CalWORKs while pregnant: apply checklist
A printable from CalWORKs While Pregnant. Fill it in by hand. Nothing you write is collected by this website.
CalWORKs while pregnant: apply checklist
- Applied at BenefitsCal or my county on: ________
- Marked that I am pregnant and signed the sworn statement
- Asked for the $100 pregnancy special needs payment
- Interview date: ________ time: ______
- Medical proof of pregnancy (name + due date) due by: ________ (30 working days)
- Sent it on: ________
- Applied for Medi-Cal and WIC too
- Baby born: reported to county on: ________ and asked to add baby
- Pregnancy ended: reported within 30 days on: ________
County worker name and phone: ______________________ Keep every notice. Each one explains your appeal rights.
From CalWORKs While Pregnant. Facts checked October 21, 2026. Free information, not legal or medical advice.