Soc 426a

Soc 426a. LAST) SOCIAL WORKER IDENTIFICATION NUMBER. Ubicaciones de Huellas Digitales. xps Created Date: 5/4/2016 10:31:25 AM Title. Read and complete the instructions on the screen by clicking on the CONTINUE TO ENROLLMENT box in the middle of the screen. Use the Cross or Check marks in the top toolbar to select your answers in the list boxes. Click on the New Document button above, then drag and drop the document to the upload area, import Form Details: Released on January 1, 2016; The latest edition provided by the California Department of Social Services; Easy to use and ready to print; Quick to customize; Compatible with most PDF-viewing applications; Fill out the form in our online filing application. ) • SOC 426A, Pagtatalaga ng Provider ng Tumatanggap ng IHSS (kailangan ang bahagi na para sa provider) • W-4, Withholding Allowance Certificate ng Empleyado (opsyonal) • DE-4 State ng Withholding Allowance Certificate ng Empleyado (opsyonal) 2. Ngày Người Phục Vụ Khởi Sự Làm Việc: *CHÚ Ý: Việc thu thập số An Sinh Xã Hội là do yêu cầu của Đạo Luật Cải Cách và Kiểm Soát Nhập Cư của năm 1986, Luật Công Cộng 99-603 (8 USC 1324a), với mục đích kiểm tra căn cước cá nhân và tình trạng được phép làm việc By completing the SOC 426a included in the Agreement, the Recipient or their Authorized Representative (AR) is agreeing to hire their Care Provider. - 5:00 p. Click the New Document option above, then drag and drop the by reviewing the electronic SOC 426A , recipient agreement. Once we receive the completed Recipient Designation of Provider SOC 426A and a completed W-4 from you, you will be linked to the IHSS Recipient's case and issue you electronic timesheets. SOCIAL WORKER NAME. Schedule an appointment. xps. This includes employers who are subject to the Federal Insurance Contributions Act (FICA) and Self-Employment Contributions Act (SECA). **Call or email our office 707-259-8359 / [email protected] for more Jul 22, 2020 · Use Fill to complete blank online CALIFORNIA pdf forms for free. Use these quick links to find the information you are searching for. Step 5: Create an Online Account After completion of all enrollment processes and documents, a cleared background, and a completed SOC 426A that your consumer completes, we can then start the payroll process to issue timesheets. • SOC 426A, Nhân viên phục vụ được chỉ định của IHSS (bắt buộc điền phần nhân viên phục vụ) • W-4, Giấy Chứng Nhận Cho Phép Lưu Giữ Tiền Lương của Nhân Viên (tùy ý) • De-4 Giấy Chứng Nhận Cho Phép Lưu Giữ Tiền Lương của Nhân Viên của tiểu bang (tùy ý) 2. Click ENROLLMENT on the left. Complete the SOC 426A IHSS Program Recipient Designation of Provider Form (the consumer must sign this form). soc 426a (1/16) korean page 1 of 3 가내 지원 서비스(ihss) 프로그램 수혜자 지정 제공자 설명서: • 검은색 또는 파란색 잉크를 사용하십시오. A provider registry is a computerized database listing qualified and screened IHSS providers. más de 40 horas para mí en una semana laboral si mi máximo de horas por semana es 40 horas o menos en una semana laboral. (FIRST. • 당신 (또는 당신의 권한 대리인)은 당신의 승인된 서비스를 제공하도록 누구를 1. Public Authority Services by Sourcewise supports consumers and independent providers of the Santa Clara County In-Home Supportive Services (IHSS) program. Submit all required enrollment forms (packet) in one of the following ways: • Email to: IHSSProviderEnrollment@acgov. Title: SOC 426A (Rev 01-16) RU. Make these fast steps to modify the PDF Soc 838 online for free: Sign up and log in to your account. O. Call IHSS at (408) 792-1600 or fill out the application and send it in by mail, email, fax, or bring it in person to the IHSS office. Viết rõ ràng toàn bộ các thông tin bằng chữ in. California Department of Social Services (CDSS) has revised the attached SOC 862 and three additional forms (IHSS Provider Enrollment Form [SOC 426], IHSS Recipient Designation of Provider [SOC 426A], and Important Information for Prospective • SOC 426A IHSS Recipient Designation of Provider (provider portion required) • W-4, Employee’s Withholding Allowance Certificate (optional) • DE-4 Employee’s Withholding Allowance Certificate State (optional) 2. (g)(2)* del W&IC. Use its powerful functionality with a simple-to-use intuitive interface to fill out Form Ihss form Ihss forms soc 426a online, e-sign them, and quickly share