Part A is living arrangements, Part B is total household expenses and Part C is the signature.
Household: members of a household share a common living space and combine money to pay for household expenses (such as rent, utilities, and food).
Homeless: homeless means you do not have a permanent residence and you do not live in an institution.
Part B: do not complete this section if you live alone or only with your spouse and/or minor child(ren).
Expenses: only list the household expenses paid by your household.
Head of household: if you pay expenses to another person in your household, the head of household must review and sign this form.
| Question | Answer |
|---|---|
| Form Name | Form SOC 453 |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 115 |
| Avg. time to fill out | 20 min |
| Edition | 8/22 |
| Issuing agency | California Department of Social Services |
| Who completes it | The applicant/recipient, when applying for CAPI and at every redetermination |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | SOC 453, SOC453, SOC-453, Form SOC 453, CAPI form, CAPI Statement of Household Expenses and Contributions |
| Official source | Form SOC 453 (Rev 8/22), California Department of Social Services |
CAPI Form SOC 453 isn’t the one you’re looking for?