This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Social Security Form For Caregiver With Dependents In San Bernardino
Category:
State:
Multi-State
County:
San Bernardino
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
You (as the consumer/recipient), your family, friends, physicians or anyone who has knowledge about your needs can make a referral to IHSS by calling. Call: You must make a referral for IHSS to the San Bernardino County Department of Aging and Adult Services by calling the IHSS Central Intake Unit at (877) 800-4544.
You (as the consumer/recipient), your family, friends, physicians or anyone who has knowledge about your needs can make a referral to IHSS by calling. Call: You must make a referral for IHSS to the San Bernardino County Department of Aging and Adult Services by calling the IHSS Central Intake Unit at (877) 800-4544.
Of those who do get approved, it can take anywhere from two weeks to several months to finally receive benefits. This is due to the meticulous amount of paperwork involved, as well as the process of the case worker assessment, background check, and other procedures.
You May Be Eligible For IHSS If You: Are 65 years of age, disabled or blind. Have a functional impairment and are at risk for out of home care placement.
How to Become an IHSS Provider Go to an IHSS Provider Orientation given by the county. Complete, sign and return the IHSS Program Provider Enrollment Form (SOC 426) directly to the County IHSS Office or IHSS Public Authority. Complete and sign the IHSS Provider Enrollment Agreement (SOC 846) .
How do I request a change of address? Complete the IHSS Change of Address/Telephone (SOC 840) form and send it to the appropriate DAAS office or the Public Authority.
Phone. Call (800) 339-4661 to apply with Call Center staff.