them without jumping tabs. *Para el texto de estas secciones del PC y del W&IC, vea el formulario SOC 426C Title: SOC 426A (Rev 01-16) RU. Isthisindividualunabletoindependentlyperformoneormoreactivitiesofdaily living (e. Contact Public Authority (209) 468-3397 for a list of available Providers. Submit fingerprints and undergo a criminal background check by Quick steps to complete and design Soc 426a online: Use Get Form or simply click on the template preview to open it in the editor. Simplemente haga clic Llevado a cabo mientras esté concluido editando y mejorando y visitar Papeleo para combinar , dividir, fijar o desbloquear el documento. Public Authority is the provider's employer of record for purposes of collective bargaining for wages and benefits. CH. We would like to show you a description here but the site won’t allow us. Add the Soc 838 for redacting. • If I do not get an approved exception, my provider will get a violation for working more than my maximum weekly hours. The Public Authority maintains a provider registry. Violations for Going In-Home Supportive Services (IHSS) Independent Providers. SOC 426A refers to a report form used for reporting occupational injuries and illnesses. Box 1912 Fresno, CA 93718-9889 Your IHSS recipient must complete the Recipient Designation of Provider SOC 426A and return it to the Public Authority to designate you as their provider. (530) 621-6287. Change of Address or Phone (SOC 840) Spanish Application for In-Home Supportive Services - SOC 295; Recipient Responsibility Checklist - SOC 332; Provider Enrollment - SOC 426; Recipient Designation of Provider - SOC 426A; Provider Direct Deposit Enrollment - SOC 829; Recipient Request for Provider Assigned Hours - SOC 838; Recipient or Provider Change of Address and/or Telephone Number Follow these quick steps to modify the PDF Ihss forms soc 426a online free of charge: Sign up and log in to your account. STATE OF CALIFORNIA ­ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES PROVIDER NUMBER. Check the box if you agree Editar soc 426a pdf form. NG D. All forms are printable and downloadable. Ilimbag ang impormasyo nang malinaw. Placerville, CA 95667. Printing and scanning is no longer the best way to manage documents. sfhsa. Follow our step-by-step guide on how to do paperwork without the paper. • I can never authorize my provider to work more than my total authorized monthly service Mar 29, 2020 · This All-County Letter (ACL) provides clarification and guidance to counties regarding administration of the provider enrollment process and flexibility in authorization of adjusted weekly service hours and overtime violations for the In-Home Supportive Services (IHSS) program as it relates to the response to the COVID-19 (also known as Recipient Designation of Provider form (SOC 426A) signed by consumer. You will need to contact the Public Authority at 1-833-423-0816, if you need to reschedule your appointment to complete the IHSS Provider Enrollment Process. • Giấy chứng nhận “được bãi miễn” (waiver) sẽ chỉ cho phép quý vị được đăng ký phục vụ cho SOC 426A (4/12) Parent Child Spouse/Domestic Partner Conservator Guardian Other: _____ IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM RECIPIENT DESIGNATION OF PROVIDER INSTRUCTIONS: † Use black or blue ink. Here you will learn important information about the program and the requirements for you to follow as a provider. 정보를 명확하게 적으십시오. HƯỚ. SOC426A SOC426A. Если исключение для меня не будет утверждено, присматривающий за SOC 847 Important Information For Prospective Providers - IHSS Provider Enrollment Process English Armenian Cambodian Chinese Farsi Korean Russian Spanish Tagalog Vietnamese SAS 426A IHSS Recipient Designation of Provider Final 5-25-17 REQUEST TO DELETE A SERVICE PROVIDER. Send soc426a form via email, link, or fax. Fees vary depending where you choose to get fingerprinted; the costs range from $40 to $90. . Go digital and save time with airSlate SignNow, the best solution for electronic signatures. SSA_IHSS_ARCCI_Fax@ssa. Highest customer reviews on one of the most highly-trusted product review platforms. Complete the SOC 426 form and answer all SOC 426A (1/16) PAGE 3OF 2. Using your home computer, smartphone, or tablet, you can complete all of the required enrollment forms, watch the required orientation videos, and schedule your quick, in-person appointment to provide your ID and Social Security cards to be uploaded into the computer system! This new, streamlined STEP 1. org 426A (RS) (1/16) 2. Bring your original social security card and valid government-issued photo ID to your appointment. 