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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.

The following “Commonly Used Recipient and Provider State Forms” is available on the California Department of Social Services website. Click here to be redirect to the California Department of Social Services website.

  • 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
Click here to view other translated forms.
The following are Riverside County’s “Commonly Used IHSS Provider Forms”.