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//]]> </script> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">      <html class="no-js" lang="en">     <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.0.0-beta3/css/all.min.css">     <link rel="stylesheet" href="/Portals/_default/Skins/CaGov-SantaBarbara - Partner//css/custom.css">    <script src="/Portals/_default/Skins/CaGov-SantaBarbara - Partner//js/libs/modernizr-2.0.6.min.js"></script> <script src="/Portals/_default/Skins/CaGov-SantaBarbara - Partner//js/spinner.js"></script>     <div class="two-column colTwo"> <header role="banner" id="header" class="global-header">   <div class="branding"> <div class="skip-to-content"> <a style="background-color: white; color: #1D5A6A; text-shadow: none" href="/accessibility">Accessibility help</a> | <a style="background-color: white; color: #1D5A6A; text-shadow: none" href="#main-content">Skip to Content</a> </div> <div class="header-cagov-logo"><a href="http://www.ca.gov/"><img src="/portals/_default/skins/cagov-santabarbara - partner/images/template2014/header-ca.gov.png" alt="CA.gov" /></a></div> <div class="header-organization-banner"> <a id="dnn_dnnLOGOd_hypLogo" title="Information & Resources" href="http://cdss.ca.gov/inforesources/"><img id="dnn_dnnLOGOd_imgLogo" src="/Portals/9/cdss-logo.png?ver=2016-10-04-165132-000" alt="Information & Resources" /></a> <span class="header-text hidden-xs hidden-sm">Department of Social Services</span> <span class="header-text hidden-lg hidden-md">Social Services</span> </div> </div>      <div class="mobile-controls"> <span class="mobile-control cagov-logo"><span class="ca-gov-icon-logo" aria-hidden="false"></span></span> <span class="mobile-control toggle-menu"><span class="ca-gov-icon-menu" aria-hidden="true"></span><span class="sr-only">Menu</span></span> <span class="mobile-control-group mobile-header-icons"> <span class="mobile-control contact-link"><span class="ca-gov-icon-chat" aria-hidden="true"></span><span class="sr-only">Contact</span></span>  </span> <span class="mobile-control toggle-search"><span class="ca-gov-icon-search" aria-hidden="true"></span><span class="sr-only">Search</span></span> <span class="mobile-control-group mobile-menu-icons">  </span> </div> <div class="navigation-search"> <div id="head-search" class="ca-search-container SearchPane"> <span id="dnn_dnnSEARCH_ClassicSearch"> <span class="searchInputContainer" data-moreresults="See More Results" data-noresult="No Results Found"> <input name="dnn$dnnSEARCH$txtSearch" type="text" maxlength="255" size="20" id="dnn_dnnSEARCH_txtSearch" class="NormalTextBox" title="Enter Text to Search for" autocomplete="off" placeholder="Search..." /> <a class="dnnSearchBoxClearText" title="Clear search text"></a> </span> <a id="dnn_dnnSEARCH_cmdSearch" class="SearchInput" href="javascript:__doPostBack('dnn$dnnSEARCH$cmdSearch','')"> </a> </span> <script type="text/javascript"> $(function() { if (typeof dnn != "undefined" && typeof dnn.searchSkinObject != "undefined") { var searchSkinObject = new dnn.searchSkinObject({ delayTriggerAutoSearch : 400, minCharRequiredTriggerAutoSearch : 2, searchType: 'S', enableWildSearch: true, cultureCode: 'en-US', portalId: -1 } ); 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Personal information may include: name, social security number, physical description, home address, home telephone number, education or financial, medical or employment history, etc. 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</li> </ul> <p>CDSS collects personal information directly from individuals who volunteer to obtain some of our services. Collection of this information is required to deliver the specific services, but use of these services is voluntary. Failure to provide requested information may result in a denial of services.<br> <br> The information collected will not be shared with any other government agencies, unless required or allowed by law to administer programs.<br> <br> Please do not provide personal information that is not requested. Any fields in the application or form with unrestricted text are intended for the requested information only.<br> <br> 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 more information, review the online <a href="/Privacy-Policy">CDSS Privacy Policy Statement</a>.<br> <br> For personal information access requests, send an email to CDSS’ Public Inquiry and Response Unit <a href="mailto:piar@dss.ca.gov">piar@dss.ca.gov</a> and/or call (916) 651-8848. They will direct you to your program representative.<br> <br> 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>”<br> <br> <img alt="Caution Security Awareness Icon" src="http://www.cdss.ca.gov/cdssweb/res/images/CautionIsYourComputerSecure.gif" unselectable="on"><br> <a href="https://oag.ca.gov/privacy/online-privacy">Security Awareness</a> </p></div> </div></div> </div></div> </div> <div id="dnn_RightPane" class="main-secondary"><div class="DnnModule DnnModule-DNN_HTML DnnModule-3609 DnnVersionableControl"><a name="3609"></a><div id="dnn_ctr3609_ContentPane" class="NoTitlePaddingContentPane"><div id="dnn_ctr3609_ModuleContent" class="DNNModuleContent ModDNNHTMLC"> <div id="dnn_ctr3609_HtmlModule_lblContent"><h3>Privacy Policy</h3> 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 information, review the online <a href="/inforesources/Forms-Brochures/Privacy-Policy">CDSS Privacy Policy Statement</a>.</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 California Department of Social Services</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`:`/inforesources/`,`sf_tabId`:`627`,`evoq_TabId`:`627`,`evoq_PageLanguage`:`en-US`,`evoq_ContentItemId`:`-1`,`evoq_UrlReferrer`:``,`evoq_UrlPath`:`http%3a%2f%2fcdss.ca.gov%2finforesources%2fforms-brochures`,`evoq_UrlQuery`:`%3fTabId%3d627%26language%3den-US`,`evoq_ContentItemReferrer`:`-1`,`evoq_PersonalizedUrlReferrer`:`-1`,`evoq_DisableAnalytics`:`False`}" /> <input name="__RequestVerificationToken" type="hidden" value="pq9pL8NFCCTH3SqJTA79v-ItUM0gNiiXYs0cseJrSML0oUrqE6F3KsUAvABN7IdYReG4KA2" /> </form>  </body> </html>