Someone Moved In

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Step 1 of 6

16%

I have an open CalFresh (food stamps) or MediCal case:*

I have a current open case in Contra Costa County

I have a open case outside Contra Costa County

I need to open a case with Contra Costa County

Let us help you apply:

Online - BenefitsCal
Telephone - (866) 663-3225
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

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.

Confirmation Number

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Date for Confirm #

Hidden field used to configure date mergetag output to confirmation number

MM slash DD slash YYYY

Name*

First Last

County Case Number

Your 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.

0 of 7 max characters

Your Date of Birth (DOB)*

MM slash DD slash YYYY

Do You Have a Social Security Number (SSN)?*

Yes

No

Last 4 digits of SSN

0 of 4 max characters

Phone*

Do you have an email address?*

Yes

No

Email

Enter Email Confirm Email

What is/are the name(s) of the person(s) who has/have moved in?*

How is/are the person(s) related to you?*

What was the starting date for this change?*

MM slash DD slash YYYY

Would you like to try add the person(s) to your case?*

Yes

No

!

We will attempt to evaluate your new household member(s), however, before making changes to your case, you will be contacted by a Contra Costa County Eligibility Worker who will request further information

I would like to upload an image to verify my change*

Yes

No

Upload your image(s) below:

There is a 2MB file size limit

Drop files here or Select files

Accepted file types: jpg, jpeg, gif, png, pdf, tif, tiff, doc, docx, xls, xlsx, Max. file size: 2 MB, Max. files: 3.

Do you need to report an additional change?*

Yes

No

Email

This field is for validation purposes and should be left unchanged.