Form Cf 37 - Recertification For Calfresh Benefits Page 4
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11STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Penalties
Program Violations
I may:
For CalFresh: I understand I may have
committed an intentional program violation
● Trade CalFresh benefits or attempt to trade
if I do any of the following:
● Lose CalFresh benefits for 24 months for the
● Lose CalFresh benefits permanently for the
CalFresh benefits for: cash, firearms, non-
first offense
eligible goods or controlled substances such
as drugs
second offense
● Give false information about who I am and
● L ose CalFresh benefits for 10 years for each
where I live so I can get extra CalFresh
offense
benefits
● Have been convicted of trading, selling or
● Lose CalFresh benefits permanently
attempting to trade CalFresh benefits worth
more than $500, or trading or attempting to
trade CalFresh benefits for firearms,
ammunition or explosives
Important Information for Noncitizens: You can apply for and get CalFresh benefits for people who
are eligible, even if your family includes others who are not eligible. Getting food benefits will not
affect you or your family’s immigration status. Immigration information is private and confidential. The
immigration status of noncitizens that are eligible and apply for benefits will be checked with the U.S.
Citizenship and Immigration Services (USCIS). Federal law says the USCIS cannot use the
information for anything else except cases of fraud.
Opting Out: You do not have to give immigration information, social security numbers, or documents
for any noncitizen family member(s) who are not applying for CalFresh benefits. However, the
County will need to know their income and resource information to correctly determine your
household’s CalFresh benefits.
The County will not contact USCIS about the people who do not
apply for CalFresh benefits.
Privacy Act and Disclosure: You are giving personal information in the application. The County
uses the information to see if you are eligible for benefits. If you do not give the requested
information, the County may deny your application. You have the right to review, change, or correct
any information that you gave to the County. The County will not show your information or give it to
others unless you give them permission or federal and state law allows them to do so. 273.2(b)(4)
Privacy Act statement. As a County agency, we must notify all households applying and being
recertified for CalFresh benefits of the following:
(i) The collection of this information, including the social security number (SSN) of each household
member, is authorized under the Food Stamp Act of 1977, as amended, 7 U.S.C. 2011-2036. The
information will be used to determine whether your household is eligible or continues to be eligible
to participate in the CalFresh Program. We will verify this information through computer matching
programs, including the Income and Earnings Verification System (IEVS). This information will
also be used to monitor compliance with program regulations and for program management.
CalFresh Program Rules Page 4 – Please take and keep for your records.
CF 37 (11/16) REQUIRED FORM - NO SUBSTITUTES PERMITTED
PROGRAM RULES PAGE 4 OF 7
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