County of Marin Health and Human Services

General Relief Application Packet

The 6 documents on this page are part of the application process for the General Relief program. Each document is available in English and Spanish. Please read, sign (where indicated), and submit each form. You must have an interview to receive General Relief. These forms will be reviewed with you during the interview.

1 - Application Cover Letter - Read about how to apply for General Relief during COVID.
English | Spanish

2 - C-IV MEDS Clearance Form - Fill out top section.
English | Spanish

3 - Rights and Responsibilities Form - Review and sign.
English | Spanish

4 - General Relief Application - Fill out completely and sign.
English | Spanish

5 - Authorization for Release of Confidential Information - Review and sign.
English | Spanish

6 - Authorization for Reimbursement Initial Claim - Review and sign.
English | Spanish