Login to Your Account. IHSS helps to pay for services to eligible aged, blind and disabled individuals who are unable to remain safely in their own homes without assistance. There will not be any change to paper warrant or direct deposit payments. No change to the total amount of consumer authorization. SOC 2255 - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement. Recent Changes to In-Home Supportive Services (IHSS) and Waiver Personal Care Services (WPCS) Workweek Exemptions for Providers This publication is for people who receive In-Home Supportive Services (IHSS) and Waiver Personal Care Services (WPCS) and the people who provide their care. Download your copy, save it to the cloud, print it, or share it right from the editor. Humic substances (HS) are complex and heterogeneous mixtures of polydispersed materials formed in soils, sediments, and natural waters by biochemical and chemical reactions during the decay and transformation of plant and microbial remains (a process called humification). 19-030. These policies, as presented, should be viewed as an integral part of the accompanying financial statements. On the next page, click Start next to Other Reportable Income. Toll Free Inquiry Line 1-888-300-4473 Specialists available Monday through Friday 8:00 am until 4:00pm (CST). User Name. www.ftb.ca.gov. A pay card is a reloadable card you can use for direct deposit and to make purchases and withdrawals. SOC2279 - In-Home Supportive Services (IHSS) Program Live-In Family Care . Scroll way down to the end - Less Common Income. Direct Deposit form - SOC829. The In-Home Supportive Services (IHSS) program provides in-home assistance to eligible aged, blind and disabled individuals as an alternative to out-of-home care and enables recipients to remain safely in their own homes. Welcome to the County of Orange Social Services Agency In-Home Supportive Services (IHSS) website. Personal Care Services Forms. For more information and forms, go to the Live-In Provider Self-Certification Information webpage. Questions regarding an IHSS home care provider's work ethics or hours worked must be directed to the consumer of IHSS services, who is the actual employer of the IHSS home care provider. Beginning January 2017, providers now have the option to self-certify living arrangements to exclude IHSS/WPCS wages from federal income tax and state tax by completing and submitting appropriate forms. The agency along with the participant will help train the caregiver to personalize the care. Over 550,000 IHSS providers currently serve over 650,000 recipients. With IHSS, you select who the agency hires or can choose to utilize an agency caregiver. Step 2: At this point, you are on the form . If you think you know the sender, contact them to ensure they sent the email/request. Blog most successful club in the world ihss statement of reporting changes. To do so, open your return and follow these steps: Click on Federal in the left-hand column, then on Wages and Income on top of the screen. This guide is to help you prepare for the county IHSS worker's initial intake assessment or the annual review. To learn how to apply for services: Get Services IHSS . Click Show more and click Start next to Miscellaneous Income at the bottom. lindsey kurowski brothers; ihss statement of reporting changes . 2001-33, 2001-17 I.R.B. Use form WI 10072A (12/18). Protective Supervision is part of the IHSS program in California. In Home Supportive Services (IHSS) Supported Individual Provider . In-Home Supportive Services; Report Abuse; Adult Protective Services; Volunteer; Forms; Meals on Wheels; . 