. Direct Deposit form - SOC829. If you think you know the sender, contact them to ensure they sent the email/request. Example: Consumer is authorized for 260 hours IHSS per month. IHSS Fraud Hotline: 888-717-8302 ihss statement of reporting changes. IHSS Self-Assessment and Fair Hearing Guide. 19-046 LIC 9229 (5/19) - Licensing Program Manger (LPM) Checklist For Complaint Review LIC 9230 (5/19) - Licensing Program Analyst (LPA) Checklist For Complaint Review, 19-045 SOC 863 (5/19) - In-Home Supportive Services (IHSS) Applicant Provider Request For General Exception, 19-044 SOC 452 (6/19) - Cash Assistance Program For Immigrants (CAPI) Income Eligibility - Adult, 19-043 CF SSA 1 (6/19) - Information For Households Applying For CalFresh With The Social Security Administration CF SSA 1LP (6/19) - Information For Households Applying For CalFresh With The Social Security Administration (20pt Font) SAR 2 (6/19) - Reporting Changes For Cash Aid And CalFresh SAR 2LP (6/19) - Reporting Changes For Cash Aid and CalFresh (20pt Font), 19-041 CF 377.1 (6/19) - Notice Of Approval For CalFresh Benefits CF 377.1LP (6/19) - Notice Of Approval For CalFresh Benefits (20pt Font) CF 377.1A (6/19) - Notice Of Denial Or Pending Status CF 377.1ALP (6/19) - Notice Of Denial Or Pending Status (20pt Font), 19-040 SOC 813 (6/19) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination, 19-039 CW 2224 (6/19) - CalWORKs Home Visiting Initiative (HVI) CW 2200 (6/19) - Request For Verification CW 2200LP (6/19) - Request For Verification (20pt Font) LIC 610E (3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly, 19-038 LIC 622 (5/19) - Centrally Stored Medication And Destruction Record EFA 14 (4/19) - Emergency Food Assistance Program (EFAP) 2018 Income Guidelines EFA 15 (4/19) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2018, 19-037 CF 31 (6/19) - CalFresh Supplemental Form For Excess Medical Deductions, 19-036 CW 2224 (6/19) - CalWORKs Home Visiting Imitative Opt-In Form, 19-035 LIC 421 BG (5/19) - Civil Penalty Assessment - BackGround Check, 19-034 SAWS 30 (3/19) - Notification Of New Employment, 19-033 GEN 727B (5/19) - County Forms Order, 19-032 SOC 2243 (4/15) - IHSS Recipients Notice Of New Timesheets - Obsolete SOC 2243L (10/18) - IHSS Recipients Notice Of New Timesheets - Obsolete SOC 2244 (1/13) - IHSS Providers Notice Of New Timesheets - Obsolete, 19-031 SOC 2298 (1/19) - In-Home Supportive Services (IHSS) Program And Waiver Personal Care Services (WPCS) Program Live-In Self-Certification Form For Federal And State Tax Wage Exclusion SOC 2299 (1/19) - In-Home Supportive Services (IHSS) Program And Waiver Personal Care Services (WPCS) Program Live-In Self-Certification Cancellation Form For Federal And State Tax Wage Exclusion SOC 2302 (5/19) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form, 19-030 RFA 10 (4/19) - Resource Family Approval Portability Application, 19-029 NA 1282 (2/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay, 19-028 SOC 804 (5/19) - Statement Of Facts For Determining Continuing Eligibility For The Cash Assistance Program For Immigrants (CAPI) SOC 813 (5/19) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination SOC 814 (5/19) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI), 19-027 SOC 2292 (1/19) - In-Home Supportive Services Program Notice To Provider Of Failure To Timely Or Completely Submit The Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Form (SOC 2272) SOC 2293 (1/19) - In-Home Supportive Services Program Notice To Recipient Of Provider's Failure To Timely Or Completely Submit The Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Form (SOC 2272) SOC 2255 (3/19) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement, 19-026 SOC 2243L (10/18) - IHSS Recipients Notice Of New Timesheets - Please Keep For Future Use, 19-025 SOC 874L (1/19) - In-Home Supportive Services (IHSS) Program Notice To Applicant Of Health Care Certification Requirement SOC 875L (10/18) - In-Home Supportive Services (IHSS) Program Notice To Recipient Of Health Care Certification Requirement SOC 876L (10/18) - In-Home Supportive Services (IHSS) Program Notice Of Provisional Approval Health Care Certification Exception Granted, 19-024 SOC 862L (10/18) - In-Home Supportive Services (IHSS) Recipient Request For Provider Waiver SOC 865L (10/18) - IHSS Request For Applicant Provider Reference SOC 873L (1/19) - In-Home Supportive Services (IHSS) Program Health Care Certification Form, 19-023 SOC 857L (10/18) - IHSS Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver SOC 859AL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes Ineligibility - Subsequent Conviction SOC 859BL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction, 19-022 SOC 855AL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 1 Crimes (Elder Or Dependent Adult Abuse/Child Abuse & Fraud Against A Government Health Care Or Supportive Services Program) SOC 855BL (10/18) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies) SOC 856L (1/19) - To Request Appeal Of Provider Enrollment Denial, 19-021 SOC 332L (1/19) - In-Home Supportive Services (Recipient/Employer Responsibility Checklist) SOC 854L (10/18) - In-Home Supportive Services Program Notice To Recipient Of Provider Eligibility SOC 855L (10/18) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process, 19-020 LIC 215TM (11/18) - Temporary Manager Candidate List Application Information LIC 216TM (11/18) - Temporary Manager Appointment Applicant Information, 19-019 LIC 610E ( 3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly WTW 51 (2/19) - Welfare To Work Noncompliance Checklist Tool, 19-018 LIC 610E-S ( 3/18) Supplemental Emergency Disaster Plan For Residential Care Facilities For The Elderly - Obsolete, 19-017 AAP 8 (9/18) - Adoption Assistance Program Nonrecurring Adoption Expenses Agreement, 19-016 HCS 402 (2/19) - Home Care Organization Dishonesty Bond HCS 9183 (1/19) - Home Care Organization Association Request HCS 9184 (1/19) - Home Care Organization Disassociation Request, 19-015 HCS 100 (1/19) - Application For Home Care Aide Registration HCS 101 (1/19) - Home Care Aide Registration Renewal HCS 105 (3/19) - Home Care Aide Registry Request For Name/Address Change, 19-014 LIC 9102 (8/06) - Advisory Notes - Obsolete, 19-013 LIC 9102TA (2/19) - Advisory Notes - Technical Assistance LIC 9102TV (2/19) - Advisory Notes - Technical Violation, 19-012 EBT 2259 (12/18) - Report Of Electronic Theft Of Cash Aid EBT 2259A (12/18) - EBT Scamming Acknowledgement, 19-011 AAP 4 (2/19) - Eligibility Certification Adoption Assistance Program, 19-010 FC 8 (2/19) - Federal Eligibility Certification For Adoption Assistance Program, 19-009 SOC 2324 (1/19) - In-Home Supportive Services (IHSS) Program County Or Public Authority (PA) Request To Remove Criminal Offender Record Information (CORI) From The Case Management, Information And Payrolling System (CMIPS), 19-008 SOC 2273 (11/18) - In-Home Supportive Services Program Request For State Administrative Review Of Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits SOC 2282 (9/18) - In-Home Supportive Services Program Notice To Provider Upholding Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits SOC 2283 (9/18) - In-Home Supportive Services Program Notice To Recipient Upholding Providers Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits, 19-007 SOC 2323 (12/18) - In-Home Supportive Services Program Provider Requirements For Minor Recipients Living With Their Parents, 19-006 CW 2223 (9/18) - Demographic Questionnaire For CalWORKs, Refugee Cash Assistance (RCA), Entrance Cash Assistance (ECA), Trafficking And Crime Victims Assistance Program (TCVAP) And CalFresh Programs, 19-005 LIC 613C (1/19) - Personal Rights Of Residents In Publicly Operated Residential Care Facilities For The Elderly LIC 613C-2 (1/19) - Personal Rights Of Residents In Privately Operated Residential Care Facilities For The Elderly, 19-004 M44-350K (12/18) - EBT Replacement Denial M44-350L (12/18) - Notice Of Overpayment, 19-003 WI 10072A (12/18) - EBT Replacement Approval WI 10072B (12/18) - EBT Replacement Review. Register for the IHSS Website to: View your timesheet and payment statuses; Enter and . Go to Sign -Sgt; Add New Signature and select the option you prefer: type, draw, or upload an image of your handwritten signature and place it where you need it. On the next page, click Start next to Other Reportable Income. SOC 2302 (5/19) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form. In-Home Supportive Services (IHSS) In-Home Supportive Services (IHSS) 1505 E Warner Ave Santa Ana, CA 92705 Phone: 714-825-3000, Monday - Friday, 8:00 a.m. to 5:00 p.m. SOC2279 - In-Home Supportive Services (IHSS) Program Live-In Family Care . Report all suspicious emails. Form DE-4; Change of Address- SOC 840; IHSS Program Recipient Designation of Provider- SOC 426A; Verification of Eligibility of Employment I-9; Senior Nutrition Meals . The maximum weekly hours