87, are: A felony offense for fraud against a public social services program, as defined in W&IC sections 10980(c)(2)* and (g)(2)*. Sign in to the editor with your credentials or click Create free account to examine the tool’s capabilities. If you have questions about an appeal, call (916) 556-1156. 1. The specific information that must be reported on SOC 426A includes: 1. Tiempo de Procesamiento para Inscripción del Proveedor de IHSS. MGA TAGUBILIN: • Gumamit ng itim o asul na tinta. • Si no recibo la aprobación para una excepción, mi proveedor recibirá una infracción por trabajar más que mi máximo de horas por semana. Get a blank copy of the SOC 426 from the County IHSS Office or Public Authority. Այն անձը, ում ես ընտրել եմ որպես իմ մատակարարող, չի կարող ստանալ դաշնային եւ/ կամ նահանգային գումար ինձ de inscripción para proveedores, el cual incluye completar, firmar y devolver en persona el formulario SOC 426, “Programa de Servicios de Apoyo en el Hogar (IHSS) - Formulario de inscripción para proveedores”, presentar las huellas dactilares, y recibir la aprobación de antecedentes a través de la revisión de antecedentes penales, IHSS Provider Online Enrollment and Orientation. Created Date. The IHSS program provides essential services to eligible individuals who are aged, blind, or disabled to help them live safely in their own homes. The San Joaquin County IHSS Public Authority can help with training in CPR, First Aid & AED, help filling out timesheets, and direct deposit forms. Office Hours: Monday - Friday. 8:00 a. 2. FAX (530) 663-8489. Start completing the fillable fields and carefully type in required information. Share your form with others. – Original IHSS Program Designation of Provider form (SOC 426A) completed by the IHSS recipient – Request For Live Scan Service form for fingerprinting background check. Ụ. Provider Workweek & Travel Agreement (SOC 2255) (required if a Provider works for two or more Recipients) Recipient Documents. Title: SOC 426A. The Public Authority works closely with Siskiyou County IHSS but is a separate entity. • State law requires that you pay the costs for fingerprinting and the criminal background check. Type text, add images, blackout confidential details, add comments, highlights and more. Watch the mandatory videos. San Jose, CA 95103-1018. IHSSPA@edcgov. Больше, чем 40 часов для меня в течение рабочей недели, если разрешенные часы рабочей недели 40 часов или меньше. Once completed you can sign your fillable form or send for signing. If you are a qualified tax professional and looking for information on filing Form 426A, then this blog post is for you. Ẫ. Return the packet to the IHSS office either via mail using the envelope provided in the packet, or in-person. I NH. What is soc 426a form? These requirements include completing, signing, and returning (in person) the Provider Enrollment Form (SOC 426), submitting fingerprints and being cleared of disqualifying crimes through a criminal background check, completing a provider orientation, and returning a signed Provider Enrollment Agreement (SOC 846). Once completed and signed by the Recipient (or their AR), the Hiring Agreement can be submitted by: Mail: County of Fresno Department of Social Services P. current_soc 426a_chinese: 128971: 4/7/2016 7:20:36 pm: 4/7/2016 7:20:36 pm: 居家援助服務 ( ihss ) 計劃 領取者指定的提供者 agency california department of social services soc 426a (ch) (1/16) 父母 子女 配偶/家中伴侶 Step 3: Complete and sign the Provider Enrollment Agreement, SOC 846 available at https://bit. ly/2LYtUEw. For Recipients, if you have any questions regarding your IHSS services or which form (s) may apply to you, please call the IHSS services Line: (916) 874-9471. Make these quick steps to edit the PDF Soc 426 online free of charge: Register and log in to your account. SOC 426A (Rev 01-16) SP. Download a fillable version of Form SOC426A by clicking the link below or The online system will allow you to complete the website orientation and return later to