Get Provider Number In-home Supportive Services Ihss Program - Pascc

This guide provides essential instructions for completing the Provider Number form for the In-Home Supportive Services (IHSS) program online. By following these steps, users can efficiently fill out the necessary information while ensuring compliance with program regulations.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. In the ‘Provider Number’ field, enter your unique provider number, ensuring it is accurate for processing.
3. Complete Section A regarding your work schedule. Here, provide the names of all clients you serve, along with their file numbers and addresses, ensuring that the total hours do not exceed 66 hours in a week.
4. For each client listed, indicate the total hours you plan to work for each day in Column D, and sum these in Column E to reflect the total hours for the week.
5. Proceed to Section B, which covers travel time. Indicate whether you will travel between clients in the same day and, if so, fill in the travel details, including distances and the estimated time required.
6. In Section C, confirm that you have read and understood the requirements outlined. Sign and date the form, ensuring that all provided information is true and correct.
7. Once completed, save any changes made to your document. You can then choose to download, print, or share the form as needed.

Complete your documents online today to ensure timely processing and compliance.