are 283 4 = 70.75. STEP 8 (8/02) - Supportive Transitional Emancipation Program - Transitional Independent Living Plan (STEP TILP) For 18 Up To 21 Years Old, STO CA 0034 (3/14) - Forged Endorsement Affidavit, TEMP 513 (4/22) - Important Information For CalWORKs Families, TEMP 1722A (10/07) - CalWORKs/Food Stamp Welfare Intercept System (WIS) Transmittal, TEMP 2120 (8/00) - Welfare To Work Referral, TEMP 2201 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Request For A Designated Alternate Card Holder/Authorized Representative, TEMP 2202 (7/02) - Cash Aid/Food Stamp Electronic Benefit Transfer - EBT Service Request, TEMP 2203 (7/02) - Request For Cash Aid Electronic Benefit Transfer - EBT Exemption, TEMP 2214 (7/08) - Additional Information About Electronic Benefit Transfer (EBT), TEMP 2229 (3/07) - ENG/SP - Important Notice - KinGAP Informing Notice, TEMP 2232 (4/08) - Notice of Possible Listing on the Child Abuse Central Index, TEMP 2250 (7/22) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients, TEMP 2252 (7/19) - State Law Changes The CalWORKs Earned Income Disregard, TEMP 2252 (12/20) - State Law Changes The CalWORKs Earned Income Disregard, TEMP 2252 (3/22) - State Law Changes The CalWORKs Earned Income Disregard, TEMP 2260 (8/16) Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Maximum Family Grant (MFG) Rule, TEMP 2316 (5/22) - Sick Leave Yearly Notification, TEMP 3005 (12/14) - Changes For People With A Prior Felony Drug Conviction, TEMP 3011 (12/21) Child and Family Team (CFT) & Child and Adolescent Needs and Strengths Tool (CANS) - For Parents, TEMP 3012 (12/21) Child and Family Team CFT and CANS - For Youth, TEMP 3013 (12/21) Child and Family Team (CFT) & Child and Adolescent Needs and Strengths Tool (CANS) - For Professionals, TEMP 3014 - (2/20) Treasury Offset Program (TOP) Pre-Offset Notice, TEMP 3015 - (2/20) Franchise Tax Board (FTB) Pre-Offset Notice, TEMP 3015A (2/20) - Franchise Tax Board (FTB) Annual Pre-Offset Notice, TEMP 3017 - (2/20) - Treasury Offset Program Notification Of Offset, TEMP 3019 (5/20) - In-Home Supportive Services Program Request To Hire Provider With Department Of Justice Criminal Background Check Via Name Only, TEMP 3020 (5/20) - Information Regarding Temporary Changes To The In-Home Supportive Services Provider Enrollment Process Due To The COVID-19 Pandemic, TEMP AD 525 (1/16) - Child Welfare Services Disaster Response Plan Template, TEMP AR 1 (2/13) - New Reporting Requirements For CalWORKs and CalFresh, TEMP CF 1468 (2/15) - CalFresh Notice Of Change, TEMP CW 2225 (10/20) - Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Child Support Disregard/Pass-Through Rules, TEMP NA 303B (4/00) - Continuation Page - Underpayment Amount Owed, TEMP NA 1221 (2/01) - Retroactive Approval Dominika V. Saena, TEMP NA 1222 (2/01) - Change Dominika V. Saena, TEMP NA 1225 (9/01) - Underpayment Computation, TEMP NA 1230 (1/02) - Retroactive Approval - Child Citizen Act Of 2000, TEMP NA 1231 (5/02) - Continuation Page- Underpayment Computation, TEMP NA 1236 (8/03) - Retroactive Eligibility - Deny (MBSAC), TEMP NA 1237 (8/03) - Retroactive Eligibility (MBSAC), TEMP NA 1238 (7/04) - Required Form - Substitute Permitted, TILP 1 (1/23) - Transitional Independent Living Plan & Agreement, TILP 2 (7/18) - Transitional Independent Living Plan (TILP) Assessment and Referral Form (Optional), TLR 3 (2/11) - Trustline To Community Care Licensing Criminal Background Clearance Transfer Request, TLR 301E (3/11) - Trustline Reference Request - Exemption, TLR 508 (10/09) - Trustline Registry Criminal Record Statement, TLR 9163G (3/21) - TrustLine Registry Application, TNB 1 (8/18) - Notice To CalFresh Recipients Transitional Nutrition Benefit (TNB) Program, TNB 2 (8/18) - Notice Of Approval For Transitional Nutrition Benefit (TNB) Program, TNB 3 (8/18) - Notice Of Change For Transitional Nutrition Benefit (TNB) Program, TNB 4 (8/20) - Notice Of Recertification For Transitional Nutrition Benefit (TNB) Program, TNB 5 (8/18) - Recertification Reminder Notice For Transitional Nutrition Benefit (TNB) Program Recertification Form Not Received Or Incomplete, TNB 6 (8/18) - Notice Of Discontinuance For Transitional Nutrition Benefit (TNB) Program, TNB 7 (6/19) - Transitional Nutrition Benefit (TNB) Informing Notice Of Receiving Intercounty Transfer, TNB 8 (6/19) - Transitional Nutrition Benefit (TNB) Informing Notice Of Sending Intercounty Transfer.

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