Parent Notification to Report Income Over SMI

This notification form can be used by CDSS contractors to inform the family of the requirement to report within 30 days if their income exceeds the income exit threshold.

This form reflects the 2026 - 2027 income thresholds.

Download 85% of SMI Parent Notification

CCTR | CMIG | CAPP | CalWORKS | CFCC

 

Note: You will be directed to Dropbox to complete download

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