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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.9 Satisfied (47 Votes) |
The form is used to request the termination of a care provider's employment under the In-Home Supportive Services (IHSS) program.
The form must be completed accurately, signed, and dated to avoid delays in processing the request.
Users must provide detailed information about the recipient, including their name and case number.
The form requires specific details for each provider being terminated, including their name, last day worked, and hours worked in the month.
To re-hire a care provider after termination, a new Enrollment Packet must be completed by the recipient.
Completed forms should be submitted to the Fresno County Department of Social Services via mail or fax.
For further assistance, users can contact the department at (559) 600-6666 or visit their website for more information.
