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Click ‘Get Form’ to open the SOC 426 in the editor.
Begin with PART A: PROVIDER INFORMATION. Fill in your full name, date of birth, gender, and addresses using black or blue ink. Ensure all information is printed clearly.
Next, provide your contact details including telephone number and email address. Don’t forget to include your Social Security Number as required by law.
Move on to PART B: PROVIDER DISCLOSURE. Answer the questions regarding any convictions for Tier 1 or Tier 2 crimes by checking the appropriate boxes.
In PART C: PROVIDER DECLARATION, read through the statements carefully and sign to confirm your understanding and agreement with the terms outlined.
Once completed, return the form in person along with your identification and Social Security card to the designated county office.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (83 Votes)
2012	4.4 Satisfied (56 Votes)
2011	4.3 Satisfied (52 Votes)

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What is soc426?

A felony offense for fraud against a public social services program, as defined in W&IC sections 10980(c)(2)* and (g)(2)*. A complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority. *See attached form SOC 426C for the text of these PC and W&IC sections.

Where do I send my Soc 295?

How do I apply? Call our office at (831) 454-4101 or (831) 763-8800, option 2. Email application (SOC295) to SOC295@santacruzcounty.us. Fax application (SOC 295) to (831) 763-8906. Mail application (SOC 295) to: IHSS Intake. P.O. Box 1320. ... Walk-in to one of our locations: 18 W. Beach Street, Watsonville, CA 95076, or.

How do I add a new provider to IHSS?

To add or change a provider, please call your provider clerk. All new IHSS providers (i.e., providers who are not currently working for any consumers) must be enrolled with the county before they are eligible for payment through the IHSS Program.

soc 426 form

SOC 846 SOC 426a PDF Where can i get the SOC 426 form SOC 426A english where to mail form (soc 426a) SOC 426 Spanish IHSS Provider enrollment form SOC 846 IHSS Provider application online

Can a wife be a IHSS provider for her husband?

In-Home Supportive Services (IHSS) This program is available to low-income families and allows them to choose who they hire to provide these services, which can include family (such as a spouse) and friends.

Where do I send my Soc 426?

WHERE DO I RETURN THE SOC 426? After you have completed and signed the SOC 426, you must return it IN PERSON to the county IHSS office or county Public Authority. You will have to show identification (ID) when you return the SOC 426.

What is soc426?

A felony offense for fraud against a public social services program, as defined in W&IC sections 10980(c)(2)* and (g)(2)*. A complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority. *See attached form SOC 426C for the text of these PC and W&IC sections.

How does a IHSS recipient add a provider?

To add or change a provider, please call your provider clerk. All new IHSS providers (i.e., providers who are not currently working for any consumers) must be enrolled with the county before they are eligible for payment through the IHSS Program.

Can an IHSS recipient have more than one provider?

If you work for one recipient and that recipient has other providers, your recipient must make a work schedule for you and the other providers to determine how many hours each of you will work. Your recipient may divide his/her total authorized hours among his/her providers as he/she sees fit.

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How can I eSign my ihss form soc 426a in Word?

Can I print my ihss provider application form and finish it on my own?

What is soc426?

Where do I send my Soc 295?

How do I add a new provider to IHSS?

People also ask

Can a wife be a IHSS provider for her husband?

Where do I send my Soc 426?

What is soc426?

How does a IHSS recipient add a provider?

Can an IHSS recipient have more than one provider?

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