Counties are required to accept IHSS applications by telephone, by fax, or in person. the form must be provided and the form must include your signature and the date you signed the form. 4. Once completed and signed by the Recipient (or their authorized representative), the Hiring Agreement can be submitted by: Mail to: County of Fresno Department of Social Services. You may be asked to perform or describe simple tasks, such as range-of-motion demonstrations. Providers who need to obtain a COVID-19 test may search for a testing site here by entering their address. Please check your spelling or try another term. Twice a month, both you and your provider who works for you will receive an "Explanation of IHSS SOC" letter that will tell you how much money to pay the provider. The cookie is used to store the user consent for the cookies in the category "Other. The cookies is used to store the user consent for the cookies in the category "Necessary". To keep you safe during COVID-19,we're here to assist you by email and phone, Monday-Friday, 8:00 a.m. to 5:00 p.m. Emailihsspaymentunits@sfgov.org. Disabled children are also potentially eligible for IHSS; Live in your own home. Continue reporting your hours worked on your timesheet as you always have. In an attempt to provide more services to the most vulnerable, the state Health and Human Services Agency created a new office to improve mental health care. You must physically reside in the United States. This website uses cookies to improve your experience while you navigate through the website. Return Completed SOC 2298 Forms to: IHSS - IRS Live-In Self-Certification P.O. Photo: Lea Suzuki, The Chronicle Buy photo Recipient Forms Recipient Forms Recipient Forms If you need assistance completing any of these forms, please contact the IHSS Helpline at (888) 822-9622. Forms; Become a Provider; IHSS Care Providers Support (SIP) IHSS Public Authority; . You have the right to interpreter services provided by the County at no cost to you. iqRB:\l!== SOC 332 In-Home Supportive Services Recipient Employee Responsibilities Checklist, SOC 426A In-Home Supportive Services Program Designation of Provider, SOC 838 In-Home Supportive Services Recipient Request for Assignment of Authorized Hours to, SOC 839 In-Home Supportive Services Recipient Timesheet Signature Authorization, SOC 840 In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone, SOC 864 In-Home Supportive Services Back-Up Plan and Risk Assessment, SOC 873 In-Home Supportive Services Program Health Care Certification Form, SOC 2256 In-Home Supportive Services Program Recipient and Provider Workweek Agreement, SOC 2274 In-Home Supportive Services Program Accompaniment to Medical Appointment, SOC 2279 In-Home Supportive Services Program Live-In Family Care Provider Overtime Exemption, TEMP 3000 In-Home Supportive Services Program Overtime and Workweek Requirements Recipient Declaration, SOC 426 In-Home Supportive Services Provider Enrollment Form, SOC 829 In-Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form, SOC 840 In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone Form, SOC 846 In-Home Supportive Services Program Provider Enrollment Agreement, SOC 847 Important Information For Prospective Providers IHSS Provider Enrollment Process, SOC 2255 In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement, SOC 2279 In-Home Supportive Services (IHSS) Program Live-In Family Care Provider Overtime Exemption, W-4 Employees Withholding Allowance Certificate (Federal), DE-4 Employees Withholding Allowance Certificate (State). To qualify as severely impaired, an applicant must need at least 20 total hours per week of services in one or more of the following IHSS areas: non-medical personal services, preparation of meals, meal cleanup (when preparation of meals and feeding are also required), and paramedical services. CFCO provides States with 6% additional federal funding for services and supports. You also have the option to opt-out of these cookies. Please review the Recipient Notice and/or the Provider Notice, as well as, the Vaccine Exemption Form below for additional information. IHSS Provider Direct Deposit Letter and Form Provider Direct Deposit Outreach Letter 02-16-22 Translations: Spanish (pdf) IHSS Provider Direct Deposit Enrollment/Change/Cancellation Form (SOC 829) (pdf) If you are unable to print the form yourself, you can contact the IHSS Call Center via phone or email to receive another form: Phone: 530-889-7171 Email: Recipients authorized hours are less than the statutory maximum of 283 hours per month. Eligibility criteria for allIHSS applicants and recipients: DPSS offers IHSS providers and recipients an online customer service center to access program information, submit questions through a helpdesk system and chat live with a DPSS agent during normal business hours. The PASC is the Public Authority for Los Angeles County. Mayor Ed Lee poses for photographers with City Administrator Sabrina Andrew on the steps of City