Form Temp 1722a - Calworks/food Stamp Welfare Intercept System (Wis) Transmittal
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CALWORKS/FOOD STAMP WELFARE INTERCEPT SYSTEM (WIS) TRANSMITTAL
NOTE: This transmittal must accompany all CalWORKs/FS Intercept Program magnetic tapes, cartridges, disks and input
documents
FOR STATE USE ONLY
TO:
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
ATTENTION: DATA PROCESSING
37503/ _____________________
744 P STREET M.S. 19-13
SACRAMENTO, CA 95814
E ____________ V ___________
COUNTY NAME
COUNTY NUMBER
CURRENT DATE
YEAR SUBMITTED
SUBMITTED BY
PHONE NUMBER
I. DOCUMENTS (DPS 249) (Attach no more than 10 pages per 1722A)
NUMBER OF DOCUMENTS: ____________
OR
II. TAPE/CARTRIDGE
TAPE NUMBER ________________ ( ) 1600 BPI
NUMBER OF RECORDS _________ ( ) 6250 BPI
( ) 3480 Cartridge
BLOCK SIZE ___________________
RECORD LENGTH ______________
OR
III. DISKETTES
______ COMPACT DISK (CD)
_______ 3 1/2 IBM COMPATIBLE
FILENAME: ______________________________________________ RECORD LENGTH: __________________________
NUMBER OF RECORDS: ___________________________________
NUMBER OF BYTES: ________________________
TEMP 1722A (10/07)
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