IHSS Forms & Resources
Essential forms, documents, and guides for IHSS recipients and caregivers.
Important IHSS Forms
SOC 821
Physician's Report for IHSS Protective Supervision — your doctor must complete this to request protective supervision.
Learn MoreSOC 825
Protective Supervision Coverage Plan — documents who will provide supervision and the schedule.
Learn MoreDPA 19
Authorized Representative form for State fair hearings — designates someone to represent you at your hearing.
Learn MoreSOC 839
IHSS Recipient Designation of Authorized Representative — authorizes someone to interact with the county on your behalf.
Learn MoreHearing Request
Request for State Fair Hearing — the form to officially appeal a county IHSS decision.
Learn MoreAid-Paid-Pending
Request to continue current services during your appeal — must be filed before the effective date.
Learn MoreCan My Doctor Charge Me for These Forms?
No. Under California Health and Safety Code Section 123114, healthcare providers cannot charge patients for completing forms required for government benefit programs. If your doctor attempts to charge you for filling out SOC 821, SOC 825, or any other IHSS-related form, inform them of this law.
Document Checklists by Case Type
Notice of Action, prior assessment, medical records, care log, DPA 19
SOC 821, medical records, incident reports, behavior log, SOC 825
NOA, hearing confirmation, DPA 19, all medical evidence, witness list, care plan
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