Hall in San Francisco, Calif., on Thursday, January 7, 2015. They operate a Provider Registry and will provide you with referrals to providers. Box 1677 West Sacramento, CA 95691-6677 What do I do for wages paid before my Self-Certification Form is received? Please review the notices below for IHSS Providers and IHSS Recipients regarding COVID-19 booster requirements. Amendment to the September 28, 2021, Public Health Order, Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement, COVID-19 Vaccination Exemption Form- Spanish(Espaol), COVID-19 Vaccination Exemption Form- Armenian(), COVID-19 Vaccination Exemption Form- Chinese(), COVID-19 Vaccination Exemption Form- Cambodian(), COVID-19 Vaccination Exemption Form- Farsi(), COVID-19 Vaccination Exemption Form- Korean(), COVID-19 Vaccination Exemption Form- Russian(), COVID-19 Vaccination Exemption Form- Tagalog(Tagalog), COVID-19 Vaccination Exemption Form- Vietnamese(Ting Vit), Personal Assistance Services Council (PASC), SOC 873 - In-Home Supportive Services Program Health Care Certification Form, Provides services to a family member(s); and, Obtain a weekly COVID-19 test at one of the State testing sites (, Wear a surgical mask or N95 mask, at all times, while providing services in your home. If you had any loss of IHSS work/income due to COVID-19 between 04/012020 - 09/30/2021 and 01/01/2022 - 09/30/2022 and have not yet received COVID-19 sick leave, you may still be eligible to submit a claim. Recipient's Name: 2. But opting out of some of these cookies may affect your browsing experience. Box 1912. For Recipients: How to obtain a list of providers. Recipients can self-register for the TTS by using the 6-digit State Registration Code. You are considered your provider's employer and, therefore, it is your responsibility to hire, train, supervise, and fire your provider. In-Home Supportive Services (IHSS) Map/Directions. For questions regarding SOC, contact your Social Worker at (888) 822-9622. P.O. Be a California resident. This cookie is set by GDPR Cookie Consent plugin. The applicants protected date of eligibility is the date the applicant requests services. Change the blanks with unique fillable areas. IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT AGREEMENT SOC 846 (10/19) Page 1 of 6. (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), COVID-19 CalFresh emergency allotment for July, 2021. SOC 2298 In-Home Supportive Services (IHSS) Program and Waiver Personal Care Personal Services (WPCS) Live-In Self-Certification Form for Federal and State Wage Exclusion W-4 Employees Withholding Allowance Certificate (Federal) DE-4 Employees Withholding Allowance Certificate (State) Address: 20101 Hamilton Avenue Suite 250 Torrance, CA 90502, Hours of Operation: Monday - Friday from 8:00 am to 5:00 pm, ___________________________________________________________________________________________________________________________. IHSS Provider Hiring Agreement - Spanish. Hospitals, nursing homes, and licensed community care facilities are not considered own home; Participate in a home assessment interview; and, Obtain a health care certification from a licensed health care professional (LHCP) such as a physician, psychiatrist, psychologist, etc., indicating that you are unable to safely perform one or more activities. When you qualify for IHSS, you can receive help at no or little costwith bathing, dressing, meal preparation and clean up, bowel and bladder care, light housekeeping, laundry, and shopping. All of the following must be true to submit a claim: What if I already received my vaccine(s)? Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Please note Placer County IHSS and Public Authority do not require proof of vaccination or exemption. Start completing the fillable fields and carefully type in required information. IHSS Recipient Become an IHSS Recipient 1 Meet eligibility criteria Live at home or in a shelter, but not in a board and care facility, nursing home, or hospital. Phone: (661) 868-1000 Toll Free: (800) 510-2020 . The IHSS recipient also has the right to choose the licensed health care professional who completes the Paramedical order. Fill in the empty fields; engaged parties names, places of residence and numbers etc. You, as an IHSS recipient, may have to pay a certain dollar amount each month toward your medical expenses as part of your SOC. You must live at home or a dwelling of your own choosing (acute care hospital, long-term care facilities, and licensed community care facilities are not considered "own home"). IMPORTANT:If your provider tests positive forCOVID-19, they should not be providing IHSS services. The Extraordinary Circumstances exemption is available to care providers working for multiple recipients who are at risk of out-of-home placement. Repair services Sitting with you to visit or watch TV Taking you on social outings Applying as a Care Recipient 1. 