Recipient designation 2026

1. Click ‘Get Form’ to open the recipient designation form in the editor.
2. In PART A, clearly print your name and county IHSS case number. Then, provide the provider's name, address, telephone number, date of birth, and Social Security number. Ensure all information is accurate.
3. Indicate the provider's gender by checking the appropriate box and specify their relationship to you if applicable. Select a start date for when you wish the services to begin.
4. Review PART B carefully. Understand that your chosen provider must complete enrollment requirements before receiving payment for services.
5. Finally, sign in PART C to acknowledge your understanding of the requirements and return the completed form to your county office.

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