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Caregiver Intake Form

IHSS Caregiver Intake FormDownload​​

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How To Become An IHSS Caregiver

 

Who can be a Provider? - Any US Citizen who is a California Resident and who has not committed any “Tier 1” Convictions or “Tier 2 Exclusionary” Crimes in the past 10 years

 

  1. Complete and Sign the “IHSS Program Provider Enrollment Form” and return it in person or mail it to your local IHSS or Public Authority office (you will be background checked after submitting this form)

    • You will be called by IHSS for your next steps once your paperwork has been filed in their system

  2. Complete an interview (bring your original Social Security card- can not be a copy)

    • You can get a new Certified Social Security card at your local Social Security office (you will need your original Birth Certificate- can not be a copy- which you can obtain from the Vital Records office of the County you were born in or on their Vital Records website)

  3. Get Fingerprinted and submit it to your local IHSS or Public Authority office

  4. Attend a Provider Orientation in person (online there is a provider orientation class schedule)

  5. Sign the “New Provider Enrollment Agreement Form” (SOC 846) after orientation is completed and return it your local IHSS or Public Authority office 

  6. Register your new online account (https://etimesheets.ihss.ca.gov/login) (you will need your Provider Number for this). You will use this website to submit your future Timesheets!

    • You will complete a video training session and then you will be able to use your etimesheets account for submitting your work hours bi-monthly

 

Start work for your client up to 90 days before your paperwork is completed! You will be backdated and paid for your time upon completion of hiring. If you are denied, you can appeal by calling (877) 762-0702 with more information at (https://ihssappeal.com/)


 

Enjoy these benefits if you choose to join our Union SEIU2015: 

  • Financial, Insurance, Travel, Discounts, Higher Education, Legal Services, and Hardship & Disaster Relief (https://www.seiumb.com/)

The union has fought on our behalf for years, gaining us benefits and increased wages that we would have gone without! 

 

If you have any questions please call the Public Authority at (707) 565 - 5700

Or In-Home Supportive Services IHSS at (707) 565 - 5900

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Thank you for helping your community!

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