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Additional Resources
Consumer Forms
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Consumer Forms
If you need assistance with completing any of these forms, please contact the IHSS Helpline at (888) 822-9622. You have the right to interpreter services provided by the County at no cost to you.
- SOC 295 (6/18) - Application For In-Home Supportive Services
- GEN 1365 - Notice of Language Services
- PA 2457 - Civil Rights Information Notice
- PUB 13 - Your Rights Under California Welfare Programs
- SOC 321 - Request for Order and Consent Paramedical Services
- SOC 332 - In-Home Supportive Services Recipient Employee Responsibilities Checklist
- SOC 426 A - In-Home Supportive Services Program Designation of Provider
- SOC 825 - Protective Supervision 24-Hours-A-Day Coverage Plan
- SOC 838 - In-Home Supportive Services Recipient Request for Assignment of Authorized Hours to Provider
- SOC 839 - In-Home Supportive Services Recipient Timesheet Signature Authorization
- SOC 840 - In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone
- SOC 864 - In-Home Supportive Services Back-Up Plan and Risk Assessment
- SOC 873 - In-Home Supportive Services Program Health Care Certification Form
- SOC 2256 - In-Home Supportive Services Program Recipient and Provider Workweek Agreement
- SOC 2274 - In-Home Supportive Services Program Accompaniment to Medical Appointment
- SOC 2279 - In-Home Supportive Services Program Live-In Family Care Provider Overtime Exemption
- TEMP 3000 - In-Home Supportive Services Program Overtime and Workweek Requirements Recipient Declaration
Services Locator
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Services Locator
Find the LA County services and facilities that serve your area...