Soc426a 2026

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4.8 out of 5

83 votes

The document is an enrollment form for providers in the In-Home Supportive Services (IHSS) program by the California Department of Social Services. It outlines eligibility criteria, particularly regarding criminal convictions that may disqualify individuals from becoming providers. The document specifies two tiers of exclusionary crimes, details the process for background checks, and explains how individuals with certain convictions may seek exemptions or exceptions to qualify as providers. Additionally, it includes instructions for completing the form and emphasizes the importance of providing accurate information.

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Click ‘Get Form’ to open the soc426a in the editor.
Begin with PART A, where you will enter your full name, date of birth, and contact information. Ensure all details are clear and accurate.
In PART B, answer the questions regarding your criminal history by marking the appropriate boxes. If applicable, provide documentation for any rehabilitation certificates.
Proceed to PART C and read through the declaration carefully. Sign and date the form to confirm your understanding and agreement with the terms outlined.
Once completed, submit the form in person at your designated County office along with a government-issued ID and Social Security card.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (83 Votes)
2012	4.1 Satisfied (51 Votes)

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soc426a

Soc426a ihss SOC 426A english SOC 426A pdf SOC 426A Spanish Ihss soc 426a form online SOC 426A Chinese IHSS Recipient Designation of Provider Form (SOC 426A) Soc426a requirements

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