The form link on this page is provided for your general use only. This form is not monitored by the County and/or Social Services Agency on a regular basis. By using this form, you are consenting to self-disclose information about yourself or family to the Social Services Agency. The privacy and security of your information is very important to us; therefore, we have reasonable controls in place to protect your information once the form is submitted. Prior to your submission, the County and Social Services Agency is not responsible or liable for any direct, indirect, incidental or inadvertent issue with the privacy and security to your data as a result of use or inability to use this form on this site. For us to provide assistance or respond to you, we will need all the required fields to be completed. If the form is incomplete, this will delay our ability to assist or respond to you.
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If you have issues completing the form or have questions while attempting to complete the form, please send an email to this inbox – SSASubmit@ssa.ocgov.com. This email is routed to our distribution workflow which is not monitored at all times. Your questions and concerns are important to us; therefore, we will have staff contact you within two business days if you provide your contact information and a brief description of the issue you encounter. In the event of a medical emergency, call 911. Thank you!
Making Orange County a safe, healthy, and fulfilling place to live, work, and play, today and for generations to come, by providing outstanding, cost-effective regional public services.
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