Email My Worker "*" indicates required fields Step 1 of 5 20% Consent*EHSD uses secure encryption to ensure your privacy and protect your data. You will receive a confirmation e-mail after you submit your information. Data you submit through this form will not be available on ehsd.org or any publicly accessible systems. I agree to the privacy policy. Choose from the options below for your CalFresh or MediCal case only:* I need to open a case with Contra Costa County I have a pending (not yet approved) CalFresh or MediCal application in Contra Costa County I have a current open CalFresh or MediCal case in Contra Costa County I have an open case outside Contra Costa County Let us help you apply: Online – BenefitsCal Telephone – (877) 505-4630 Mail – Mail in an application to EMPLOYMENT AND HUMAN SERVICES CONTRA COSTA COUNTY PO BOX 4114 Concord, Ca 94524-9700 In Person or Drop off – Drop off your competed application to a local district office Fax – (925) 228-0310 Return to Help Page Please contact your current county for assistance with your case. Please visit the California Department of Heath Care Services website for county contact information Return to Help Page Confirmation NumberThis field is hidden when viewing the formDate for Confirm #Hidden field used to configure date mergetag output to confirmation number MM slash DD slash YYYY Name* First Last County Case NumberYour case number is located at the top of any Notice of Action you have received in the mail from Contra Costa County and looks like 1F12345 If you do not know your case # please provide as much info as possible.Your Date of Birth (DOB)* MM slash DD slash YYYY Do You Have a Social Security Number (SSN)?* Yes No Last 4 digits of SSNPhone*Do you have an email address?* Yes No Email Enter Email Confirm Email What is your worker’s name?CategoryCalFresh – Case Status/Letter Received inquiryCalFresh – SAR7 QuestionCalFresh – ReCertificationCalFresh – Benefit ProblemCalFresh – EBT Card ReplacementCalFresh – Stop/Cancel my benefitsMedi-Cal – Case Status/Letter Received inquiryMedi-Cal – ReInvestigationMedi-Cal – Coverage/Benefit ProblemMedi-Cal – Medi-Cal/BIC Card ReplacementMedi-Cal – Stop/Cancel my coverage or benefitsWhat would you like to communicate to your worker? I would like to upload an image to send to my worker* Yes No Upload your image(s) below:There is a 2MB file size limit and maximum of 3 files per submission Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, pdf, tif, tiff, doc, docx, xls, xlsx, Max. file size: 2 MB, Max. files: 3. EmailThis field is for validation purposes and should be left unchanged.
