Ihss Referral FormFill Out and Use This PDF 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the IHSS Applicant section. Enter the applicant's last name, first name, middle initial, and contact information including street address, zip code, phone number, and email.
  3. Indicate the applicant's gender identity and sex at birth. Provide details about sexual orientation and ethnicity as required.
  4. Complete the Referent Information section if applicable. Include the referent's name, relationship to the applicant, and agency details.
  5. In the Residence/Discharge Information section, specify living situation details such as whether the applicant lives alone and their current status (e.g., at home or hospitalized).
  6. Fill out emergency contact information and provide any medical or mental health information relevant to the application.
  7. Finally, review all sections for completeness before submitting your form through our platform.

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM. PROVIDER ENROLLMENT FORM.
Cost Per Hour Continues to Increase. As shown in Figure 2, the average IHSS hourly wage has increased by 5.7 percent annually since 2014. The growth in IHSS hourly wages in part is due to increases to the state minimum wagefrom $8 per hour in January 1, 2014 to $16.50 per hour in January 1, 2025.
The information you provide on the Provider Enrollment Form (SOC 426) will be verified by a criminal background check by the California Department of Justice (DOJ). The criminal background check is required to be a provider (See Step 2).
SOC 2298 allows providers to self-docHub their living arrangements in order to claim the exclusion. SOC 2298 must be completed, signed, and returned to the State at the address provided.
Effective 4/1/25, the monthly income limit for the IHSS program for a single applicant is $1,801. When both spouses are applicants, there is a couple income limit of $2,433 / month.

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How did this happen? Caregivers and our advocates made sure the American Rescue Plan Act (ARPA) included funding to give IHSS providers Heroes Pay: a one-time payment of $500 to any IHSS provider who worked a minimum of two months between March 2020 and March 2021.
You must have a physician or other licensed health care professional fill out a Health Care Certification (SOC 873) form and you must return it to the county before care services can be authorized. You will be notified if your application for IHSS has been approved or denied.
Certain criminal convictions will disqualify you from serving as an IHSS provider. Under California law (Welfare Institutions Code 12305.81), permanent exclusions apply for convictions related to: Abuse of a child or elder. Violent felonies, including homicide and assault.

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