Ihss New Provider Form

Form SOC846 Download Fillable PDF or Fill Online Inhome Supportive

Ihss New Provider Form. Web if you want to become an ihss provider, you must complete all the steps outlined in the document linked below before you can be enrolled as a provider and receive payment from the ihss program for providing services. Web 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).

This health order does not apply to a provider who: For additional guidance, contact your county ihss office or ihss public authority. Lives with the recipient (s), or. Web complete, sign and return the ihss program provider enrollment form (soc 426) directly to the county ihss office or ihss public authority. The paper enrollment form is available on the cdss website for those who want to use it. Web go on to the next page provider enrollment form instructions: Armenian | chinese | spanish Do not send the form to cdss. Web if you want to become an ihss provider, you must complete all the steps outlined in the document linked below before you can be enrolled as a provider and receive payment from the ihss program for providing services. Web 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).

Use black or blue ink to fill out. Fill out, sign and return this form in person to the office or location designated by the county. For additional guidance, contact your county ihss office or ihss public authority. To learn how to apply for services: Web the paper enrollment form is available on the cdss website for those who want to use it. Web go on to the next page provider enrollment form instructions: Web complete, sign and return the ihss program provider enrollment form (soc 426) directly to the county ihss office or ihss public authority. Do not send the form to cdss. Armenian | chinese | spanish This health order does not apply to a provider who: Web 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).