Ihss New Provider Form. Lives with the recipient (s), or. Web complete, sign and return the ihss program provider enrollment form (soc 426) directly to the county ihss office or ihss public authority.
Web go on to the next page provider enrollment form instructions: Lives with the recipient (s), or. Use black or blue ink to fill out. Fill out, sign and return this form in person to the office or location designated by the county. Spanish (pdf) ihss provider direct deposit enrollment/change/cancellation form (soc 829) (pdf) To learn how to apply for services: Armenian | chinese | spanish Web the paper enrollment form is available on the cdss website for those who want to use it. Web if you want to become an ihss provider, you must complete all the steps outlined in the document linked below before you can be enrolled as a provider and receive payment from the ihss program for providing services. For additional guidance, contact your county ihss office or ihss public authority.
Web go on to the next page provider enrollment form instructions: For additional guidance, contact your county ihss office or ihss public authority. This health order does not apply to a provider who: Web these requirements include completing, signing, and returning (in person) the provider enrollment form (soc 426), submitting fingerprints and being cleared of disqualifying crimes through a criminal background check, completing a provider orientation, and returning a signed provider enrollment agreement (soc 846). Web complete, sign and return the ihss program provider enrollment form (soc 426) directly to the county ihss office or ihss public authority. Web the paper enrollment form is available on the cdss website for those who want to use it. Armenian | chinese | spanish The paper enrollment form is available on the cdss website for those who want to use it. Web go on to the next page provider enrollment form instructions: Lives with the recipient (s), or. Use black or blue ink to fill out.
