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Information Line Survey
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Name of County:
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Name of Agency or Department:
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Your Name:
County Food Stamp Website (if applicable):
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Phone Number
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Your Email Address
To be emailed a copy of completed form, enter email again here:
Pre-application forms are now being accepted for the Fiscal Year that Begins October 2007. If your non-profit organization would like to be considered, please identify the status of your proposal:
County Direct Connect
Call Center Direct Connect
Modified County Direct Connect
No Direct Connect
Outreach Partner Direct Connect: Name of Partner Organization
What Number Should We Transfer Calls To (put call center if selecting that option)
English Calls
Spanish Calls
During Business Hours
After Business Hours
If you have any specific instructions to assist in directing calls from your county, please let us know here:
Please, describe the application process in your county. You may cut and paste from an existing document or upload an existing document using the tool below. If the process is different for people who have Medi-Cal or other benefits is different, please explain how. You may also include instructions for Expidited FS here too.
To upload a document that describes the application process in your county press browse, select the document then press upload.
Now we'd like to ask a couple of questions about your county's application process. Does your county have any of the following application or outreach concessions in place?
Face-to-Face Hardship Waiver Form
Mail-in Application Proceedure
Outstation of the Application Process
Home-visits by eligibility workers for hardship
We'd like to hear from counties about their outreach efforts. How would you describe your current efforts? Mark all that apply.
The County Oustations Workers and Determines Eligibility On The Spot
The County Oustations Workers and Takes Applications
The County is Working on an Electronic Application
The County Works with Community Based Organizations to Generate Applications
The County Distributes Materials
The County Hosts or Participates in an Outreach Committee
The County is Interested in Outreach, but Has Not Yet Started
The County Cannot Do Outreach At this Time
Other
We would like to know the community based organizations you partner with. Please list them here:
If you have any questions, comments, complaints, ideas or sugguestions, we would appreciate it if you would let us know.
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Indicates Response Required