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Alameda County, CA, acgov.org
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Hotlines

  • Adult Protective Services
    24 Hour Elder Abuse Hotline
    1-866-225-5277
    1-866-CALL-APS
  • Ombudsman—Advocates for residents in long-term care facilities:
    Working Hours Line
    510-638-6878
    After Hours Crisis Line
    1-800-231-4024
Contact Information
  • Adult and Aging Contact Page
  • IHSS Payroll Information: 577-1877
  • To apply for IHSS: 577-1900
  • AAA Information & Assistance
    1-800-510-2020
    510-577-3530
  • Public Administrator
    (510) 577-1972
  • Public Guardian-Conservator (Probate)
    (510) 577-3585
  • Public Guardian- Conservator (LPS)
    (510) 577-1900
  • Area Agency on Aging (AAA)
    510-577-1900

Address

Adult & Aging Services
Eastmont Self Sufficiency Center
6955 Foothill Boulevard Suite 300
Oakland CA 94605

In-Home Supportive Services: Application Information

How to apply for In-Home Supportive Services (IHSS)

You may download the Application for IHSS (SOC295). Blind and visually impaired individuals may download the large font application (please note: the large font application is 10 pages)

 

Language Application Materials
English SOC295 SOC295 - Large Font
Espanol SOC295 SOC295 - Large Font
Chinese SOC295 SOC295 - Large Font

In-Home Supportive Services Provider Information:

To become an IHSS provider, you must:

  • Complete the IHSS Provider Enrollment Packet;
  • Attend a mandatory provider orientation; and
  • Be fingerprinted and complete a criminal background check.

All of these requirements must be completed before you can receive payment as an IHSS provider.

Provider Enrollment Packet Checklist:

Complete and return the folllowing forms:

IHSS Forms - REQUIRED
Form# Description Language
70-7 Instructions for SOC 838 English
Cambodian
Farsi
Mandarin
Cantonese
Spanish
Tagalog
Vietnamese
70-8 Chore Provider Agreement English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
70-19 Provider Leave or Discontinuance English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 426 Provider Enrollment Form English
Chinese
Cambodian
Farsi
Tagalog
Vietnamese
Spanish
SOC 426A Recipient Designation of Provider English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 838 Assignment of Authorized Hours English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 2255 Provider Workweek and Travel Agreement English
Cambodian
Cantonese
Farsi
Mandarin
Spanish
Tagalog
Vietnamese
SOC 2256 IHSS Program Recipient and Provider Workweek Agreement English
Cambodian
Cantonese
Farsi
Mandarin
Spanish
Tagalog
Vietnamese
W-4 W-4 English
Spanish

IHSS Forms - SUPPLEMENT
Form# Description Language
72-16 Homecare Worker and Recipient Universal Precautions English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
PUB 104 Individual Provider Benefits and Services Information English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 426C Program California Code Sections English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 829 Provider Direct Deposit Enrollment/Change/Cancellation Form English
Cambodian
Chinese
Farsi
Tagalog
Spanish
Vietnamese
SOC 839 IHSS Recipient Timesheet Signature Authorization English
Cambodian
Chinese
Farsi
Spanish
Tagalog
Vietnamese
SOC 840 Provider/Recipient Change of Address and/or Telephone Number English
Chinese
Cambodian
Farsi
Spanish
Tagalog
Vietnamese
SOC 847 Information for Prospective Providers about Enrollment Process English
Cantonese
Cambodian
Farsi
Mandarin
Tagalog
Vietnamese
Spanish
York-WC York-Workers Compensation English
70-21 Request For Provider Reinstatement English
Cambodian
Cantonese
Farsi
Mandarin
Spanish
Tagalog
Vietnamese
70-22 Request for Replacement Timesheets English
Cambodian
Cantonese
Farsi
Mandarin
Spanish
Tagalog
Vietnamese
70-23 Request for Verification of Employment/Income English
Cambodian
Cantonese
Farsi
Mandarin
Spanish
Tagalog
Vietnamese

Current Providers:

If you are an existing or returning provider who has completed the provider orientation AND it has been less than one (1) year since you cleared the background check, please submit the following items to the In-Home Supportive Services office at 6955 Foothill Blvd., Suite 300 (3rd floor), Oakland, CA 94605:

  1. Completed Provider Enrollment Packet;(see provider enrollment checklist above)
  2. Copy of your signed social security card and your original Resident Alien or Employment Authorization Card if your Social Security Card states, "Authorization Needed"; and
  3. Copy of your valid/unexpired government issued photo identification (Driver's License, Identification Card, U.S Passport or Military Identification)

New Providers:

If you are a new provider (not previously enrolled OR it has been 12 months or more since you last worked, please submit the following items in person to the In-Home Supportive Services office at 6955 Foothill Blvd., Suite 300 (3rd floor), Oakland 94605:

  1. Completed Provider Enrollment Packet (see provider enrollment checklist above).
  2. Original signed Social Security Card and your original Resident Alien or Employment Authorization Card if your Social Security Card states, "Authorization Needed";
  3. Original valid/unexpired government issued photo identification; and (Driver's License, Identification Card, U.S Passport or Military Identification)
  4. Complete the IHSS Provider Orientation. Only one session is required.

  5. IHSS Provider Orientation Drop-In Sessions are held in the IHSS office every Thursday of each month except the first (1st) Thursday of each month.

    Session Times:
    -------------------------------------
    Session I: 9:00-11:00AM

    Session II: 11:00AM-1:00PM

    Session III: 1:00-3:00PM

    Orientations are for NEW providers only-No guests including IHSS recipients and children will be permitted to attend the orientations.
    -------------------------------------

  6. Complete a criminal background check by the California Department of Justice. Information regarding Live Scan fingerprinting sites will be provided to you in order for you to complete the criminal background check. You are responsible for paying for the fingerprinting fees.




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