IHSS is a program intended to enable aged, blind, and disabled individuals who are most at risk of being placed in out-of-home care to remain safely in their own home by providing domestic/related and personal care services.
In-Home Supportive Services (IHSS) Program - California Dept.
You must submit a completed Health Care Certification form. A county social worker will interview you at your home to determine your eligibility and need for IHSS.
To the Applicant: All sections of this form must be completed. Information provided is subject to verification. NOTE: Retain your copy of your completed application.
IHSS is a program intended to enable aged, blind, and disabled individuals who are most at risk of being placed in out-of-home care to remain safely in their own home by providing domestic/related and personal care services.
Recipient Forms - Department of Public Social Services
If you need assistance completing any of these forms, please contact the IHSS Helpline at (888) 822-9622. You have the right to interpreter services provided by the County at no cost to you.
Basic ADLs are: eating, bathing, dressing, using the toilet, walking, and getting out of bed or a chair. Other ADLs are: housekeeping, preparing meals, shopping for food or other necessities, taking medication, etc. Attached is a blank copy of the Health Care Certification Form (SOC 873) that you can give to your LHCP to complete.
In-Home Supportive Services Plus - DHCS
The IHSS Plus Program pays enrolled care providers, including parents or spouses, to provide services to qualified Medi-Cal recipients. Eligibility for program participation includes persons who are 65 years or older, blind, or disabled who might be placed in an out-of-home care facility.
IHSS Forms - San Bernardino County, California
The IHSS Program is a federal, state and locally funded program designed to help pay for services provided to you so that you can remain safely in your own home. You may be eligible if you are 65 years of age, disabled, or blind. Disabled children are also eligible for IHSS.
IHSS Forms & Documents | Humboldt County, CA - Official Website
Browse through forms and documents helpful to consumers and providers.
Forms | Contra Costa IHSS Public Authority
Provider Workweek & Travel Time Agreement (Required when provider works for more than one recipient and/or is claiming travel time.) Recipient and Provider Workweek Agreement (Required when a recipient has more than one provider.) Live-in Certification form.
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