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CalFresh Household Change Report DFA 3775-2026

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The document is a CalFresh Household Change Report (DFA 377.5) from the California Department of Social Services, outlining instructions for reporting changes in household income, composition, resources, medical expenses, and other relevant factors affecting eligibility for food assistance. It emphasizes the requirement to report changes within 10 days and provides sections for detailing various types of changes, including income fluctuations, household member status, and expenses.

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Click ‘Get Form’ to open the CalFresh Household Change Report DFA 3775 in the editor.
Begin by entering your Case Name and Case Number at the top of the form. This information is crucial for identifying your application.
In Section 1, report any income changes. Indicate if there was a change in unearned or earned income by selecting 'Yes' or 'No'. If applicable, provide details in Section 1(C) including amounts and sources.
Move to Section 2 to report household composition changes. Answer questions regarding new members, departures, or significant life events such as marriage or disability.
In Section 3, detail any resource changes. If you acquired a vehicle or your cash resources exceeded specified limits, complete the relevant fields.
Continue through Sections 4 to 12, providing necessary details about medical expenses, address changes, dependent care costs, and any other relevant updates.
Finally, review all entries for accuracy before signing and dating the certification section at the end of the form.

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Versions	Form popularity	Fillable & printable
2013	4.3 Satisfied (42 Votes)
2006	4.9 Satisfied (60 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much can you make before you lose your food stamps?

SNAP Income Limits Household SizeGross monthly income (130% of poverty)Net monthly income (100% of poverty) 1 $1,580 $1,215 2 $2,137 $1,644 3 $2,694 $2,0722 more rows May 22, 2025

How does CalFresh define a household?

1:31 3:27 In person you can also report changes in person at your local social services office simplifiedMoreIn person you can also report changes in person at your local social services office simplified reporting rules.

How does CalFresh verify household?

Acceptable collateral contacts include employers, landlords, social service agencies, migrant service agencies, and neighbors of the household. The CalFresh office can contact these types of individuals to confirm admissions by the household.

How do I report changes to food stamps online in California?

An email address is required. Create a BenefitsCal account and log in. BenefitsCal is Californias official website for food benefits. Link your CalFresh case. Once youre logged in to BenefitsCal, scroll down to the Things to do section. Submit your SAR 7/Periodic Report.

How do I talk to someone at CA EBT customer service?

If you have questions, please contact the EBT Customer Service Helpline (877) 328-9677. If your EBT card is lost or stolen, or if you need to change your PIN, call (877) 328-9677.

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How to report changes to Medi Cal online California?

For Medi-Cal, you must report it within 10 days. To report changes, call Covered California at (800) 300-1506 or sign in to your online account. You can also find a Licensed Insurance Agent, Certified Enrollment Counselor or county eligibility worker who can provide free assistance in your area.

CalFresh Household Change Report DFA 3775-2026

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