Provider Forms

English Forms/Handouts

IHSS Provider Enrollment Processing Timeline

Provider Enrollment Checklist

Recipient Designation of Provider Form (SOC 426A)

Live Scan Locations

Live Scan Form

6-Month Retroactive Pay Affidavit

Direct Deposit Form (SOC 829)

Live-In Self-Certification Form (SOC 2298)

Paid Sick Leave Request Form (SOC 2302)

Spanish Forms/Handouts

Tiempo de Procesamiento para Inscripción del Proveedor de IHSS

Formulario de Designación de un Proveedor por el Beneficiario (SOC 426A)

Ubicaciones de Huellas Digitales

Formulario de Depósito Directo (SOC 829)

Formulario de Auto Certificación de Residente Con Quien se Convive (SOC 2298)

Formulario de Solicitud del Proveedor de IHSS para Pago por Ausencia por Enfermedad (SOC 2302)

Vietnamese Forms/Handouts

Lịch Trình Tiến Hành Ghi Danh Người Chăm Sóc IHSS

Nơi Cung Cấp Dịch Vụ Lăn Tay

Đơn Chuyển Khoản (SOC 829)