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Ihss Referral FormFill Out and Use This PDF 2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- Indicate the applicant's gender identity and sex at birth. Provide details about sexual orientation and ethnicity as required.
- Complete the Referent Information section if applicable. Include the referent's name, relationship to the applicant, and agency details.
- 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).
- Fill out emergency contact information and provide any medical or mental health information relevant to the application.
- Finally, review all sections for completeness before submitting your form through our platform.
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