How to Fill Out and Submit the LA County CBEST Referral Form

The LA County CBEST referral form is the intake document that connects someone who is homeless or at risk of homelessness with a free county advocate who will help them apply for SSI, SSDI, or CAPI. The form takes about 15 minutes to complete. After you submit it, expect two to four weeks before an advocate is assigned, so accuracy on the first pass matters.1Los Angeles County. CBEST Referral Guide CBEST stands for Countywide Benefits Entitlement Services Team and is run by the Los Angeles County Department of Homeless Services and Housing, with teams based at DPSS General Relief district offices across the county.2Los Angeles County Department of Public Social Services. Countywide Benefits Entitlement Services Team

Before You Fill It Out: Who the Form Is For

CBEST serves people who meet two conditions at once: a disabling physical or mental health condition, and homelessness or risk of homelessness.3LA County HSH. Countywide Benefits Entitlement Services Team Most referrals come through General Relief participants at DPSS, but you don’t have to be on GR. Community organizations, healthcare providers, other county agencies, and the person themselves can all submit a referral.

The disability does not need to be formally diagnosed before you submit. The form asks whether the person has a health impairment expected to last more than one year that they feel prevents them from working. That mirrors the federal standard: for SSI or SSDI, the condition has to be severe enough that the person cannot earn more than $1,690 per month in 2026, the Social Security Administration’s substantial gainful activity threshold.4Social Security Administration. Substantial Gainful Activity CBEST advocates help figure out whether the person likely meets it. You don’t need the answer before referring.

CBEST also helps with CAPI (Cash Assistance Program for Immigrants) applications for noncitizens who have a qualifying disability but can’t get SSI because of immigration status, and with Veterans’ Benefits applications for people who served in the U.S. Armed Forces.2Los Angeles County Department of Public Social Services. Countywide Benefits Entitlement Services Team

Where to Get the Form

The referral form is available as a fillable PDF on the LA County Department of Homeless Services and Housing site at homeless.lacounty.gov.3LA County HSH. Countywide Benefits Entitlement Services Team You can type into it and then print, or print blank and complete it by hand. Paper copies are also stocked at all 14 DPSS General Relief district offices; a caseworker can hand one to you during an appointment. Use the DPSS office locator at dpss.lacounty.gov to find the closest office.5Department of Public Social Services. Office Locations

How to Fill Out Each Section

Work through the form in order. Have the person’s identification and any medical information nearby before you start. Here is what each section wants and where people commonly get stuck.

Pre-Screening and Eligibility

The first section screens for the program. Check “Yes” next to SSI, SSDI, or CAPI, whichever the person wants to apply for. Then mark whether they are currently homeless (not housed) or at risk (housed but unstable), and estimate how many months they have been homeless. An approximation is fine.

The form also asks about earlier SSI or SSDI applications. If the person applied before, fill in the date and outcome — approved, pending, denied, or unknown — and note any appeal date. This tells the advocate whether to file fresh or reopen an old claim. If there was no prior application, check “No.”

Two more items sit in this section: recent incarceration and U.S. citizenship. The form notes that incarceration does not affect CBEST eligibility. Noncitizens should say what documentation they hold (green card, visa, work permit) and whether it is current or expired. There is also an optional checkbox to consent to a referral to immigration legal services, which can help noncitizens working through both disability and immigration questions.

Client Identifying Information

Enter the person’s full legal name, any aliases, Social Security Number, date of birth, and place of birth. If the person has a CHAMP ID (the county identifier used across homeless services), include it. Not everyone will have one, and leaving it blank will not stall the referral.

Contact Information

This is where most referrals stumble. If the advocate cannot reach the person, the case sits. Give a mailing address if one exists. If there isn’t one, answer the form’s question about where the person is most likely to be found — a shelter, an intersection, a service site. CBEST teams do outreach and use this information to make contact.

Include a primary phone number and, if possible, an alternate. A shelter phone or a friend’s number where messages can be left counts. Add an email if the person uses one, and note the language preference so an interpreter can be arranged.

Health Information

Describe the physical and mental health conditions the person believes prevent them from working. Separate fields exist for each. Be specific. “Chronic lower back pain with nerve damage” gives the advocate more to work with than “back problems.” For each category, note whether the person is currently in treatment. If they aren’t, that’s okay. CBEST teams include clinicians who can help build a treatment record, which strengthens the federal application later.

The form also asks about U.S. Armed Forces service. Answering “Yes” can open the door to Veterans’ Benefits alongside or instead of SSI or SSDI.

Referrer Information

The last section captures who is submitting: name, organization, phone, and email. If you are a caseworker, outreach worker, or clinician, use your professional contact details. Self-referrals are accepted; in that case, put yourself down as the referrer.

How to Submit the Completed Form

Three channels are available:

  • Email the completed form to cbestreferral@dhs.lacounty.gov. This is the simplest option if the PDF is filled out digitally or you can scan the paper form.
  • Fax the form to (323) 389-4322. Keep the confirmation page as proof of submission.
  • Use the CBEST online referral portal to enter the information directly. If you cannot access the portal, email and fax work as alternatives.1Los Angeles County. CBEST Referral Guide

Keep a copy of the form and any confirmation you get back. If you are submitting for someone else, tell them a referral has been filed and remind them CBEST will try to reach them using the contact information on the form.

What Happens After You Submit

A CBEST coordinator screens the referral for completeness and confirms the person meets eligibility. That review runs two to four weeks.1Los Angeles County. CBEST Referral Guide The coordinator may call to clarify something during that window, which is another reason to make sure the contact section is right.

Once the referral is accepted, a dedicated benefits advocate takes the case. CBEST teams include advocates, clinicians, and legal partners who stay with the participant through the entire federal application.3LA County HSH. Countywide Benefits Entitlement Services Team The advocate gathers medical records, documents the health history, prepares and submits the SSI, SSDI, or CAPI application, and provides legal representation if the application is denied and needs to be appealed. The advocate also connects participants to case management for housing and supportive services. All of this is free to the participant.

Roughly two out of three initial SSI and SSDI applications are denied, and an initial application typically takes six to eight months to process. Having an advocate handle the paperwork, the medical evidence, and any appeal is the main reason to file the referral in the first place. Be straightforward on the form about the person’s condition and circumstances, even where things are complicated. CBEST advocates work with real cases, not tidy ones.