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Forms

The following “Commonly Used Recipient and Provider State Forms” is available on the California Department of Social Services website at: http://www.cdss.ca.gov/inforesources/Forms-Brochures/Forms-Alphabetic-List/Q-T#soc.

  • Application for In-Home Supportive Services - SOC 295
  • Recipient Responsibility Checklist - SOC 332
  • Provider Enrollment - SOC 426
  • Recipient Designation of Provider - SOC 426A
  • Provider Direct Deposit Enrollment - SOC 829
  • Recipient Request for Provider Assigned Hours - SOC 838
  • Recipient or Provider Change of Address and/or Telephone Number - SOC 840
  • Provider Enrollment Agreement - SOC 846
  • Health Certification - SOC 873
  • Provider Workweek and Travel Time Agreement - SOC 2255
  • Provider Live-In Certification - SOC 2298
  • Provider Live-In Cancellation - SOC 2299
  • Provider Paid Sick Leave Request - SOC 2302
Translated forms are also available at: http://www.cdss.ca.gov/inforesources/Translated-Forms-and-Publications.
The following are Riverside County’s “Commonly Used IHSS Provider Forms”.