CalFresh Referral Form

Please fill out the form below to refer someone to the CalFresh Food Program

Referrer Information

I would like to refer the following person to be contacted about CalFresh

Is there at least one member in applicant's household that is a U.S. Citizen, Legal Permanent Resident, Refugee or Asylee?*
Are there any members of your householdwho receive SSI (Supplemental Security Income)? Now SSI recipients may qualify for CalFresh Food?*
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Best time for applicant to be reached