19-029. For the first time, maximum IHSS consumer hours will be calculated by week and by month (using 4 weeks per month). STATEMENT OF CHANGES IN NET ASSETS AVAILABLE FOR BENEFITS . Print this Publication. IHSS recipients are responsible for reporting work-related injuries to the Public Authority. Below details how to change your address with IHSS. The In-Home Supportive Services (IHSS) program is a federal, state, and locally funded program designed to provide assistance to those eligible aged, blind, and disabled individuals who, without this care, would be unable to remain safely in their own homes. #5013.01. NA 1282 (2/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay. Therefore, the CDSS has decided the IHSS/WPCS program will not be participating in the deferral of withholding of 2020 payroll taxes. SOC 404 (10/11) - In-Home Supportive Services Program Direct Deposit Enrollment/Change/Cancellation Form SOC 409 (2/23) - IHSS/CMIPS Elective State Disability Insurance (SDI) Form SOC 425 (7/03) - Physician's Certification Of Medical Necessity SOC 426 (2/23) - In-Home Supportive Services (IHSS) Program Provider Enrollment Form 2021 DE4. The Form W-2 contains all wages and tax information for an employee regardless of the . Select Language. Notice 2014-7 provides guidance on the federal income tax treatment of certain payments to individual care providers for the care of eligible individuals under a state Medicaid Home and Community-Based Services waiver program described in section 1915 (c) of the Social Security Act (Medicaid Waiver payments). 2022 W4. Ann. Your In-Home Supportive Services (IHSS) income may be exempt if you received income from a Medicaid waiver or IHSS program for providing care to an individual you lived with. HPES (Medicaid) Forms. Owner Documents. Scroll down to locate the Less Common Income section. These behaviors must be regularly occurring and random. . It really is very easy to complete the soc829 ihss. Visit IRS's Certain Medicaid Waiver Payments May Be Excludable from Income for more information. Using guidelines developed by the California Department of Social Services, a social worker completes a face-to-face appointment with you in your home to gather information and makes an assessment of your need for in-home care based on all information provided including your medical condition, your living arrangement, and what assistance you . Direct Deposit Information. Copyright 2023 California Department of Social Services. These are the basic steps to go through: Step 1: The initial step should be to choose the orange "Get Form Now" button. IHSS Training/Information - Fact Sheetsand Educational Videos, IHSS Timesheet Issues/Questions: They'll tell you what documents they require, and they'll let you know if this changes your eligibility. To report a change, contact your state's Medicaid office. Provider Sick Leave Request Form SOC 2302. ihss statement of reporting changes. **Due to browser constraints please download forms for full functionality. IHSS Remittance Statements and California State Controller's Office Envelope Issue. We will update this flyer on an ongoing basis as we get more information. IHSS Payroll Department if you require additional W-4s, need to change your withholding, or need to determine the status of your withholding. Your In-Home Supportive Services (IHSS) income may be exempt if you received income from a Medicaid waiver or IHSS program for providing care to an individual you lived with. 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. IHSS Recipients: 6 Providers who are approved for an exemption may exceed the 66-hour workweek limit up to a maximum of 360 hours per month combined for all IHSS recipients they serve. Report or Change Private Health Insurance Office of the Ombudsman Transportation Services Medi-Cal Access Program California Children's Services Genetically Handicapped Persons Program (GHPP) Early & Periodic Screening, Diagnosis & Treatment Medi-Cal Dental In-Home Supportive Services Program (IHSS) Rights & Responsibilities Below are frequently used forms: 2023 W4. LAKE COUNTY - The preliminary version of Gov. Report all suspicious emails. 11/15)TEMP 2262A (9/16) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Failure To Submit SOC 846 (REV. Add a legally-binding signature. The paper enrollment form is available on the CDSS website for those who want to use it. How to Apply for IHSS During regular business hour: Monday through Friday, 8am - 5pm except holidays, call the ODAS IHSS Referral Line at 707-784-8259 and provide as much known information listed below for the person in need of IHSS such as: To download and IHSS application provided by the State of California website go to: SOC 2302 (5/19) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form. 2015 Notice Of Forms Changes 15-273 HCS 402 (12/15) - Home Care Organization Dishonesty Bond 15-271 HCS 9201 (12/15) - Home Care Organization Inspection Checklist 15-270 LIC 9163 (11/15) - Request For Live Scan Service - Community Care Licensing 15-269 LIC 9188 (10/15) - For posting info only - Criminal Record Exemption Transfer request Disabled children are also potentially eligible for IHSS. This guide will also help you represent yourself and others in fair hearings when there is a dispute about the number of In-Home Supportive . Then the last one for Other Reportable Income. Nursing Facilities Forms. ihss statement of reporting changes. . RFA 10 (4/19) - Resource Family Approval Portability Application. The appropriate CDSS form to download and fill out is the SOC 840 IHSS Program Provider or Recipient Change of Address and/or Telephone. The 2022 Form W-2 includes warrants/payments with issue dates of January 1, 2022 through December 31, 2022. 260 4 = maximum 65 hours/week. We may apply a penalty that will reduce your SSI payment by $25 to $100 for each time you fail to report a change to us, or you report the change later than 10 days after the end of the month in which the change occurred. Effective July 1, and until further notice IHSS providers who receive payment through Direct Deposit will not receive their mailed Remittance Advice (RA) statement. Finish filling out the form with the Done button. SOC 426 - In-Home Supportive Services Program Provider Enrollment Form, [Espaol] [] [] [] [] [] [Tagalog] [Ting Vit] [], SOC 840 - In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone Form, SOC 846 - In-Home Supportive Services Program Provider Enrollment Agreement Form, SOC 847 - Important Information For Prospective Providers - IHSS Provider Enrollment Process, SOC 2255 - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement, SOC2279 - In-Home Supportive Services (IHSS) Program Live-In Family Care Provider Overtime Exemption, SOC 2298 - In-Home Supportive Services (IHSS) Program and Waiver Personal Care Personal Services (WPCS) Live-In Self-Certification Form for Federal and StateWage Exclusion, SOC 2299 - Personal Services (WPCS) Live-In Self-Certification Cancellation Form for Federal and State Wage Exclusion, SOC 2327 - In-Home Supportive Services Providers Right to File a Sexual Harassment Complaint, DE-4 - Employee's Withholding Allowance Certificate (State), W-4 - Employees Withholding Allowance Certificate (Federal). 1. If you have more questions, contact us by: Phone: (888) 960-4477 Fax: (951) 686-1419 or Mailing Address: IHSS Public Authority PO Box 7300 Moreno Valley, CA . The Form W-2 reflects wages paid by warrants/direct deposit payments issued during the 2022 tax year, regardless of the pay period wages were earned. Registration. SOC 840 - In-Home Supportive Services Program Provider or Recipient Change of Address and/or Telephone Form [] [] [] [Ting Vit] SOC 846 - In-Home Supportive Services Program Provider Enrollment Agreement Form . In this fact sheet, you will learn about: IHSS Overview; Making a Back-Up Plan; Finding Backup IHSS workers; COVID-19 Changes Affecting IHSS Applicants, Recipients and Providers The form must be submitted to the county in person and . Learn more aboutpay cards and online direct deposit service. Complete the IHSS Change of Address/Telephone (SOC 840) form and send it to the appropriate DAAS office or the Public Authority. toms river schools calendar menchey music lancaster; are frozen fruit smoothies good for you; international soccer games in phoenix IHSS is available to qualified participants on the following three HCBS Waivers: After evaluation and consideration of the IRS guidance, the Department of Social Services (CDSS) is concerned that while the regular taxes would not be taken from 2020 payroll, the providers would experience a double withholding from their payroll taxes in 2021. Our software was built to be easy-to-use and help you fill out any document swiftly. The Online Direct Deposit Enrollment Service allows current, active IHSS/WPCS providers in all California counties the ability to electronically enroll, change or dis-enroll via the CDSS IHSS ESP website, instead of using a paper form. We may overpay you and you may have to pay us back. On August 8, 2020, President Trump issued a Presidential Memo directing the IRS to allow the optional deferral of withholding from employees 2020 taxes between September 1, 2020 and December 31, 2020. 