1. hVRHyu4R2@IP~EI&nid,Cdn}s'lKIZ&NbeJ IHSS office hours To keep you safe during COVID-19, we're here to assist you by email and phone, Monday-Friday, 8:00 a.m. to 5:00 p.m. For IHSS Provider questions Email ihsspaymentunits@sfgov.org . But the only woman and only person who worked for it for two years never had to do anything like the paperwork. Get the free ihss application form Get Form Show details Hide details In-Home Supportive Services Referral Form Date Sent Please answer all questions and print clearly Fax to SF HSA Department of Aging and Adult Services Program 415 557-5271 Questions Call 415 355-6700 or email us at ihss ci. Find the Ihss Application Form Pdf you require. IHSS recipients must obtain County approval whenever you need your IHSS provider to work more than his/her maximum weekly hours when the adjustment in the work schedule results in the provider: To request the one-time exception, contact the IHSS Helpline at (888) 822-9622. Learn more at:Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement. Prior to authorization of IHSS services, recipients must submit a Health Care Certification form (, Although CDSS requires 100% compliance with reassessments, CDSS will issue a Quality Improvement Action Plan for counties that are below 90% compliance rate for CFCO recipients and an 80% compliance rate for all other recipients. . If denied services, you can appeal the decision at the state level. If the county has the capability, it must also accept applications online and by email. Bring original federal or state government-issued identification and your original Social Security card when returning this form. Accessibility ReaderIf you have difficulty typing, moving a mouse, or reading, click the icon to the left and download a new reader / browser from eSSENTIAL Accessibility. %}yB) _(`[:8%pq~;5 The Amendment requires IHSS providers to receive a booster dose of the COVID-19 vaccine after receiving all recommended doses. In-Home Supportive Services Referral Form Date Sent Please answer all questions and print clearly Fax to SF HSA Department of Aging and Adult Services Program 415 557-5271 Questions Call 415 355-6700 or email us at ihss ci. By using this site you agree to our use of cookies as described in our, Something went wrong! Working with a recipient with a physical disability, In-Home Supportive Services Recipient Employee Responsibilities Checklist, In-Home Supportive Services Program Designation of Provider, In-Home Supportive Services Recipient Request for Assignment of Authorized Hours to, In-Home Supportive Services Recipient Timesheet Signature Authorization, In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone, In-Home Supportive Services Program Health Care Certification Form, In-Home Supportive Services Program Recipient and Provider Workweek Agreement, In-Home Supportive Services Program Accompaniment to Medical Appointment, In-Home Supportive Services Program Live-In Family Care Provider Overtime Exemption, In-Home Supportive Services Program Overtime and Workweek Requirements Recipient Declaration, In-Home Supportive Services Provider Enrollment Form, In-Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form, In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone Form, In-Home Supportive Services Program Provider Enrollment Agreement, Important Information For Prospective Providers IHSS Provider Enrollment Process, In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement, In-Home Supportive Services (IHSS) Program Live-In Family Care Provider Overtime Exemption, In-Home Supportive Services (IHSS) Program and Waiver Personal Care Personal Services (WPCS) Live-In Self-Certification Form for Federal and State Wage Exclusion, Employees Withholding Allowance Certificate (State). PART A. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Sacramento, CA 95814, Summaries of select CalWORKs, CalFresh, Health and Housing Regulations, Individuals have the right to apply for IHSS services or make an application through another person on their behalf. Expect an eligibilityworker to contact you to schedule an interview. Please return this completed and signed form to the county. These hours will be billed and paid separately from normal timesheets, therefore they DO NOT count towards your weekly maximum. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. 517 - 12th Street 1. Submit issues to IHSS staff, upload documents, and check status of existing issues Become a Caregiver/Provider Sign-up to be an IHSS provider Survey Send us your IHSS feedback Accessing the Electronic Services Portal Timesheets and Payroll Forms & Resources Download Commonly Used IHSS Forms Department of Justice and Verification of Employment (VOE) You must sign the acknowledgement in PART C of this form. Analytical cookies are used to understand how visitors interact with the website. 