Common California IHSS Forms in One Place

A map of the forms families see first

County IHSS files use SOC numbers for statewide forms. The numbers look similar on a kitchen table. They do different jobs. Some pages belong to the person who needs care. Some belong to the person who hopes to be paid. Some belong only to live-in providers who self-certify for Electronic Visit Verification. This guide is a map. Each deeper page explains one job in more detail.

CDSS publishes the program, provider, and EVV pages that sit behind these numbers. County offices apply them. If a clerk hands you a local cover sheet, treat that as part of the same packet. Do not invent extra forms, and do not skip a number the county named in writing.

Recipient forms: SOC 295 and SOC 873

SOC 295 is the statewide IHSS application. You send it to the county IHSS office that serves the applicant. It starts the file. It does not enroll a provider and it does not certify medical need by itself.

SOC 873 is the Health Care Certification. A licensed health professional completes it, or the county accepts alternative documentation. Services are not authorized until that medical piece is in. Extra hospital dumps can slow the file. Keep those records for the county packet and return the certification unless a worker asked for a specific page. How to get SOC 873 signed is the errand version of that rule.

Provider forms: SOC 426 and SOC 846

If an adult child, another relative, a friend, or a neighbor will be the individual provider, that person finishes enrollment after (or alongside) the recipient case. CDSS describes enrollment as including county orientation, SOC 426, SOC 846, and a Department of Justice criminal background check where required. The recipient remains the employer. The State issues the provider payment after authorization and accepted timesheets.

SOC 426 is part of the provider enrollment set. SOC 846 is the provider agreement. Each person signs their own provider forms. Do not sign a parent’s provider pages as if they were yours, and do not sign your pages as if they were the recipient’s. Paid hours start after enrollment and authorization are done. The provider enrollment guide is the step-by-step path.

• SOC 295: recipient application to the county IHSS office
• SOC 873: Health Care Certification, or acceptable alternative documentation
• SOC 426: provider enrollment form
• SOC 846: provider agreement
• SOC 2298: live-in provider self-certification that changes EVV steps

Live-in and EVV: SOC 2298

California uses Electronic Visit Verification for many IHSS visits. Timesheets use an EVV method such as ESP, TTS, or the EVV app. Live-in providers who self-certify on SOC 2298 have different EVV steps. That is a recording rule, not a substitute for SOC 295 or SOC 873. Ask the county or Public Authority which method you should use before the first timesheet.

Do not assume every adult child who stays overnight is a live-in provider for EVV. The county explains how they treat that status. The EVV guide stays with the recording rules. This map only tells you why SOC 2298 appears in the same drawer as the application.

Which packet to send first

1. Confirm Medi-Cal status or start that application.
2. Send SOC 295 to the county IHSS office.
3. Return SOC 873 or acceptable alternative documentation.
4. Meet the social worker at home when scheduled.
5. Read the Notice of Action.
6. Finish provider enrollment (SOC 426, SOC 846, orientation, background check) if you will give the care.
7. Ask about EVV, and about SOC 2298 if you live in the home.

Some counties let you start provider enrollment while the assessment is still pending. That can help the first timesheet. It does not replace a complete recipient packet. An incomplete application still sits if SOC 295 is missing a signature or SOC 873 is blank.

What this map does not include

Counties may add local cover sheets, appointment letters, and notices. Keep those with the SOC pages. State law (WIC 12300) and CDSS regulations (MPP 30-757) list service categories. Those rules live on the coverage page and in the personal care, protective supervision, and paramedical guides. They are not extra SOC numbers.

Keep copies of every form and notice. If you want the county to speak with you about a parent’s case, ask for the local release or authorization step. That paper is often local, not one of the five SOC numbers in this map. See asking the county to speak with you.

Official pages for the map

Use the CDSS IHSS page for the application and certification, the provider resources page for SOC 426 and SOC 846, the EVV help page for live-in recording rules, and the county office list for where to send pages. The families checklist puts those forms in adult-child order.