Get Ca Soc 2255 2015-2026

The CA SOC 2255 is an essential form for providers in the In-Home Supportive Services (IHSS) program to outline their workweek and travel time agreements. This guide offers a clear and supportive approach to filling out this form efficiently and accurately online.

Follow the steps to complete the CA SOC 2255 online.

1. Press the ‘Get Form’ button to obtain the CA SOC 2255 form and open it in your online document editor.
2. Enter your provider name in the designated field at the top of the form. Ensure your name is spelled correctly to avoid complications.
3. Fill in your provider number in the appropriate section just below your name. This is important for identification purposes.
4. In Part A, begin your workweek schedule. Start by writing down the names of all recipients you provide services for in Column A.
5. Enter each recipient's case number in Column B. This information helps link your services specifically to each person you care for.
6. Provide the addresses of each recipient in Column C. Accuracy is key for proper service delivery.
7. In Column D, indicate the number of hours you plan to work each day for each recipient. Make sure the total does not exceed the authorized hours.
8. Calculate the total weekly hours for each recipient in Column E by summing the daily hours entered in Column D.
9. At the bottom of Column E, calculate and write the combined total number of hours you will work across all recipients.
10. Proceed to Part B if you plan to travel between recipients. Indicate your travel intentions with a 'yes' or 'no' response.
11. Complete the travel time section by estimating the time and distance between recipients in the provided columns.
12. In Part C, declare your agreement to the requirements outlined in the document by signing and dating where indicated.
13. Finally, review all entries for accuracy, then save your changes, download, print, or share your completed CA SOC 2255 form as needed.

Start completing your CA SOC 2255 form online today to ensure compliance with IHSS program requirements.