https://oag.ca.gov/privacy/online-privacy"> <img src="/Portals/9/Images/Security1.gif" alt="Illustraion logo of a laptop with the word security above it."><br> Security Awareness</a> </p></div> </div></div> </div></div> </div> </div> </div>  <footer id="footer" class="global-footer"> <div style="padding-bottom: 10px; color: white;"> <a href="#head-search">Back to Top</a>&emsp; <a href="/Accessibility">Accessibility</a>&emsp; <a href="/accessibility-certification">Accessibility Certification</a>&emsp; <a href="/Conditions-of-Use">Conditions of Use</a>&emsp; <a href="/Contact-Us">Contact Us</a>&emsp; <a href="/Tips-for-Using-Adobe-PDF-Files">Get Free Reader</a>&emsp; <a href="/Notice-on-Collection">Notice on Collection</a>&emsp; <a href="/Privacy-Policy">Privacy Policy</a>&emsp; </div>   <div class="copyright"> <span id="dnn_dnnCOPYRIGHT_lblCopyright" class="Copyright">Copyright © 2024 State of California</span> </div>  </footer>  <div class="decoration-last"> </div> </div><script src="/Portals/_default/Skins/CaGov-SantaBarbara - Partner//js/cagov.core.js"></script> <script src="/Portals/_default/Skins/CaGov-SantaBarbara - Partner//js/common.js "></script> <script> (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', 'UA-77698819-4', 'auto'); ga('send', 'pageview'); </script> <script type="text/javascript"> function googleTranslateElementInit() { new google.translate.TranslateElement({pageLanguage: 'en', gaTrack: true, gaId: 'UA-77698819-4'}, 'google_translate_element'); } </script><script type="text/javascript" src="//translate.google.com/translate_a/element.js?cb=googleTranslateElementInit"></script> <input name="ScrollTop" type="hidden" id="ScrollTop" /> <input name="__dnnVariable" type="hidden" id="__dnnVariable" autocomplete="off" value="`{`trackLinks`:`false`,`__scdoff`:`1`,`sf_siteRoot`:`/`,`sf_tabId`:`1518`,`evoq_TabId`:`1518`,`evoq_PageLanguage`:`en-US`,`evoq_ContentItemId`:`-1`,`evoq_UrlReferrer`:``,`evoq_UrlPath`:`http%3a%2f%2fwww.cdss.ca.gov%2fnotice-on-collection`,`evoq_UrlQuery`:`%3fTabId%3d1518%26language%3den-US`,`evoq_ContentItemReferrer`:`-1`,`evoq_PersonalizedUrlReferrer`:`-1`,`evoq_DisableAnalytics`:`False`}" /> <input name="__RequestVerificationToken" type="hidden" value="WB3ZNjJ_J0OOtnFZ9QppC3lG5PEmDC8imWHdZOHvazpFW94Ywh-N3kgXDlqqdocT2GPppA2" /> </form>  </body> </html>