If you need assistance 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 - Application For In-Home Supportive Services
SOC 295L - Application For In-Home Supportive Services (Large Print)
SOC 426A - In-Home Supportive Services Program Designation of Provider
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SOC 873 - In-Home Supportive Services Program Health Care Certification Form
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SOC 321- Request for Order and Consent Paramedical Services
SOC 825 - Protective Supervision 24-Hours-A-Day Coverage Plan
SOC 839 - In-Home Supportive Services Designation of Authorized Representative
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SOC 2256 - In-Home Supportive Services Program Recipient and Provider Workweek Agreement
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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
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PA 2457 - Civil Rights Information Notice
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PUB 13 - Your Rights Under California Welfare Programs
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PUB 13 Your Rights Under California Welfare Programs (Large Print)
