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Ihss application form
unable to perform some activity of daily living independently and without IHSS the individual would be at risk of placement in out-of-home care. This health care certification form must be completed and returned to the IHSS worker listed above. The IHSS worker will use the information provided to evaluate the individual’s , и The below form(s) are required, depending on your circumstances. Please review the descriptions after each form to help determine when to complete a form. For information on the enrollment process for new providers (never been paid in IHSS), please select this link to take you to the New Provider Enrollment web page . To submit an IHSS application via fax, fax your application to 805-654-3206 (Ventura, Ojai, Camarillo, Oxnard area) or 805-906-7910 (Thousand Oaks, Simi Valley area) Changes have been made to the Application for In-Home Supportive Services (SOC 295) to gather information the State is required to collect. , , , , , , , In-Home Supportive Services (IHSS) is a federal, state and locally funded program providing assistance to eligible aged, blind, and disabled individuals receiving Medi-Cal benefits who are unable to remain safely in their own homes without assistance. Individuals who want to receive In-Home Supportive Services (IHSS) complete an application, then a Department of Health and Human Services (DHHS) employee will come to the individual’s home and assess the individual’s abilities to live safely at home. .
You must have a physician or other licensed health care professional fill out a Health Care Certification (SOC 873) form and you must return it to the county before care services can be authorized. You will be notified if your application for IHSS has been approved or denied. If denied, you will be notified of the reason for the denial. APPLICATION FOR IN-HOME SUPPORTIVE SERVICES SOC 295 (9/18) Page 1 of 8 To the Applicant: All sections of this form must be completed. Information provided is subject to verification. NOTE: Retain your copy of your completed application. Regarding your Social Security Located in northern California, the Official website of the County of Santa Clara, California, providing useful information and valuable resources to County residents.
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT FORM CONTINUE READING THE INFORMATION BELOW CAREFULLY . BEFORE YOU BEGIN TO COMPLETE THIS FORM Individual Waiver of an Exclusion for Conviction for a Tier 2 Crime . If you are found ineligible based on a conviction for a Tier 2 exclusionary crime but an , APPLICATION FOR IN-HOME SUPPORTIVE SERVICES SOC 295 (9/18) Page 1 of 8 To the Applicant: All sections of this form must be completed. Information provided is subject to verification. NOTE: Retain your copy of your completed application. Regarding your Social Security To become an IHSS Provider, contact Riverside’s HOME Call Center at (888) 960-4477. Phones are answered Monday – Friday from 8:00 AM to 5:00 PM Pacific time, excluding County holidays. In-Home Supportive Services Providers will need to: Complete a Livescan fingerprint process; Complete and submit form SOC 426a
Your share of cost would be $1,197.50 - $943.72 = $253.78 per month. That means you’d have to pay $253.78 each month for the in-home support services you get and the IHSS program would pay the rest. In-Home Supportive Services (IHSS) is a federal, state and locally funded program providing assistance to eligible aged, blind, and disabled individuals receiving Medi-Cal benefits who are unable to remain safely in their own homes without assistance. и A home care program that helps elders, dependent adults and minors live safely in their own homes or other non-institutional settings. If you would like more information or if you would like to apply for IHSS, please call us toll free at 1-888-960-4477.