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CA HHSA 11-44H - San Diego County 2006-2025 free printable template

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90-100 APPENDIX A. FORM 11-44H HHS CASE NAME County of San Diego Health and Human Services Agency CASE # WORKER # AFFIDAVIT OF HOMELESS LIVING SITUATION (To be completed by applicant) I, swear and
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How to fill out CA HHSA 11-44H - San Diego County

01
Obtain the CA HHSA 11-44H form from the San Diego County Health and Human Services Agency website or your local office.
02
Read the instructions provided with the form carefully.
03
Fill in your personal information such as your name, address, and contact details in the designated fields.
04
Provide details regarding your family members, including their names and relationship to you.
05
Enter information about your household income, including any wages, benefits, or other sources of income.
06
Fill out information regarding your expenses, including housing, utilities, and childcare, if applicable.
07
Review all entries for accuracy and completeness before submitting the form.
08
Submit the completed form to the designated department at the Health and Human Services Agency, either in person or via mail.

Who needs CA HHSA 11-44H - San Diego County?

01
Individuals and families in San Diego County seeking assistance with public benefits applications.
02
Those who are applying for financial aid or social services through the Health and Human Services Agency.
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CA HHSA 11-44H is a form used by the San Diego County Health and Human Services Agency to collect information related to certain health and human services provided to individuals and families.
Individuals and families receiving services from San Diego County Health and Human Services may be required to file CA HHSA 11-44H to report their information as part of the service provision process.
To fill out the CA HHSA 11-44H form, carefully read the instructions provided, ensure all relevant personal and service information is accurate, and submit the form as directed by the agency.
The purpose of CA HHSA 11-44H is to enable the San Diego County Health and Human Services Agency to efficiently gather data necessary for the administration of health and social services.
The CA HHSA 11-44H form requires the reporting of personal information, service details, and any relevant circumstances that may affect the services provided to the individual or family.
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