Form 11 44h hhsa 2025

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The document is an affidavit form (Form 11-44H) from the County of San Diego Health and Human Services Agency, intended for individuals experiencing homelessness. It requires applicants to declare their living situation by checking various options such as shelters, vehicles, or friends' houses. The form also asks for details about their living conditions, any payments made for housing, and information about where they obtain meals. The applicant must sign the form under penalty of perjury.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your case name, case number, and worker number at the top of the form.
In the affidavit section, clearly state your name and affirm your living situation by checking all applicable boxes that describe where you have been staying.
If you are staying in a vehicle, trailer, or boat, provide the owner's name in the designated fields.
Indicate whether you pay any money for your living situation and specify the amount if applicable.
Provide a detailed address or description of your current living location, including nearby cross streets or landmarks if necessary.
List where you have been eating and include details about your last five meals if needed.
Finally, sign and date the form to declare that all information provided is true and complete.

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