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

Name Description Type Action
IHSS-PA-100-Caregiver-Registry-Application-and-Instructions File Download
IHSS-PA-100-Caregiver-Registry-Application-and-Instructions-(Sp) File Download
PA Eform Online Form View
SOC 341A Mandated Reporter Acknowledgement SOC 341A Mandated Reporter Acknowledgement Link External Link
SOC 341A (Sp) Mandated Reporter Acknowledgement SOC 341A (Spanish) Mandated Reporter Acknowledgement Link External Link
SOC 426 IHSS Provider Enrollment Form SOC 426 IHSS Provider Enrollment Form Link External Link
SOC 426 (Sp) IHSS Provider Enrollment Form SOC 426 (Spanish) IHSS Provider Enrollment Form Link External Link
SOC 846 IHSS Provider Enrollment Agreement SOC 846 IHSS Provider Enrollment Agreement Link External Link
SOC 846 (Sp) IHSS Provider Enrollment Agreement SOC 846 (Spanish) IHSS Provider Enrollment Agreement Link External Link
SOC 2255 Provider Workweek & Travel Time Agreement SOC 2255 Provider Workweek & Travel Time Agreement Link External Link
SOC 2255 (Sp) Provider Workweek & Travel Time Agreement SOC 2255 (Spanish) Provider Workweek & Travel Time Agreement Link External Link
SOC 2256 IHSS Program Recipient and Provider Workweek Agreement SOC 2256 IHSS Program Recipient and Provider Workweek Agreement Link External Link
SOC 2256 (Sp) IHSS Program Recipient and Provider Workweek Agreement http://www.cdss.ca.gov/cdssweb/entres/forms/Spanish/SOC2256_SP.pdf Link External Link
SOC 2279 Live In Family Care Provider Overtime Exemption SOC 2279 Live In Family Care Provider Overtime Exemption Link External Link
SOC 2279 (Sp) Live In Family Care Provider Overtime Exemption SOC 2279 (Spanish) Live In Family Care Provider Overtime Exemption Link External Link
SOC 2302 In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form Link External Link
Provider-2nd-Violation-Self-Certification-Instructional-Review-Materials Provider 2nd Violation Self-Certification Instructional Review Materials File Download
Provider-2nd-Violation-Self-Certification-Instructional-Review-Materials-SP Provider 2nd Violation Self-Certification Instructional Review Materials SP 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