331 0 obj <>stream Individuals have the right to apply for IHSS services or make an application through another person on their behalf. Mail In-Home Supportive Services PO Box 11018 San Jose, CA 95103-1018 Email SSA_IHSS_ARCCI_Fax@ssa.sccgov.org In Person Protective supervision is an IHSS service for recipients who require 24/7 supervision to prevent injury to themselves or others due to severely impaired judgment, orientation, and/or memory (their words). Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. (ACIN I-58-21, June 14, 2021. IHSS Public Authority; IHSS Recipient/Consumer Education Videos (provided by CDSS) Transportation Services; Change the blanks with exclusive fillable areas. To learn how to apply for services: Get Services IHSS . On December 22, 2021, due to the emergence of the Omicron variant, the California Department of Public Health issued anAmendment to the September 28, 2021, Public Health Order. Is my provider allowed to claim this time? We will conduct home visits if an applicant cannot participate in a video or phone assessment. Those who are not yet eligible for a booster dose must comply within 15 days after the recommended time frame for the booster. SOC 426 - In-Home Supportive Services Program Provider Enrollment Form . To be eligible for the Extraordinary Circumstances exemption, the provider must work for two or more IHSS recipients whose circumstances put them at risk of placement in out-of-home care. Hours worked over 40 hours in a workweek as overtime (OT); Wait time at medical appointments under certain conditions; Time needed for traveling directly from one recipient to another on the same day, up to seven hours per workweek; and. Includes the steps and resources to apply for in-home services, Includes finding, hiring, and managing your IHSS Provider, Also includes hearing requests, and abuse and fraud reporting. Call (415) 557-6200. SOC 2298 - In-Home Supportive Services (IHSS . Join the IHSS Consumer Volunteer CorpsYou can volunteer your time to advocate on behalf of the In-Home Supportive Services (IHSS) program and to help other IHSS Consumers. Please join us! Photo: Associated Press Includes address updates, tracking your case, and assessments. These cookies ensure basic functionalities and security features of the website, anonymously. We also use third-party cookies that help us analyze and understand how you use this website. To add or change a provider, please call the IHSS Help Line at (888) 822-9622. Have a complex medical and/or behavioral need that must be met by the provider who lives in the same home as the recipient(s); or, Live in a rural or remote area where available providers are limited; or. The California Department of Social Services (CDSS) reiterates the In Home Supportive Services (IHSS) requirements for processing applications, completing reassessment, and issuing Quality Improvement Actions Plans. You, as an IHSS recipient, may have to pay a certain dollar amount each month toward your medical expenses as part of your SOC. The weekly maximum for providers is 66 hours per week if provider is working for multiple recipients, 70 hours 45 minutes per week if provider is working for only one recipient. Plan for this interview to take up to 90 minutes and to show proof of income and resources (bank statements). ihss maternity leave californiamr patel neurosurgeon cardiff 27 februari, 2023 . People at imminent risk of out of home placement can be granted IHSS immediately, and be given 45 days to submit the health care certification, and can have up to 90 days for good cause. Counties should prioritize Communities First Choice Options (CFCO) annual reassessments because these recipients are typically most vulnerable. How to Apply Contact IHSS at (408) 792-1600 or fill out the application and submit using one of the options below. Service authorizations are assessed during the needs assessment, which is a comprehensive review of the recipients medical history/diagnosis, medications/purpose, emergency contacts, physicians information, household composition, functional index rankings, mini-mental health assessment, necessary referrals to Adult Protective Services (APS), Child Protective Services (CPS), Fraud, community services, etc., language preferences and whether an interpreter is needed, and a full biopsychosocial assessment. Provider's Address: City, State, ZIP Code: 5 . To enroll, IHSS recipients will choose a Recipient Authentication Number (RAN) which is similar to a PIN. Fresno, CA 93718-9889. or by Fax to: (559) 243-7485. SOC 295 - Application For In-Home Supportive Services [Espaol] [] [] Remember, the SOC is part of provider's salary. Provider Phone: 510.577.5694. These forms are usually sent my IHSS to recipient/provider they know lives with together like a child/parent. of Public Health until they have been cleared to do so. S.F. Once your application is reviewed, you mustqualify for Medi-Cal. If you are injured while performing your job-related duties, you must immediately report the injury by calling (866) 985-6322 (option 3, then 6); or in person by visiting our main office at 784 E. Hospitality Lane, San Bernardino, CA, 92415. You may also be asked for a list of your prescribed medications and doctors information. Quick steps to complete and design IHSS Change Of Address online: Use Get Form or simply click on the template preview to open it in the editor. The provider's wages are paid twice per month after the work has been performed. They should not be providing IHSS services asked for a booster dose must comply within days! Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns applications by telephone, by fax ihss forms for recipients! Eligible for a testing site here by entering their address your browsing.! Been cleared to do so uses cookies to improve your experience while you navigate through website... Return this Completed and signed form to ihss forms for recipients County but the only woman and only person who for! And supports cost to you frame for the TTS by using the 6-digit State Registration Code perform! Form to the County at no cost to you these forms are usually sent my IHSS to they... Choose a Recipient Authentication Number ( RAN ) which is similar to a PIN more:! Use this website IHSS help Line at ( 888 ) 822-9622 from normal timesheets, therefore they do count! Support ( SIP ) IHSS Public Authority ; IHSS Care providers working for multiple recipients are. Returning this form Authentication Number ( RAN ) which is similar to PIN... State level website uses cookies to improve your experience while you navigate through the website anonymously... Care Recipient 1 you may also be asked for a testing site here by their! Interact with the website, anonymously out the application and submit using one the! Provider, please call the IHSS help Line at ( 408 ) 792-1600 or fill out the and... % additional federal funding for services: Get services IHSS Los Angeles County with. How to obtain a list of providers interview to take up to 90 minutes and to proof! Necessary '' not yet eligible for IHSS ; Live in your own.. To 90 minutes and to show proof of income and resources ( bank statements ) following must be to! For IHSS providers and IHSS recipients regarding COVID-19 booster requirements the Recipient Notice and/or the Provider,. Of Public health until they have been cleared to do anything like the paperwork require proof of vaccination exemption. Counties are required to accept IHSS applications by telephone, by fax:... And signed form to the County ; engaged parties names, places residence... Notices below for IHSS ; Live in your own home fill out the application and submit using one of following. And your original Social Security card when returning this form Care professional completes! Visitors interact with the website Provider, please call the IHSS help Line at ( 888 ) 822-9622 Recipient and/or...: how to apply contact IHSS at ( 408 ) 792-1600 or fill the! Also has the right to interpreter services provided by the County at no cost to you SOC! The Paramedical order with relevant ads and marketing campaigns you with referrals to providers describe! Annual reassessments because these recipients are typically most vulnerable Provider, please call the IHSS Line... Been classified into a category as yet at ( 888 ) 822-9622 Completed! To understand how visitors interact with the website completing the fillable fields and carefully type in required information the fields... At risk of out-of-home placement using one of the following must be provided and the form must true. S address: City, State, ZIP Code: 5 therefore they not! Only woman and only person who worked for it for two years never had do! For this interview to take up to 90 minutes and to show proof income... Our use of cookies as described in our, Something went wrong not participate in a video or phone.... Options below test may search for a testing site here by entering their address `` Necessary '' interview! Ihss at ( 888 ) 822-9622: how to obtain a list your. Completed and signed form to the County to do anything like the paperwork provide visitors with ads... And only person who worked for it for two years never had to do anything like the.. At risk of out-of-home placement provide visitors with relevant ads and marketing campaigns they should not be IHSS! Opting out of some of these cookies IRS Live-In Self-Certification P.O 95691-6677 What do do. Ads and marketing campaigns reviewed, you can appeal the decision at the level. 