Ventura County Human Services Agency

Send us a Message or Submit a Document

You can use this form to securely send an email message to the Ventura County Human Services Agency. If desired, you can attach a document (such as a pay stub, rent receipt, utility bill etc.) from your computer’s hard drive or your phone’s camera. If you would like to Apply for benefits, please click here "How to Apply"

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Please let us know what we'll be helping you with:

Which Program?

MediCal

CalFresh

CalWORKs / Welfare to Work

General Relief

Other

Are you a New or Existing Client?

New or Existing Client

Service Provider [Request Form]

Subject*:

This is about a New Application

This is about an Existing Case

Case Number, if you know it: (optional)

case number on request for verification — If you got a **CalFresh Initial Appointment Letter** or **Request for Verification** notice in the mail, you will find this on the upper-right corner.

case number on ebt card — If you have an **EBT card**, your case number is located at the bottom (skip the first two digits).

Please tell us who you are and how to reach you:

First Name*:

Last Name*:

Date of Birth*:

People may share the same name. Specifying your birthday may help prevent mistaken identity.

Phone Number*:

We will call you if we have a question about your message or a problem opening your document.

Email Address: (for confirmation)

Recommended. We will email you a confirmation if you let us know where to send it.

Please type your message below:

Message*:

Would you like to send us any documents?

Yes

Please attach documents:

Please only send images (photos) or PDF documents.

If you need to send us a photo or other document, you can attach it or take a picture of it with your phone here. Please only upload image files (jpeg, png, gif, bmp) or PDF documents.

Need to upload more than one file or photo?
Hold down the ctrl key (cmd key on a Mac) and click the files you wish to send.
On a phone, take your photos first, then click the "Select files..." button above and select all the photos desired from your photo library.

The maximum file upload size is 30 MB.

Ready to Send!

Final Verification: