In-Home Supportive Services (IHSS)

Supported Individual

• In-Home Supportive Services Application Form (English)
• In-Home Supportive Services Application Form (Spanish)
• In-Home Supportive Services (IHSS) Program Health Care Certification Form (PDF)

Care Provider

English Documents

• IHSS Direct Deposit Enrollment/Change/Cancellation Form
• Form W-4
• Form DE-4
• Change of Address- SOC 840
• IHSS Program Recipient Designation of Provider - SOC 426A
• Verification of Eligibility of Employment I-9

Spanish Documents

• Formulario de inscripción / cambio / cancelación de depósito directo de IHSS
• Formulario W-4
• Formulario DE-4
• Cambio de Dirección-Teléfono Formulario SOC 840
• Designación de un Proveedor Por el Beneficiario - Formulario SOC 426A
• Verificación de Elegibilidad de Empleo Formulario I-9

Commission on Aging

• Centenarian Recognition Form

Senior Nutrition

• Meals on Wheels Intake Form

Reporting Abuse

• Report Elder or Dependent Abuse Online
• FAQ for Submitting Online Reports

AAA Grievance Procedures

• Grievance Procedures
• Grievance Form
• Formulario de queja de CDA

Long-Term Care Ombudsman

• AHCD Intake Application
• Facility Visit Report
• Long-Term Care Ombudsman Volunteer Application
  
  • Long-Term Care Ombudsman Volunteer FAQ