Print, Complete, and Bring These Required Enrollment Documents to Your Appointment

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IMPORTANT REMINDER:

Bring your ORIGINAL, VALID Social Security card (work permit if applicable) and ID card to your scheduled appointment.  Otherwise, you will be turned away and MUST reschedule your appointment.

Provider Enrollment Checklist

(SOC 426A-ENG) Recipient Designation of Provider Form

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

(The SOC 426A Form is applicable only if you are already providing services to an IHSS Recipient.)

Get fingerprinted before your appointment and bring the copy of your Live Scan Form receipt

Live Scan Form

Live Scan Form Example

Live Scan Locations

If you do not have access to a printer, please call the Provider Enrollment Hotline at 714-825-3195 and the necessary enrollment paperwork will be mailed to you.

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You cannot continue without required enrollment documents

Are all enrollment documents obtained?

CLICK HERE to Continue Online Enrollment