DEBS & DFCS CalFresh Disclosure of Case Information

The form, Consent to Release CalFresh Confidential Case Information (SCD 2577) must be utilized when a Social Worker (SW) in the Department of Family and Children Services (DFCS) is assisting the applicant or recipient in obtaining eligibility information on a CalFresh case.

Consent to Release Form SCD 2577

The SCD 2577 is a fillable form and is located in the DEBS forms library. The SCD 2577 is valid for one year from the original signature date. The SCD 2577 must be scanned to IDM. When a SCD 2577 has expired a new SCD 2577 is required to be completed prior to disclosing information. In completing the form, do not leave fillable sections blank. Enter “NA” for items that are not applicable (NA).

The SCD 2577:

• Is located in the DEBS forms library.
• Is valid for one year from the original signature date.
• Must be signed and dated by the applicant/recipient and the DFCS SW.
• Must be imaged into CalSAWS.

Documentation of Consent to Release

EWs must document in the case record when a new SCD 2577 is obtained and imaged into CalSAWS. The EW must document information released when disclosing case information to the DFCS SW utilizing the SCD 2577. EWs must document in the case record:

• When a new SCD 2577 is obtained and imaged into CalSAWS.
• The purpose and the name of the DFCS SW receiving CF case information.
• Information that was released utilizing SCD 2577.

Related Topics

Confidentiality & Personal Identifiable Information (PII) Overview