Get 426a

The 426a form, also known as the IHSS Recipient Designation of Provider, is an essential document for individuals receiving in-home supportive services. This guide provides clear, step-by-step instructions on how to accurately complete this form online to ensure that your chosen provider is properly designated.

Follow the steps to fill out the 426a form online effectively.

1. Press the ‘Get Form’ button to access the 426a form. This will open the document in the online editor for you to begin filling it out.
2. Provide your recipient name in the designated field. Ensure that the name is written clearly without any spelling mistakes.
3. Enter your County IHSS Case Number (#), which can typically be found on past correspondence from the county.
4. Fill in the provider’s name as it appears in official documents. This is crucial for accurate designation.
5. Input the provider’s Social Security Number; double-check for accuracy as this is required for identification purposes.
6. Select the provider’s gender by checking the appropriate box for either Male or Female.
7. Enter the provider’s date of birth in the specified section to confirm their age.
8. Fill in the provider’s address, including city, state, and zip code, ensuring all details are correct.
9. Provide the provider’s telephone number so that the county may contact them if necessary.
10. Indicate the provider’s relationship to you in the section provided, selecting the most appropriate option.
11. Lastly, fill in the provider’s start date, which is when they will begin providing services to you.
12. Once all required sections are completed, review the form for accuracy. After confirming all information is correct, save your changes.
13. After saving, you may download, print, or share the completed form as needed, and ensure it is submitted to the county.

Complete the 426a form online to designate your provider effortlessly.