Form Gen 1031 - Annual County Training Plan Page 10
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10STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
ANNUAL COUNTY TRAINING PLAN CERTIFICATION
In accordance with the California Department of Social Services Manual of
Policies and Procedures, Division 14, Staff Development Training Section.
I certify that the Annual County Training Plan is completed and a copy for
review or audit is available in our County Office as required by regulations.
County:
Date
Staff Development Officer Name and Signature
Date
County Welfare Department Director Name and Signature
Please submit no later than August 1, 2017 to:
California Department of Social Services
Fiscal Systems Bureau
744 P Street, MS 9-5-03
Sacramento, CA 95814
Attn: Racquel Flanagan
NOTE: Please send only this certification form - do not send your annual training plan.
Please complete the following section. CDSS is continuously updating our contact listing for Staff Development Officers.
Please complete fully even if no staff changes have been made in the past year.
Your Name:
____________________________________________________________________
Your Title:
____________________________________________________________________
Phone Number:
____________________________________________________________________
E-mail Address:
____________________________________________________________________
Mailing Address:
____________________________________________________________________
____________________________________________________________________
Fax Number:
____________________________________________________________________
Thank you for your cooperation.
GEN 1031 (4/17) CERTIFICATION
PAGE 10 OF 10
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