Recipient Forms

Frequently used 

SOC 295

Application for In-Home Supportive Services

English     Spanish

SOC 839

Designation of Authorized Representative
English     Spanish

SOC 332

Recipient / Employer Responsibility Checklist

English     Spanish

SOC 426 (a)

Recipient Designation of Provider

English     Spanish

SOC 873

Health Care Certification Form

English     Spanish

SOC 2327

Right to File a Sexual Harassment Complaint

English     Spanish

Recipient Educational Forms

Overview of IHSS Program

English     Spanish

Recipient Educational Forms

IHSS Authorized Tasks

English     Spanish

Recipient Educational Forms

Paramedical Services

English     Spanish

Recipient Educational Forms

Functional Index Rankings and Hourly Task Guidelines

English     Spanish

Recipient Educational Forms

Share of Cost
English     Spanish

Recipient Educational Forms

Telephone Timesheet System
English     Spanish