Pasc application 2025

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4 out of 5

47 votes

The document is an application form for consumers seeking services from the PASC Homecare Registry, specifically for In-Home Supportive Services (IHSS). It collects personal information, service needs, and preferences of consumers to facilitate referrals to homecare providers. The document outlines the responsibilities of both the consumer and the registry, including a release agreement that limits the registry's liability. Additionally, it includes sections for emergency contacts and authorization for information release related to IHSS.

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Click ‘Get Form’ to open the pasc application in the editor.
Begin by entering your personal information, including your first name, last name, and middle initial. Ensure that you complete at least one of the identification items such as your IHSS Case number or Social Security number.
Fill in your contact details, including phone numbers and email address. Provide your home address along with city, state, and zip code.
Indicate your gender and date of birth if comfortable. You may also specify your race/ethnic group and languages spoken for statistical purposes.
List emergency contacts with their names and phone numbers for health-related emergencies.
Select the IHSS services authorized for you by checking the relevant boxes. If you require a provider with special skills, specify those needs in the provided space.
Complete the work schedule section by marking the days and times you need services. Finally, review all information before signing to certify its accuracy.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (80 Votes)
2009	4 Satisfied (47 Votes)

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What is PASC used for?

The Personal Assistance Services Council (PASC) strives to improve In-Home Supportive Services (IHSS), support independence, and enhance the quality of life for all who receive and provide In-Home Supportive Services.

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