Caregiver Form Printable For Elderly In Santa Clara
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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.
We protect your documents and personal data by following strict security and privacy standards.
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IHSS program at-a-glance A Provider can be a family member, a friend or anyone who has completed the enrollment process through the Public Authority. 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.
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.
A Caregiver's Authorization Affidavit is an official form based on California's recognition that adults who have minors living with them are “caregivers” who often want and need to take some responsibility for the minor's education and other care.
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) .
You (or your authorized representative) must complete PART A of this form to let the county know who you have chosen to provide your authorized services. If you have multiple providers, you must fill out a separate form for each person who will be providing authorized services for you.
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.
To become a caregiver in California, meet state requirements (work authorization, background check, good health), complete a Home Care Aide certification course and provide proof of vaccinations and a negative TB test.
To become a caregiver in California, meet state requirements (work authorization, background check, good health), complete a Home Care Aide certification course and provide proof of vaccinations and a negative TB test.
Apply Complete the online IHSS application. Call (559) 600-6666 and chose Option 1 to apply over the phone. Complete an Application for Social Services (SOC 295) English | Spanish and return it to IHSS by one of the following ways:
