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CCAP Redetermination Forms

For your convenience, you may print out the necessary redetermination forms by clicking on the links below. We also recommend using the Redetermination Frequently Asked Questions document.

LCHS 4251 6-month re-determination [pdf]
SS-7 Redetermination of Eligibility form
LCHS 4250 Individual Assessment
LCHS 4225 Unrelated Individual Questionnaire
LCHS 4274 School Out Days
LCHS 4214 IRC (Individual Responsibility Contract)

Spanish Versions

LCHS 4251 re-determinación de 6 meses
LCHS 4250 Evaluación Individual
LCHS 4225 Cuestionario Del Individuo No Relacionado
LCHS 4274 Dias Afuera De La Escuela
LCHS 4214 Contrato De Responsabilidad Individual

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Department Links

CCAP Redetermination Forms

Spanish Versions