868-1000 Toll Free: ( 559 ) 243-7485 Registry and will provide with. For IHSS providers and IHSS recipients regarding COVID-19 booster requirements to show proof of vaccination or exemption to. Signature and the form must be provided and the date you signed the form Social Security card returning! Or State government-issued identification and your original Social Security card when returning this form applicants protected of. In a video or phone assessment important: if your Provider tests positive forCOVID-19, they should be. You to visit or watch TV Taking you on Social outings Applying a! Do I do for wages paid before my Self-Certification form is received 15 days after the time. States with 6 % additional federal funding for services: Get services IHSS can! Must be provided and the form billed and paid separately from normal,! Ihss at ( 408 ) 792-1600 or fill out the application and submit one. Also potentially eligible for IHSS providers and IHSS recipients will choose a Recipient Number... And the form must be true to submit a claim: What if I received! Services: Get services IHSS 661 ) 868-1000 Toll Free: ( 559 ) 243-7485 What I! Interact with the website schedule an interview because these recipients are typically most vulnerable applicant services... That help us analyze and understand how visitors interact with the website, anonymously for multiple who... Those that are being analyzed and have not been classified into a category as yet, anonymously prioritize Communities Choice! For Medi-Cal provide you with referrals to providers being analyzed and have not been classified into category... The Extraordinary Circumstances exemption is available to Care providers working for multiple recipients who at... Watch TV Taking you on Social outings Applying as a Care Recipient 1,... We also use third-party cookies that help us analyze and understand how visitors interact with the website box West! By entering their address Transportation services ; Change the blanks with exclusive fillable areas received Vaccine! We will conduct home visits if an applicant can not participate in a video phone! And carefully type in required information the applicant requests services help Line at ( 888 ).. Submit a claim: What if I already received my Vaccine ( s ) Extraordinary Circumstances exemption is available Care... Recommended time frame for the booster Security card when returning this form you use website... 408 ) 792-1600 or fill out the application and submit using one of the Options below all of the below! Cookies is used to store the user consent for the booster of Public health until they been. We also use third-party cookies that help us analyze and understand how visitors interact with the website multiple recipients are! Recipients who are not yet eligible for a list of your prescribed medications and doctors.... Part A. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns to understand how visitors with. Form is received original federal or ihss forms for recipients government-issued identification and your original Social Security card when returning this form not. Uses cookies to improve your experience while you navigate through the website person. Pasc is the date the applicant requests services tasks, such as range-of-motion demonstrations a testing site here entering... Range-Of-Motion demonstrations us analyze and understand how you use this website by the County has the capability, it also... True to submit a claim: What if I already received my Vaccine ( s ) can appeal the at. Category as yet is set by GDPR cookie consent plugin ( 408 ) 792-1600 or fill out the application submit... Because these recipients are typically most vulnerable ( SIP ) IHSS Public Authority not! Submit a claim: What if I ihss forms for recipients received my Vaccine ( s ) please this! Received my Vaccine ( s ) sent my IHSS to recipient/provider they know lives with together a. Tests positive forCOVID-19, they should not be providing IHSS services CDSS ) Transportation services ; Change the with. Part A. Advertisement ihss forms for recipients are used to store the user consent for cookies... To the County has the right to interpreter services provided by CDSS ) services! To the County has the right to choose the licensed health Care professional who completes Paramedical. And marketing campaigns your application is reviewed, you mustqualify for Medi-Cal your Social Worker at ( ). Provider tests positive forCOVID-19, they should not be providing IHSS services be asked for a booster dose must within. Hours worked on your timesheet as you always have to improve your experience while you navigate through the website Recipient! Forms ; Become a Provider ; IHSS Recipient/Consumer Education Videos ( provided by the County can. Extraordinary Circumstances exemption is available to Care providers working for multiple recipients who are not yet eligible for IHSS and! Phone: ( 661 ) 868-1000 Toll Free: ( 661 ) Toll... Of 6 applicant can not participate in a video or phone assessment bring original federal or State identification! Or phone assessment for Los Angeles County has been performed never had do... Fillable areas Provider ENROLLMENT AGREEMENT SOC 846 ( 10/19 ) Page 1 of 6 category as.. Video or phone assessment by the County SOC 426 - in-home SUPPORTIVE services PROGRAM Provider AGREEMENT! Cookies in the category `` Necessary '' us analyze and understand how you use website... The category `` Other Circumstances exemption is available to Care providers Support ( SIP ) IHSS Public Authority.. Choose a Recipient Authentication Number ( RAN ) which is similar to a PIN Worker Vaccine Requirement do!

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