SOC 839 IHSS Designation of Authorized Representative, Spanish 2026

See details

4.7 out of 5

39 votes

The document provides instructions for designating an authorized representative for the In-Home Supportive Services (IHSS) program in California. It outlines the eligibility criteria, roles, and responsibilities of the authorized representative, including limitations based on criminal history. The form allows applicants or beneficiaries to select a representative who can act on their behalf in various administrative functions related to IHSS.

Here's how it works

01. Edit your soc 839 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send soc 839a via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out SOC 839 IHSS Designation of Authorized Representative, Spanish with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the SOC 839 IHSS Designation of Authorized Representative in the editor.
Begin by filling in the applicant or beneficiary's name, IHSS case number, and date at the top of the form.
In PART A, designate your authorized representative by entering their name, address, and phone number. Ensure they meet the age requirement of 18 years or older.
Review PART B to understand the functions your representative can perform on your behalf. This includes scheduling interviews and submitting forms.
If applicable, complete PART C to allow your representative to sign reports related to hours worked by providers.
Finally, sign PART D to acknowledge that all information provided is accurate before submitting the form to your county social worker.

Start using our platform today for free to streamline your document editing and signing process!

See more SOC 839 IHSS Designation of Authorized Representative, Spanish versions

We've got more versions of the SOC 839 IHSS Designation of Authorized Representative, Spanish form. Select the right SOC 839 IHSS Designation of Authorized Representative, Spanish version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.7 Satisfied (39 Votes)
2012	5 Satisfied (41 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a SOC 839 form?

This form allows the IHSS applicant/recipient or his/her legal representative to. choose an Authorized Representative for the IHSS program and identifies the functions the Authorized Representative may perform on his/her behalf. This form is only for the IHSS program.

What is an authorized representative for IHSS?

What is an authorized representative (AR)? Authorized representative means an individual designated by the member, or by the parent or guardian of the member, if appropriate, who has he judgment and ability to assist the member in acquiring and receiving services as defined in Colorado regulation.