reschedule or change your in-office appointment for your Live Scan fingerprinting. IHSS office location. Step 4: Submit fingerprints and pass a criminal background investigation SOC 426A is a form used for Quarterly Contribution Return and Report of Wages (DET Quarterly Contribution Return and Report of Wages). Complete CA SOC 426A (Tagalog) 2009-2024 online with US Legal Forms. MIDDLE. IHSS Xin Giấy Bãi Miễn Cho Người Phục Vụ” (Mẫu SOC 862) về Văn Phòng IHSS hoặc cho Giới Thẩm Quyền Công Cộng Về IHSS của Quận-Hạt. org The SOC 426A form is required to be filed by employers who are subject to the Social Security Employer Wage Reporting rules. Utilize the Circle icon for other Yes/No SOC 426A (1/16) PAGE 3OF 2. I know an IHSS consumer who wants me to be their Independent SOC 295 (9/18) Page 1 of 8 To the Applicant: All sections of this form must be completed. • Provider cannot be paid federal and/or state money for providing services until completion of all the provider enrollment requirements. RECIPIENT INFORMATION . When you call please have your new provider's first and last name or provider number and your case number. More than 40 hours for me in a workweek if my maximum weekly hours are 40 hours or less in a workweek. complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority. ՍՏԱՑՈՂԻ ՊԱՅՄԱՆԱԳԻՐ. PO Box 11018. IHSS Fraud Hotline: 1- (888) 717-8302, Tier 2 crimes , as set forth in W&IC section 12305. ՄԱՍ B. • Ikaw (o ang iyong pinahintulutang kinatawan) ay dapat punan ang BAHAGI A ng pormularyong ito (SOC 426A-SPAN) Formulario de Designación de un Proveedor por el Beneficiario (The SOC 426A Form is applicable only if you are already providing services to an IHSS Recipient. Use its powerful functionality with a simple-to-use intuitive interface to fill out Provider enrollment form soc 426 online, design them, and quickly share them without jumping tabs. C V. state of california - health and human services agency california department of social services soc 426a (1/16) cambodian ទំព័រទី2 នៃ 3 10. I PH. SOC 839 (Sp) Soc 839. Save or instantly send your ready documents. pdf (California) form is 3 pages long and contains: SOC 426A (Spanish) IHSS Program Recipient Designation of Provider form. Individuals can enter their 5-digit ZIP code to be connected to their county Adult Protective Services staff, 7 days a week, 24 hours a day. A Provider is one who is providing services to an IHSS Recipient in their home. IHSS, In home suppotive services a program Soc 426A Form PDF Details. (for county use only) state of california - health and human Adult Protective Services hotline: 1- (833) 401-0832. Email. This step includes an electronic signature by you (the recipient) stating you have reviewed the declaration and acknowledge that you understand the terms and conditions of the agreement , and that the information entered is true and correct. SOC 426A- In-Home Supportive Services (IHSS) Program Recipient Designation of Provider Form: Your client must sign and date the last page. Easily fill out PDF blank, edit, and sign them. Go to an IHSS Provider Orientation given by the county. Fill out an application. Here we will provide an overview of the Soc 426A form, as well as offer helpful tips to make sure your filing process goes smoothly. Steps to Enroll. Formulario de Designación de un Proveedor por el Beneficiario (SOC 426A) description. Print information clearly. It is primarily used by employers to report the wages paid and the taxes withheld from their employees during a specific quarter. Box 1912 Fresno, CA 93718-9889 SOC 426A (1/16) (Armenian) PAGE 1 OF 3. Read the information carefully before you complete the form. ԵՍ ՀԱՍԿԱՆՈՒՄ ԵՎ ՀԱՄԱՁԱՅՆ ԵՄ ՈՐ. *See attached form SOC 426C for the text of these Apr 11, 2012 · A copy of the SOC 857A should be retained in the recipient’s case file along with the invalid SOC 862. 