Forms & Documents > Adult Services > Public Authority (IHSS Providers) Forms

Name Description Type Action
SOC-846-IHSS-Provider-Enrollment-Agreement File Download
SOC-846-SP-IHSS-Provider-Enrollment-Agreement File Download
SOC-426-IHSS-Provider-Enrollment-Form File Download
SOC-426-SP-IHSS-Provider-Enrollment-Form File Download
SOC-341A-Mandated-Reporter-Acknowledgement File Download
SOC-341A-SP-Mandated-Reporter-Acknowledgement File Download
SOC-2255-Provider-Workweek-and-Travel-Time-Agreement File Download
SOC-2255-SP-Provider-Workweek-and-Travel-Time-Agreement File Download
SOC-2256-IHSS-Program-Recipient-and-Provider-Workweek-Agreement File Download
SOC-2256-SP-IHSS-Program-Recipient-and-Provider-Workweek-Agreement File Download
SOC-2279-Live-In-Family-Care-Provider-Overtime-Exemption File Download
SOC-2279-SP-Live-In-Family-Care-Provider-Overtime-Exemption File Download
Provider-2nd-Violation-Self-Certification-Instructional-Review-Materials File Download
Provider-2nd-Violation-Self-Certification-Instructional-Review-Materials-SP File Download