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Forms & Documents > Adult Services > IHSS Forms

Name Description Type
DSS-IHSS-360-What-is-Protective-Supervision DSS IHSS 360 What is Protective Supervision form File
DSS-IHSS-360-What-is-Protective-Supervision-(Sp) DSS IHSS 360 What is Protective Supervision (Sp) File
Online IHSS Application Form Online Form
SOC 295 Application for IHSS Services SOC 295 Application for IHSS Services form Link
SOC 295 (Sp) Application for IHSS Services SOC 295 (Spanish) Application for IHSS Services form Link
SOC 295 Large Font Application for IHSS Services SOC 295 Large Font Application for IHSS Services form Link
SOC 295 (Sp) Large Font Application for IHSS Services SOC 295 (Spanish) Large Font Application for IHSS Services form Link
SOC 426A IHSS Program Recipient Designation of Provider SOC 426A IHSS Program Recipient Designation of Provider form Link
SOC 426A (Sp) IHSS Program Recipient Designation of Provider SOC 426A (Spanish) IHSS Program Recipient Designation of Provider form Link
SOC-839-In-Home-Supportive-Services-(IHSS)-Designation-of-Authorized-Representative SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative File
SOC-839-In-Home-Supportive-Services-(IHSS)-Designation-of-Authorized-Representative-(Sp) SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative (Sp) File
SOC 873 Health Care Certification Form SOC 873 Health Care Certification Form Link
SOC 873 (Sp) Health Care Certification Form SOC 873 (Spanish) Health Care Certification Form Link

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