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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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Under the law, you are ineligible to work in the IHSS program ONLY if you have been convicted within the last 10 years of: 1) fraud against a government health care or supportive services program; 2) child abuse; or 3) abuse of an elder or dependent adult.
To be eligible for IHSS, an individual must be Medi-Cal eligible or must be receiving Supplemental Security Income (SSI) benefits. The IHSS program provides payment for non-medical in-home care for qualified individuals who are unable to remain safely in their homes without this assistance.
Become a Provider Step 1: Set up Your Account. Visit the IHSS enrollment website and. Step 2: Get Fingerprinted. Step 3: Attend the In-Person Orientation. Step 4: Fill Out and Return the SIP Packet. Step 5: Create an Online Account.
MY PHONE: Call 510-577-1800 weekdays from AM - 12 Noon or - PM. Once you dial, when prompted, press “1” for English and then “1” for applying for IHSS and “1” a third time to speak with an intake screener. 2. BY MAIL: Request an application to be mailed to client's home.
Eligibility. To become an IHSS Provider, you must: Complete and sign all mandatory forms included in the IHSS Program Provider Enrollment Packet and return it to the County IHSS Office. Be fingerprinted and go through a criminal background check by the California Department of Justice (DOJ).
Submit a completed and signed Application for In-Home Supportive Services SOC 295 to: IHSSSOC295Apps@acgov.
Caregiver Consent Form. A Caregiver Consent Form, prepared in advance, assures that the caregiver will be able to make medical decisions guided by health care professionals in your absence.
The form is also called a "Caregiver Authorization Affidavit." The form says you are sharing medical and educational decision-making power with the caregiver you name. You can find instructions from the Massachusetts Probate Court on how to fill out the form.
A Caregiver's Affidavit will allow you to 1) enroll the child in school and 2) if you are a relative, consent to medical care on behalf of the child. If you are not a relative, you may consent to school-related medical care only and it is recommended that you obtain legal guardianship.
A guardian is different from a caregiver because when a child has a caregiver, either the caregiver or the parent can make decisions for the child. When a child has a guardian, only the guardian, not the parent, can make decisions.