County General Assistance — intake packet

Short-term cash assistance for adults 18+ without dependent children

Audience · Adults 18+ in acute economic crisis, no dependent childrenTime · ~12 min

Find on the resource map (3 places) →

1Fill it out
2Review
3Sign
4Download

Applicant information

Full legal name

Date of birth

Phone (mobile preferred)

Current address (or note if unhoused)

If you're escaping abuse or unsafe at your current address, ask the partner where you'll submit this form whether you can use a safe-address (FJC, library, or partner agency). We won't track which address you used.

How we handle addresses →

If unhoused, describe where you sleep most nights.

Last employer (if any)

Skip this if you've never worked or can't remember.

Have you worked in the last 12 months?

Pick the closest answer — the worker can fill in details at the interview.

Last day worked (if you remember)

Leave blank if you don't remember or it's been more than a year — the worker can help fill this in.

Household

Total household size

Any minor children in your household?

Households with minor children should apply for CalWORKs instead — county GA is for adults without dependent children.

Number of adult dependents you support

Adults you care for who depend on you — e.g., a disabled adult relative, an aging parent. Leave blank or enter 0 if none.

Other monthly income (SSDI, SSI, VA, UI, child support, etc.)

Have you received county GA before?

GA is a loan, so prior balances may roll forward. It's OK if you're not sure — the worker can look it up.

If yes, roughly when? (year or month/year is fine)

Only fill this if you answered yes above. A rough year is fine — e.g., "2022" or "early 2024".

Documents you'll need (have these ready)

You don't have to upload anything here — this checklist just prepares you for what the county HHS agency will ask for at the interview.

Which of these do you already have?

SSN card or proof of SSN application · Photo ID OR birth verification · Proof of residence · Pay stubs / income documents · Bank statements · SSA / VA / UI / DI award letters · Savings bonds / stock / retirement statements (if any).

Why you need help right now

This is the most important section. Tell the worker who reads this what just happened and what you need to stay safe.

Your situation, in your own words

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