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CalFresh Prescreen Application

Please answer the following questions to see if you may be eligible for CalFresh benefits. Once you submit your form a CalFresh Outreach team member will reach out to you via email and/or text to discuss eligibility.

In order to determine the number of people on an application we must review the number of people in your household. Household = a person living alone or a group of people living together who purchase and prepare food together.

Effective September 30, 2021

Number of People in Household Gross Monthly Income Limit CalFresh Food Allotment Range
1 $2,148 $250
2 $2,904 $459
3 $3,660 $658
4 $4,418 $835
5 $5,174 $992
6 $5,930 $1,190
7 $6,688 $1,316
8 $7,444 $1,504
Each Additional Member +$758 +$188

NOTE: when answering the following questions, feel free to select Not Sure and a BaNC representative can reach out to assist.

1. How many people do you purchase and prepare food with?
2. Using both the chart above and your answer from question 1, is your household under the gross monthly income?
3. Does your household include at least one US citizen, a person with a Green Card, or lawful permanent resident (LPR)?
4. Does anyone in your household receive the Food Distribution Program on Indian Reservations (FDPIR) ?
5. Is anyone in your household physically/mentally unable to work and/or is receiving disability benefits from any source?
6. Is anyone in your household a college student per CalFresh Food guidelines: enrolled at least half-time (6 units) AND between ages of 18-49?
7. Students Must Meet at Least ONE; please mark all that apply.
  • $0 Expected Family Contribution (EFC) as defined by CSAC or on Student Aid Report
  • Eligible for state or federal work study as determined by the Financial Aid office on each campus
*As determined by the county on a case-by-case basis