Forms & Documents > Adult Services > IHSS Forms

Name Description Type Action
DSS-IHSS-360-What-is-Protective-Supervision DSS IHSS 360 What is Protective Supervision form File Download
DSS-IHSS-360-What-is-Protective-Supervision-(Sp) DSS IHSS 360 What is Protective Supervision (Sp) File Download
Functional-Ranking-Criteria Functional Ranking Criteria File Download
Online IHSS Application Form Online Form View
SOC-295-Application-for-IHSS-Services SOC 295 Application for IHSS Services File Download
SOC-295-SP-Application-for-IHSS-Services SOC 295 SP Application for IHSS Services File Download
SOC-295-Large-Font-Application-for-IHSS-Services SOC 295 Large Font Application for IHSS Services File Download
SOC-295-Large-Font-SP-Application-for-IHSS-Services SOC 295 Large Font SP Application for IHSS Services File Download
SOC-873-Health-Care-Certification-Form SOC 873 Health Care Certification Form File Download
SOC-873-SP-Health-Care-Certification-Form SOC 873 SP Health Care Certification Form File Download
DSS-IHSS-306-Appointment-of-IHSS-Authorized-Representative DSS IHSS 306 Appointment of IHSS Authorized Representative File Download
DSS-IHSS-306-SP-Appointment-of-IHSS-Authorized-Representative DSS IHSS 306 SP Appointment of IHSS Authorized Representative File Download
SOC-321-Paramedical-Services-Request-for-Order-and-Consent SOC 321 Paramedical Services Request for Order and Consent File Download
SOC-321-SP-Paramedical-Services-Request-for-Order-and-Consent SOC 321 SP Paramedical Services Request for Order and Consent File Download
SOC-821-Assessment-of-Need-for-Protective-Supervision SOC 821 Assessment of Need for Protective Supervision File Download
SOC-426A-IHSS-Program-Recipient-Designation-of-Provider SOC 426A IHSS Program Recipient Designation of Provider File Download
SOC-426A-SP-IHSS-Program-Recipient-Designation-of-Provider SOC 426A SP IHSS Program Recipient Designation of Provider File Download
SOC-2256-IHSS-Program-Recipient-and-Provider-Workweek-Agreement SOC 2256 IHSS Program Recipient and Provider Workweek Agreement File Download
SOC-2256-SP-IHSS-Program-Recipient-and-Provider-Workweek-Agreement SOC 2256 SP IHSS Program Recipient and Provider Workweek Agreement File Download
SOC-450-Voluntary-Services-Certification SOC 450 Voluntary Services Certification File Download
SOC-450-SP-Voluntary-Services-Certification SOC 450 SP Voluntary Services Certification File Download

Contact Social Services

Child and Adult Hotline Information:

  • If you suspect there is an emergency requiring immediate intervention, call 911
  • To report suspected child abuse or neglect call the 24 hour Child Abuse Hotline at (805) 781-KIDS (5437) or toll free 1-800-834-KIDS (5437)
  • To report suspected elder abuse or neglect call the Adult Services Hotline at (805) 781-1790 during regular business hours, or after business hours call (844) 729-8011