0 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY. Child Hotline Information: If you suspect there is an emergency requiring immediate intervention, call 911; To report suspected child abuse or neglect call the 24 hour Child Abuse Hotline at (805) 781-KIDS (5437) or toll free 1-800-834-KIDS (5437) Welcome to Social Services The Fresno County Department of Social Services (DSS) serves some of the most ethnically and culturally diverse communities in the State of California. The following forms are to assist you in filing your report of suspected dependent adult or elder abuse. This form, as adopted by the California Department of Social Services (CDSS), is required under Welfare and Institutions Code (WIC) Sections 15630 and 15658(a)(1). All other persons should complete form SOC 341. Do not submit report to California Department of Social Services Adult Programs Bureau. Information provided is subject to verification. PLEASE PRINT OR TYPE. A licensed nursing home, rehabilitation center, intermediate care facility, or adult day health care program Contact the local Long-Term Care Ombudsman Program, the Long-Term Care Ombudsman CRISISline at 1-800-231-4024 or the local police or sheriff’s department. All other persons should complete form SOC 341. soc 341 elder abuse CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. This form documents the information given by the reporting party on the suspected incident of abuse of an elder or o•„">û'§æÓ íçóD:F–"vöB$g9P‘êõ’ö3. Hit the arrow with the inscription Next to move on from one field to another. Report of Suspected Dependent Adult/Elder Abuse, SOC 341 (PDF) / Spanish (PDF) Report of Suspected Dependent Adult/Elder Financial Abuse, SOC 342 (PDF) Additional Resources: Adult Protective Services – Information from the California Department of Social Services Name of Applicant: Social Security Number: State of California – Health and Human Services Agency California Department of Social Services APPLICATION FOR IN-HOME SUPPORTIVE SERVICES SOC 295 (9/18) Page 1 of 8 To the Applicant: All sections of this form must be completed. soc 341 12/06. Report of Suspected Dependent Adult/Elder Abuse, SOC 341 (pdf) :už Øu¯\)7\ròë²=QDvÈk¸*BæWÏ)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(CՆ°ÏsCûä-µÕ¸ÕM )/V 4>> endobj 248 0 obj /Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/Type/Catalog/ViewerPreferences<>>> endobj 249 0 obj <> endobj 250 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Tabs/W/TrimBox[0 0 612 792]/Type/Page/u2pMat[1 0 0 -1 0 792]/xb1 0/xb2 612/xt1 0/xt2 612/yb1 0/yb2 792/yt1 0/yt2 792>> endobj 251 0 obj <>/Subtype/Form/Type/XObject>>stream Use the e-signature solution to add an electronic signature to the form. Use this step-by-step guideline to fill out the Get And Sign Soc 341 Form 2015-2019 quickly and with perfect accuracy. AGENCY NAME ADDRESS OR FAX # DATE MAILED: DATE FAXED: L. RECEIVING AGENCY USE ONLY Telephone Report Written Report 1. State of California – Health and Human Services Agency California Department of Social Services SOC 341 (11/18) Page 5 of 9 REPORT OF SUSPECTED DEPENDENT ADULT/ELDER ABUSE GENERAL INSTRUCTIONS PURPOSE OF FORM This form, as adopted by the California Department of Social Services (CDSS), is required under. Government; Resources; Adult/Elder Abuse; Suspected Dependent Adult/Elder Abuse SOC 341 Form State of California – Health and Human Services Agency California Department of Social Services SOC 341 (11/18) Page 3 of 9 D. REPORTING PARTY Check appropriate box if reporting party waives confidentiality to All All but victim All but perpetrator Name Signature Occupation Agency/Name of Business Relation to Victim/How Abuse is Known **Help Desk response times may be longer than usual during the holidays. This form, as adopted by the California Department of Social Services, is required under Welfare and Institutions Code (WIC) Sections 15630 and 15658(a)(1). PURPOSE OF FORM This form, as adopted by the California Department of Social Services (CDSS), is required under Welfare and Institutions Code ( WIC) Sections 15630 and 15658(a)(1). Soc341. Government; Resources; Adult/Elder Abuse; Suspected Dependent Adult/Elder Abuse SOC 341 Form endstream endobj 252 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Form Soc2298 Is Often Used In California Department Of Social Services, California … SignNow's web-based service is specifically created to simplify the management of workflow and optimize the whole process of proficient document management. soc 341 (12/06) appendix a. form soc 341 state of california -health and human services agency california department of social services confidential report - not subject to public disclosure report of suspected dependent adult/elder abuse date completed: to … S T A T E O C A L I O R N I A Please be patient. CALIFORNIA DEPARTMENT OF SOCIAL.If you are employed by a financial institution, please complete form SOC 342. Complete Soc 341 Form 2020 online with US Legal Forms. A Request for Grievance Hearing form; f. A copy of these grievance procedures ... STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES SOC 833 (3/08) PAGE 1 OF 2. ii. Report Received by: Date/Time: ... SOC 341 (rev. soc 341 pdf NAME.STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY. All other persons should complete form SOC 341. Box 14102 Orange, CA 92863 FAX: 714-704-6161 %%EOF This form is to be used by officers and employees of financial institutions mandated reporters to report. If you do not complete this section, social service staff will make a determination. CONFIDENTIAL REPORT.SOC 341A 303. clss.cahwnet.oovFormsEnqiish800341.pdf. • A minor may use one of the following forms approved and issued by the California Department of Social Services and executed by an agency administering foster care duties: — — in Foster Family Agency (Form SOC 154A), or — (Form SOC – 156). Contact Social Services. All other persons should complete form SOC 341. How to complete the Get And Sign Soc 341 Form 2015-2019 online: Read more about Due to Coronavirus (COVID-19), children who are eligible for free or reduced-price meals at school will get extra food benefits. This form documents the information given by the reporting party on the suspected incident of abuse or neglect of an elder or dependent adult. State of California – Health and Human Services Agency California Department of Social Services SOC 341 (11/18) Page 5 of 9 REPORT OF SUSPECTED DEPENDENT ADULT/ELDER ABUSE GENERAL INSTRUCTIONS PURPOSE OF FORM This form, as adopted by the California Department of Social Services (CDSS), is required under. Adult Protective Services – Information from the California Department of Social Services. As an employee or volunteer at a licensed facility, you … Adult Protective Services (APS) Adult Protective Services (APS) provides a system of in-person response, 24-hours a day, 7 days a week, APS Social Workers receive and respond to reports of dependent adult and elder abuse of individuals in Riverside County. Easily fill out PDF blank, edit, and sign them. SEE GENERAL … Û. If you are employed by a financial institution, please complete form SOC 342. DA: 72 PA: 72 MOZ Rank: 53 Our representatives will respond as soon as possible. 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