​​Forms: DHCS 0-11

• DHCS 0001 (05/09) - U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity
  
alt: Arabic, Armenian, Chinese, Farsi, Hmong, Cambodian, Korean, Laotian, Russian, Spanish, Tagalog, Vietnamese
• DHCS 0002 (01/08) - Proof of Citizenship and Identity--New Requirements for Medi-Cal Beneficiaries who are U.S. Citizens or Nationals
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• ​ DHCS 0003 (06/07) - Affidavit of Reasonable Effort to Get Proof of Citizenship
  
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• ​ DHCS 0004 (06/07) - Request for California Birth Record
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0005 (02/08) - Receipt of Citizenship and Identity Documents
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0006 (08/07) - Proof of Citizenship and Identity
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0007 (12/07) - Acceptable Citizenship and Identity Documents
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0008 (01/08) - Proof of Citizenship and Identity Requirements - For Children who are U.S. Citizens or Nationals filling out the Heidhy Families/Medi-Cal Joint Application
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0009 (09/07) - Affidavit of Identity for U.S. Citizen or National Children Under 18
  
alt: Arabic , Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese
• DHCS 0010 (01/08) - Affidavit of Identity for U.S. Citizens or National for Disabled Individuals Living in Institutional Care Facilities
• DHCS 0011 (06/08) - Proof of Acceptable Citizenship or Identity Documents
alt: Arabic, Armenian , Chinese , Farsi , Hmong , Cambodian , Korean , Laotian , Russian , Spanish , Tagalog , Vietnamese