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 form Link External Link
SOC 295 (Sp) Application for IHSS Services SOC 295 (Spanish) Application for IHSS Services form Link External Link
SOC 295 Large Font Application for IHSS Services SOC 295 Large Font Application for IHSS Services form Link External Link
SOC 295 (Sp) Large Font Application for IHSS Services SOC 295 (Spanish) Large Font Application for IHSS Services form Link External Link
SOC 321 Paramedical Services Request for Order and Consent SOC 321 Paramedical Services Request for Order and Consent form Link External Link
SOC-321-SP-Paramedical-Services-Request-for-Order-and-Consent SOC 321 SP Paramedical Services Request for Order and Consent File Download
SOC 426A IHSS Program Recipient Designation of Provider SOC 426A IHSS Program Recipient Designation of Provider form Link External Link
SOC 426A (Sp) IHSS Program Recipient Designation of Provider SOC 426A (Spanish) IHSS Program Recipient Designation of Provider form Link External Link
SOC 450 Voluntary Services Certification SOC 450 Voluntary Services Certification form Link External Link
SOC 450 (Sp) Voluntary Services Certification SOC 450 (Spanish) Voluntary Services Certification form Link External Link
SOC 821 Assessment of Need for Protective Supervision SOC 821 Assessment of Need for Protective Supervision form Link External Link
SOC 873 Health Care Certification Form SOC 873 Health Care Certification Form Link External Link
SOC 873 (Sp) Health Care Certification Form SOC 873 (Spanish) Health Care Certification Form Link External Link
SOC 2256 IHSS Program Recipient and Provider Workweek Agreement SOC 2256 IHSS Program Recipient and Provider Workweek Agreement form Link External Link
SOC 2256 (Sp) IHSS Program Recipient and Provider Workweek Agreement SOC 2256 (Spanish) IHSS Program Recipient and Provider Workweek Agreement form Link External Link
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

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