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Forms & Documents > Adult Services > IHSS Forms

Name Description
PUB 521 Adults (ENG) IHSS Protective Supervision Services for Adults
PUB 521 Adults (Sp) IHSS Protective Supervision Services for Adults (Spanish)
PUB 522 Children (ENG) IHSS Protective Supervision for Minor Children (English)
PUB 522 Children (Sp) IHSS Protective Supervision for Minor Children (Spanish)
SOC 295 Application for IHSS Services SOC 295 Application for IHSS Services form
SOC 295 (Sp) Application for IHSS Services SOC 295 (Spanish) Application for IHSS Services form
SOC 295 Large Font Application for IHSS Services SOC 295 Large Font Application for IHSS Services form
SOC 295 (Sp) Large Font Application for IHSS Services SOC 295 (Spanish) Large Font Application for IHSS Services form
SOC 426A IHSS Program Recipient Designation of Provider SOC 426A IHSS Program Recipient Designation of Provider form
SOC 426A (Sp) IHSS Program Recipient Designation of Provider SOC 426A (Spanish) IHSS Program Recipient Designation of Provider form
SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative
SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative (Sp) SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative (Sp)
SOC 873 Health Care Certification Form SOC 873 Health Care Certification Form
SOC 873 (Sp) Health Care Certification Form SOC 873 (Spanish) Health Care Certification Form
Online IHSS Application Form

Contact Social Services

Child 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)

Adult Hotline Information:

  • If you suspect there is an emergency requiring immediate intervention, call 911
  • 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
  • Mandated Reporter