Form Wtw 40 - Assembly Bill (Ab) 74 County Welfare Department Family Stabilization (Fs) Plan

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STATE OF CALIFORNIA - HEALTH AND HUMAN RESOURCES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
ASSEMBLY BILL (AB) 74
COUNTY WELFARE DEPARTMENT FAMILY STABILIZATION (FS) PLAN
COUNTY WELFARE DEPARTMENT (CWD):
DATE:
CWD CONTACT INFORMATION
NAME/POSITION:
ADDRESS:
PHONE NUMBER:
EMAIL ADDRESS:
Please describe how your CWD plans to utilize funds allocated for the FS Program and include responses to the following
nine categories. There is an additional text box to enter other information about your FS program if needed. The text boxes
will accept up to 1,000 characters of text. If more space is needed you may also submit attachments to accommodate the
additional information. You may also attach any materials that address each of the areas below if the materials can be
converted to a pdf format for posting to the CDSS website (i.e. not scanned copies).
Please indicate the date your CWD will begin offering an FS program:
What types of services will be provided under the FS program?
■ ■
Homelessness
■ ■
Mental Health
■ ■
Substance Abuse
■ ■
Domestic Violence
■ ■
Other, please list________________________________________________________________________________
How will clients be informed of the FS program?
How will clients be able to request participation in the FS program?
How will the county determine which clients will be selected for the FS program?
WTW 40 (2/14)
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