Restrictive Covenant Modification Form

Online Assessor Forms

Statement to Obtain the Ballot of a Relative

Health Disclosure Form - Formulario de Divulgacion de Salud

Request to Withdraw Signature From Recall Petition

Referral for Mental Health Services- Formas de Referencia para Salud Mental

Uniform and Equipment Advance Request Forms

Behavioral Health Services During COVID-19 Response

All Mental Health and Substance Use Disorder Services are still available via Tele-health. Call 1(800) 507-3530 for more information.

How to make a face covering from the CDC

COVID-19 HHSA Services Update

HHSA lobby closures due to COVID-19

Social Services COVID-19 Response


With the current situation we are facing with the COVID-19 (Coronavirus), Glenn County Health & Human Services, Social Services Department is taking many precautionary steps to protect our staff and community. You might notice that our service delivery has changed with appointments being conducted by mail and/or phone. We want to make sure that our service delivery meets the needs of our community and keeps everyone safe. We are prepared to make the necessary changes as things evolve.

Please contact each department for specific questions, and we ask that you are patient as our call volume has increased.  

The Glenn County Health and Human Services Agency is committed to ensuring the continuity of Essential Services during the COVID-19 pandemic.

Essential Services include:

  • Child Welfare Services--emergency response and assuring the safety of dependent children
  • Adult Protective Services--emergency response and assuring the safety of seniors and dependent adults from abuse
  • In-Home Supportive Services (IHSS)--intake and reassessments triggered by reports of change in needs, IHSS Payroll, and the Public Authority for IHSS if a care provider is needed

Public Assistance Programs--CalWORKS, CalFRESH, Medi-Cal and Homeless assistance

You can apply for Cash Aid, CalFresh and Medi-Cal Online at

C4Yourself is an online application system that allows you to apply for benefits. This is a secure site, and all of your information will be private and safe. 

  • You can apply for Cash Aid, CalFresh and Medi-Cal
  • After you apply online, you can: 
  • Check the status of your application
  • See your worker’s name and phone number
  • See your current benefit amount(s)
  • Get and print your semi-annual report forms
  • Renew or recertify your application
  • Get messages from your worker
  • Get a fax or mail-in coversheet to send information to your worke
  • Obtain necessary information about Cash Aid, CalFresh and Medi-Cal
  • Obtain office closure information
  • See important announcements

Report Suspected Child Abuse or Neglect: 

Call 911 if a child is in immediate danger, or you are concerned about a life-threatening situation.

All other reports, call Glenn County Child Welfare Services

Report Suspected Elder Abuse or Exploitation: 

Please call the APS/IHSS duty number (530-865-6164) to report any suspected abuse of disabled or elderly individuals.