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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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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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Effective 4/1/24, the monthly income limit for the IHSS program for a single applicant is $1,732. When both spouses are applicants, there is a couple income limit of $2,352 / month.
To enroll as an IHSS Provider: Go to the IHSS Independent Provider Enrollment Center for Santa Cruz County Website. Click on the “Start” button and complete the Provider Information section. Click on the “Watch the Orientation Video” button and watch the mandatory provider videos.
You can get 283 hours (the maximum) per month if: You are in the CFCO, IPO, or IHSS-R subprogram, you get protective supervision, and you are “severely impaired,” or. You need at least 283 hours per month in IHSS services. For example, you get non-medical personal care, related, paramedical, and/or other IHSS services.
Postal service: IHSS, PO Box 11018 San Jose, CA 95103-1018. Fax: (408) 792-1601. In-person: 353 W. Julian Street, San Jose.
Go to an IHSS Provider Orientation given by the county. Here you will learn important information about the program and the requirements for you to follow as a provider. Complete, sign and return the IHSS Program Provider Enrollment Form (SOC 426) directly to the County IHSS Office or IHSS Public Authority.
The maximum amount of IHSS hours an individual can get is 283 hours per month. These programs are: Personal Care Services Program (PCSP) Community First Choice Option (CFCO)
You are blind, live with a disability or are 65 years of age or older. You must live at home in Santa Clara County. You must have Medi-Cal. Apply for Medi-Cal.
How do I apply? Call our office at (831) 454-4101 or (831) 763-8800, option 2. Email application (SOC295) to ALTC_Support_Staff@santacruzcountyca. Fax application (SOC 295) to (831) 763-8906. Mail application (SOC 295) to: IHSS Intake. Walk-in to one of our locations: 500 Westridge Drive, Watsonville, CA 95076, or.