Apply for Benefits

Ways to Apply


 

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IN-PERSON

Monday - Friday 8:00am-5:00pm except for county holidays

Benefits Assistance Center – 1867 Senter Road, San Jose CA 95112
General Assistance Services – 1919 Senter Road, San Jose, CA 95112
North County Office – 1330 W. Middlefield Road, Mountain View, CA 94043
South County Office – 379 Tomkins Court, Gilroy, CA 95020

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Fax*

1-408-295-9248

* Call 408-758-3800 to get an application mailed or pick it up in one of our lobbies

DFCS Envelope icon on circle

Mail*

PO Box 11018, San Jose, CA 95103

* Call 408-758-3800 to get an application mailed or pick it up in one of our lobbies

Need More Help


If you have a disability (physical, mental/emotional, or learning), you have the right to tell us how we can accommodate you.

Do any of these apply to you?

  • Have a visual, hearing, or speaking impairment
  • Need a language interpreter
  • Have difficulty walking, sitting, or standing for a long time
  • Need help filling out or understanding forms or complicated instruction


If you need help, inform a staff member.

You have the right to equal access to programs and services. If denied an accommodation, you may file a civil rights complaint or disability grievance with this office’s disability rights coordinator.

Tere Cohn-Hayes - Equal Opportunity Supervisor/Civil Rights Coordinator (408) 755–7299 | [email protected]

 

 

Some information provided on your application may require additional documents be submitted. A County Eligibility Worker will let you know if any information needs additional documentation.

Documents can be submitted:

  • Online - Submit Documents Online
  • Fax - 408-295-9248
  • Mail - PO Box 11018, San Jose, CA 95103
  • Drop Box at Office Locations:

    Benefits Assistance Center – 1867 Senter Road, San Jose CA 95112
    Continuing Benefit Services - 1870 & 1877 Senter Road, San Jose CA 95112
    CalWORKs Employment Services - 1879 Senter Road, San Jose CA 95112
    General Assistance Services – 1919 Senter Road, San Jose, CA 95112
    North County Office – 1330 W. Middlefield Road, Mountain View, CA 94043
    South County Office – 379 Tomkins Court, Gilroy, CA 95020

Please include your name and case number on all submitted documents.

The following is a list of documents that could be needed to process your application.

Information

Commonly Used Verification Documents


Birth/Citizenship

  • Birth Certificate
  • US Passport
  • Certificate of Naturalization

Identity

  • Department of Motor Vehicles ID or Driver's License
  • Work or School ID
  • Passport
  • USCIS (Immigration) Documents

Residency

  • Department of Motor Vehicles ID or Driver's License
  • Postmarked envelope or postcard addressed to you
  • Utility Bill
  • Rental Agreement
  • Bill or other document with your name and address

Relationship

  • Marriage or Domestic Partner Certificate
  • Birth Certificate
  • Court Papers (divorce, guardianship, etc.)

Social Security Number (SSN)

  • Social Security Card
  • Proof of application for SSN

Immigration Status

  • Permanent Resident Card/Green Card (I-551)
  • Employment Authorization Card (I-766)
  • Foreign Passport with Form I-94/I-94A
  • Notice of Action (I-797)

Earned Income

  • Check Stubs
  • Letter from employer with gross pay, hours worked, etc.
  • Self-Employment Tax Forms (IRS Schedule C, etc.)

Other Income
(Examples; SSA, Unemployment, Disability, Retirement)

  • Benefits Award Letter
  • Current Benefit Check
  • School Grants/Loans/Financial Aid Statements

Property

  • Bank Statements
  • Vehicle Registration
  • Mortgage Bills
  • Property Deeds
  • Life Insurance Policy, Stocks, Bonds, IRAs
  • Most Recent Retirement Account Statements

Housing & Utility Costs

  • Rental Agreement or Rent Receipt
  • Mortgage Bill
  • Utility Bill
  • Property Tax Statement
  • Home or Renter's Insurance Bills
  • Hotel/Motel Receipt

Medical Costs

  • Medical Bills or Receipts
  • Medical Transportation Bills or Receipts
  • Health or Dental Insurance Policies or Premiums

Medical Verification

  • Proof of Pregnancy from Doctor/Clinic with Expected Due Date
  • Doctor Statement

Immunization Records
(for children under 6)

  • Stamped Immunization Card
  • Statement from parent or caretaker relative explaining why the child cannot be vaccinated
  • Statement from doctor that immunizations are not available

Paper verifications will not be requested if the county already has current information or the information can be electronically verified. The County can help you get documents if necessary.

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