11/15), 16-123CW 2190A (4/16) - CalWORKs 48-Month Time Limit Extender Request Form CW 2190B (5/16) - CalWORKs 48-Month Time Limit Extender Determination Form, 16-122CW 2184 (8/16) - CalWORKs 48-Month Time Limit CW 2189 (3/15) - Notice of your CalWORKs Time Limit - 42nd Month on Aid, 16-121AD 900B (9/16) - Statement Of Understanding Independent Adoptions Program - Alleged Father of an Indian Child - Independent Adoptions Program, 16-120WTW 50 (6/16) - Program Integrity Request For Regulation Interpretation, 16-119SAR 2 CR (7/15) - Reporting Changes For Cash Aid And CalFresh - ObsoleteAR 2 CR (7/15) - Reporting Changes For CalWORKs And CalFresh - Obsolete, 16-118FC 1B (10/16)- Transitional Housing Pus Foster Care (THP+FC) Program & Other Revenue, 16-117FC 1A (10/16) - Transitional Housing Program Plus Foster Care (THP+FC) Program Cost Report, 16-116RFA 08 (9/16)- Resource Family Approval (RFA) Tuberculosis (TB) Screening Questionnaire RFA 802 (9/16) - Complaint Intake Report, 16-115RFA 02 (7/16) - Resource Family Out-Of-State Child Abuse Registry Checklist, 16-114CF 37 (9/16) - Recertification For CalFresh Benefits CF 285 (9/16) - Application For CalFresh And Benefits, 16-113CF 11 (8/16) - ENG/SP - Notice To All CalFresh Recipients Important - Please Read, 16-112SOC 2245 (10/16) - In-Home Supportive Services (IHSS) Fraud Data Reporting Form, 16-111PUB 13 (8/16) - Your Rights Pamphlet (Requires 8-1/2" x 14" paper printed landscape)PUB 13 (8/16) - Your Rights Pamphlet (Large print 8-1/2" x 11"), 16-110TEMP 2260 (8/16) -Changes To The California Work Opportunity And Responsibility To Kids (CalWORKs) Maximum Family Grant (MFG) RuleTM44-314 (8/16) - Basic Approval, 16-109CW 2103 (6/16) - Reminder For Teens Turning 18 Years OldCW 2218 (7/16) - Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-needy Caretaker Relative With Relative Foster Child), 16-108SOC 873 (10/16) - In-Home Supportive Services (IHSS) Program Health Care Certification FormSOC 874 (10/16) - In-Home Supportive Services (IHSS) Program Notice To Applicant Of Health Care Certification Requirement, 16-107TEMP 2250 (7/16) - State Law Changes Maximum Aid Payment (MAP) Levels For Cash Aid Recipients TM44-315I (8/16) - Law Change to MAP levels, 16-106AD 900 (9/16) - Statement Of Understanding Independent Adoptions Program Parent Who Gave Physical Custody (Custodial Parent) of the Indian Child to the Petitioner(s) - Independent Adoptions Program, 16-105AD 927 (9/16) - Statement Of Understanding - Independent Adoptions Program - Indian Child, 16-104AD 900A (9/16) - Statement of Understanding Independent Adoptions Program - Parent Who Did Not Give Physical Custody (non-custodial) Of The Indian Child To The Petitioner(s) - Independent Adoptions Program, 16-103PUB 461(8/16) - Volunteer Emergency Service Team (VEST), 16-102RFA 01C (8/16) - Resource Family Application-Confidential, 16-101FC 30 (8/16) - Group Home Extension RequestFC 31 (8/16) - Accreditation Reimbursement Request, 16-100PUB 400B (9/16) - Safely Surrendered Baby Kit--Order Form, 16-099SOC 851A (5/16) - In-Home Supportive Services Program Notice To Applicant Provider Of Incomplete Provider Process 15-Day Notification, 16-098SOC 2293 (7/16) - 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), 16-097SOC 2292 (7/16) - 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), 16-096SOC 2291 (5/16) - For Posting Info OnlySOC 2291 (6/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Fourth Violation (One-Year Period Of Ineligibility), 16-095SOC 2290 (5/16) - For Posting Info OnlySOC 2290 (6/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Fourth Violation (One-Year Period Of Ineligibility), 16-094SOC 2289 (5/16) - For Posting Info OnlySOC 2289 (7/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Recipient Rescinding Providers Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits, 16-093SOC 2288 (5/16) - For Posting Info OnlySOC 2288 (7/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Provider Rescinding Third Violation Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits, 16-092SOC 2287 (5/16) - For Posting Info OnlySOC 2287 (6/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Providers Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/Or Travel Time Limits, 16-091SOC 2286 (5/16) - For Posting Info OnlySOC 2286 (6/16) - In-Home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/Or Travel Time Limits, 16-090SOC 2285 (5/16) - For Posting Info OnlySOC 2285 (7/16) - In-Home Supportive Services Program Notice To Recipient Upholding Providers Fourth Violation (One-Year Period Of Ineligibility) For Exceeding Workweek And/Or Travel Time Limits, 16-089SOC 2284 (5/16) - For Posting Info OnlySOC 2284 (7/16) - In-Home Supportive Services Program Notice To Provider Upholding Fourth Violation (One-Year Period Of Ineligibility)For Exceeding Workweek And/or Travel Time Limits, 16-088SOC 2273 (8/16) - In-Home Supportive Services Program State Administrative Review Request Of Third Or Fourth Violation For Exceeding Workweek And/Or Travel Time Limits, 16-087SOC 2272 (5/16) - For Posting Info OnlySOC 2272 (6/16) - For Posting Info OnlySOC 2272 (7/16) - In-Home Supportive Services Program Notice To Provider Of Right To Dispute Violation For Exceeding Workweek And/Or Travel Time Limits, 16-086SOC 2283 (5/16) - For Posting Info OnlySOC 2283 (6/16) - For Posting Info Only SOC 2283 (7/16) - In-Home Supportive Services Program Notice To Recipient Upholding Providers Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/Or Travel Time Limits, 16-085SOC 862 (5/16) - In-Home Supportive Services (IHSS) Recipient Request For Provider WaiverSOC 870 (5/16) - In-Home Supportive Services Program (IHSS) Notice To Provider Of Provider Eligibility Acknowledgment Of Receipt Of Waiver, 16-084SOC 855B (5/16) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies) SOC 857 (5/16) - IHSS Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver, 16-083SOC 852A (5/16) - IHSS Program Notice To Provider Applicant Of Provider Ineligibility Tier 2 Crimes (Serious/Violent Felonies; Sex Offender Felonies; Fraud Against Government Agencies) SOC 855 (5/16) - In-Home Supportive Services Program Notice To Recipient Of Provider Ineligibility Incomplete Provider Process, 16-082SOC 813 (7/16) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination, 16-081FC 30 (7/16) - Group Home Extension RequestFC 31 (7/16) - Accreditation Reimbursement Request, 16-080PUB 400B (7/16) - Safely Surrendered Baby Kit-Order Form, 16-079SOC 2282 (5/16) - For Posting Info OnlySOC 2282 (6/16)- In-Home Supportive Services Program Notice To Provider Upholding Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/Or Travel Time Limits, 16-078SOC 2280 (5/16)- For posting Info OnlySOC 2280 (6/16) - In-Home Supportive Services Program Notice To Provider Upholding First Or Second Violation For Exceeding Workweek And/Or Travel Time LimitsSOC 2281 (5/16) - For Posting Info OnlySOC 2281 (6/16) -In-Home Supportive Services Program Notice To Recipient Upholding Providers First Or Second Violation For Exceeding Workweek And/Or Travel Time Limits, 16-077SOC 851 (5/16) - In-Home Supportive Services Program Notice To Applicant Provider Of Provider Ineligibility Incomplete Provider Process, 16-076SOC 813 (6/16) - Cash Assistance Program For Immigrants (CAPI) Indigence Exception Determination, 16-075SOC 826 (8/15) - Child Fatality/Near Fatality - County Statement of Findings and Information, 16-074SOC 859B (5/16) - IHSS Program Notice To Recipient Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction, 16-073SOC 857B (6/16) - In-Home Supportive Services Program Notice To Provider Of Provider Ineligibility Criminal Background Check NeededSOC 858B (5/16) - IHSS Program Notice To Provider Of Provider Ineligibility Tier 2 Crimes Ineligibility - Subsequent Conviction, 16-072SOC 847 (5/16) - Important Information For Prospective Providers About The In-Home Supportive Services (IHSS) Program Provider Enrollment Process SOC 848 (5/16) - In-Home Supportive Services Program Notice Of Provider Eligibility SOC 848A (5/16) - In-Home Supportive Services Program Lapse of Ten-Year Timeframe