03. Create an account (Important! be sure to write down your username, password, and answers to the security questions). Add the Ihss forms soc 426a for redacting. Identifying information: This includes the name, address, and contact details of the employer. RecipientsIn Home Supportive Services (IHSS) is designed to allow persons with significant disability to reside within their own homes by having support for personal care and/or household needs. SOC 426A (1/16) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider SOC 426C (10/10) - In-Home Supportive Services (IHSS) Program California Code Sections SOC 431 (5/03) - Personal Care Services Program Contract Agency Enrollment Spanish Forms/Handouts. description. Una lista completa de los Delitos de Nivel 2 está disponible si la solicita a la Oficina de IHSS del Condado o a la Autoridad Pública de IHSS. Add the Soc 426 for redacting. Complete, sign and return the IHSS Program Provider Enrollment Form (SOC 426) directly to the County IHSS Office or IHSS Public Authority. g. Regarding your Social Security Number, it is mandatory that you provide your Social Security Number(s) as required California Department of Social Services Adult Programs Branch IHSS Provider Enrollment Appeals, MS 19-04 PO Box 944243 Sacramento, CA 94244-2430. Sign in to the editor using your credentials or click on Create free account to examine the tool’s functionality. Mail. PAGE 2. Recipient Notice (Temp 3002) (notice sent to all Recipients) How to Become an IHSS Provider. us. Sign it in a few clicks. CH V. *** To request a form, call 415-557-6200 or visit www. 2/27/2017 3:18:09 PM. In-Home Supportive Services. IHSS provider enrollment form, also known as the In-Home Supportive Services Provider Enrollment Agreement (SOC 426A), is a document used by the California Department of Social Services (CDSS) to enroll individuals as providers in the IHSS program. Poner y cambiar mensaje de texto, colocar nuevos elementos, reorganizar páginas web, añadir marcas de agua y sitio cifras, y más. In-Home Supportive Services (IHSS) Program Recipient Designation of Provider (SOC 426A) is a crucial document issued by the Department of Social Services for California participants in the IHSS program. Once you have hired an IHSS provider it is very important that you: Call our office (831) 454-4101 to request a IHSS Recipient Designation of Provider form (SOC 426A) so your new provider can receive his/her time sheets. xps Created Date: 2/27/2017 5:38:50 PM By completing the SOC 426a included in the Agreement, the Recipient or their Authorized Representative (AR) is agreeing to hire their Care Provider. • SOC 426A IHSS Recipient Designation of Provider (provider portion required) • W-4, Employee’s Withholding Allowance Certificate (optional) • DE-4 Employee’s Withholding Allowance Certificate State (optional) 2. These requirements include completing, signing, and returning (in person) the Provider SOC 426A (1/16) Page 3 of 3 • If my provider works for another recipient, the maximum number of hours that he/she may claim in a workweek for all of the time he/she works for his/her recipients combined is (begin underline) 66 (end underline) 66hours. SOC 873 Health Care Certification Form. 00 in Cash, Money Order, or Cashier’s check payable to “Kingdom Security” Complete “Recipient Designation of Provider” form (SOC 426A) with your IHSS recipient. Change of Address or Phone (SOC 840) English. The SOC 846 states that the provider understands and agrees to the rules of the IHSS program and the responsibilities of being an IHSS provider. Child Abuse hotline: California Counties Child Abuse Reporting Telephone numbers links. With DocHub, making changes to your paperwork takes only some simple clicks. ẬN HƯỞ. The SOC426A SOC426A. I must make a work schedule for my provider to determine how SOC 846 (11/15) PAGE 3 OF 6. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. org Fraude en contra de un programa del gobierno para el cuidado de la salud o de servicios de apoyo. org **Name on the ID and Social Security card must match; photocopies are not accepted. Information provided is subject to verification. 02. As of October 1, 2021, new providers who submit a Provider Enrollment Agreement Form SOC 846 as part of the IHSS provider enrollment process must present original identification documents. Ị. Sign in to the editor using your credentials or click on Create free account to examine the tool’s capabilities. Provider Registry. SOC 426A (SP) (1/16) PAGE 3 OF 3 2. Recipient’s Name: soc 426a (1/16) page 2 of 3 (soc 426) (soc 846) ihss ihss ihss ihss ihss ihss (soc 2271): 4-4 1. ***If you are in need of a recipient and want to be placed on the Provider Registry List, please contact the San IHSS recipients are still required to complete Recipient Designation of Provider Form SOC 426A. