Get Soc 839

Filling out the Soc 839 form is an important step in designating an authorized representative for the In-Home Supportive Services program. This guide provides clear, step-by-step instructions to help users easily navigate the online form and understand its components.

Follow the steps to complete the Soc 839 form online.

1. Press the ‘Get Form’ button to obtain the Soc 839 form and open it for editing.
2. Enter the applicant/recipient’s name, IHSS case number, and date at the top of the form.
3. In PART A, designate the authorized representative by providing their name, street address, city, zip code, and telephone number.
4. Answer the questions in PART A regarding any Tier 1 or Tier 2 crimes the authorized representative may have been convicted of in the past 10 years by selecting 'Yes' or 'No.'
5. Review PART B to understand the functions your authorized representative can perform, then give consent for them to act on your behalf for the IHSS program.
6. If necessary, complete PART C to appoint a separate authorized representative to sign timesheets and other provider-related documents, specifying the tasks they are authorized to perform.
7. In PART D, sign and date the acknowledgment to confirm that the information provided is accurate, and ensure that it is signed by the authorized representative as well if applicable.
8. After completing the form, submit it to your county social worker for processing.

Complete your Soc 839 form online today to ensure the timely designation of your authorized representative.