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. SOC 426A (1/16) - VIETNAMESE CHƯƠNG TRÌNH DỊCH VỤ TRỢ GIÚP TẠI NHÀ (IHSS) NGƯỜ. b. Download In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider (SOC 426A) – Department of Social Services (California) form SOC 332 IHSS Recipient/Employer Responsibility Checklist (PDF, 41 KB) SOC 426A Recipient Designation of Provider form ( PDF , 56 KB) SOC 426A Recipient Designation of Provider form in Spanish ( PDF , 46 KB) TAGALOG PAHINASOC 426A (1/16) 1 NG 3 PROGRAMA NG SERBISYONG PANTAGUYOD SA LOOB NG TAHANAN (IHSS) PAGTATALAGA NG TAGABIGAY PARA SA TAGATANGGAP. If you have any other questions about the SOC 426, ask your county IHSS Office or IHSS Public Authority. Isumite ang lahat ng kinakailangang form para sa pag-eenroll (packet) sa SOC 426A (1/16) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider ; SOC 426C (10/10) - In-Home Supportive Services (IHSS) Program California Code Sections ; SOC 445 (6/99) - Medi-Cal Recovery For The Personal Care Services Program ; SOC 450 (2/23) - Voluntary Services Certification Apr 12, 2019 · We would like to show you a description here but the site won’t allow us. • I can never authorize my provider to work more than my total authorized monthly service If you would prefer to update your address and/or phone number by submitting the SOC 840, please submit your completed & signed form by USPS mail, fax or Secure Document Submission. RECIPIENT’S OR LEGALLY AUTHORIZED REPRESENTATIVE’S SIGNATURE: DATE: PRINTED NAME: SOC 426A (4/12) Title: SOC 426A. SOC 838 (10/12) We would like to show you a description here but the site won’t allow us. NOTE: Retain your copy of your completed application. org. Complete the yellow highlighted area only $40. Edit your soc 426a online. The Provider Registry recruits and maintains a database of providers who are able to provide in home care to In-Home Supportive Services (IHSS) Recipients in our community. pdf Created Date: 5/4/2016 10:31:25 AM UNDERSTAND AND AGREE that the county can provide information about my authorized services and service hours to the provider named above. Return the SOC 426A and photocopies of your valid government issued Photo ID and Social Security card (also bring originals for verification) to the IHSS Office or Public Authority (PA) • Have the recipient complete and sign the IHSS Program Recipient Designation of Provider (SOC 426A) form, which includes your actual start date. pdf Created Date: 2/27/2017 5:38:50 PM Go digital and save time with airSlate SignNow, the best solution for electronic signatures. Download SOC 426A - In-Home Supportive Services Program Designation of Provider – Public Social Services (Los Angeles County, CA) form SOC 426 (6/16) - In-Home Supportive Services (IHSS) Program Provider Enrollment Form ; SOC 426A (1/16) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider; SOC 426C (10/10) - In-Home Supportive Services (IHSS) Program California Code Sections; SOC 445 (6/99) - Medi-Cal Recovery For The Personal Care Services Program 3057 Briw Road. m. Formulario de Depósito Directo (SOC 829) • SOC 426A IHSS Recipient Designation of Provider (provider portion required) • W-4, Employee’s Withholding Allowance Certificate (optional) • DE-4 Employee’s Withholding Allowance Certificate State (optional) 2. ) Get fingerprinted before your appointment and bring the copy of your Live Scan Form receipt Feb 28, 2023 · We would like to show you a description here but the site won’t allow us. , eating, bathing, dressing, using the toilet, walking, etc. SOC 839 In-Home Supportive Services (IHSS) Designation of Authorized Representative. Hire a Care Provider. Ỉ ĐỊNH NGƯỜ. N: • Xin dùng mực đen hoặc xanh. If you wish to become a Public Authority Registry Provider: Request and complete a Registry Application packet, available through Public Authority SOC 847 (5/16) PAGE 1 OF 4 STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY. Complete and sign the IHSS Program Provider Enrollment Form (SOC 426), and return it in person to the County IHSS Office or IHSS Public Authority. sccgov. pdf (California) On average this form takes 5 minutes to complete. zk pz bc vi wq dc ms un ph mi