for Tier 2 Crime, 16-071SOC 426 (5/16) - For posting info only - In-Home Supportive Services (IHSS) Program Provider Enrollment Form SOC 426 (6/16) - In-Home Supportive Services (IHSS) Program Provider Enrollment Form, 16-070TLR 9163A (10/15) - Request For Live Scan Service TrustLine Registry Applicants, 16-069LIC 606 (4/16) - Residential Care Facility For The Elderly Disclosure Worksheet, 16-068CW 2218 (3/16) -Rights, Responsibilities And Other Important Information For The California Work Opportunity And Responsibility To Kids (CalWORKs) Program (Non-needy Caretaker Relative) CW 2219 (5/16) - Application For California Work Opportunity And Responsibility To Kids (CalWORKs) (Non-Needy Caretaker Relative With Relative Foster Child), 16-067SOC 2263 (3/16) -In-Home Supportive Services Program Notice To Provider Rescinding ViolationSOC 2264 (3/16) -In-Home Supportive Services Program Notice To Recipient Rescinding Provider Violation, 16-066SOC 2272A (4/16) - In-Home Supportive Services Program Notice To Provider Acknowledgement Of Receipt Of County Violation Review SOC 2272B (4/16) - In-Home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits, 16-065WTW 18 (4/16) - Learning Needs Screening, 16-064LIC 9151 (8/14) - Property Owner/Landlord Notification Family Child Care Home, 16-063PUB 341 (4/16) - Adoptions Services Bureau Career Opportunities, 16-062LIC 9150 (8/14) - Parent Notification - Additional Children in Care, 16-061SOC 396A (7/15) - Kinship Guardianship Assistance Payment (Kin-GAP) Program Agreement Amendment, 16-060LIC 624-LE (4/16) - Law Enforcement Contact Report, 16-059LIC 9214 (5/16) - Application For Administrator Initial Certification - Administrator Certification Program, 16-058LIC 9142A (5/16) - Roster Of Participants - For Vendor Use Only - ICTP Or CEU Courses - Administrator Certification Program, 16-057M40-125B SAR (4/16) - Restore After a SAR7 DiscontinuanceM40-125C SAR (4/16) - Incomplete Semi-Annual Report (SAR7) Denial of RestorationM44-207I SAR (4/16) - Financial Eligibility, 16-056LIC 9219A (3/16) - Crisis Day Care Sign-In, 16-055LIC 9219 (3/16) - Crisis Nursery Monthly Report, 16-054HCS 500 (4/16) - Registered Home Care Aide Training Log, 16-053LIC 421D (1/16) - Civil Penalty Assessment - Death, 16-052EFA 14 (4/16) - Emergency Food Assistance Program (EFAP) 2016 Income Guidelines EFA 15 (4/16) - Alternate Pick-Up Request Form Emergency Food Assistance Program (EFAP) 2016 Income Guidelines, 16-051HCS 100 (12/15) - Application For Home Care Aide RegistrationHCS 100 (10/15) - Revised - No GEN 127posting for thispreviously approved versionHCS 100 (9/15) - New - No GEN 127 postingfor thisprior approved version, 16-050LIC 9149 (8/14) - Family Child Care Home Property Owner/Landlord Consent Form, 16-048HCS 001 (12/15) - Home Care Organization Suboffice RequestHCS 105 (12/15) - Home Care Aide Registry Request For Name/Address Change, 16-047DPA 435 (11/15) - County Allegation Of Intentional Program Violation/Statement Of Position (Request For An Administrative Disqualification Hearing), 16-046NA 1280 (2/16) - Notice Of Action - Discontinue Approved Relative Caregiver (ARC) Payment16-045NA 1279 (1/16) - Notice Of Action Deny Approved Relative Caregiver (ARC) Payment, 16-044NA 1277 (1/16) - Notice Of Action - Approved Relative Caregiver (ARC) OverpaymentNA 1278 (1/16)- Notice Of Action - Approve Approved Relative Caregiver (ARC) Payment, 16-043AD 504 (5/15) - Relinquishment Out of State In Armed Forces (Birth Mother/Biological Father/Presumed Father), 16-042GEN 1389 (3/16) - Functional Assessment Service Team (FAST) Leader Course Application, 16-041SOC 2269A (1/16) - In-Home Supportive Services Program Notice To Provider Cancellation Of Alternate Schedule Due To Recurring EventSOC 2270 (2/16) - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement (SOC 2256)SOC 2270A (1/16) - In-Home Supportive Services Program Notice To Provider Failure To Complete Workweek And Travel Agreement (SOC 2255), 16-040SOC 2266 (1/16) - In-Home Supportive Services Program Notice To Recipient Approval Of Exception To Exceed Weekly HoursSOC 2266A (1/16) - In-Home Supportive Services Program Notice To Provider Approval Of Exception To Exceed Weekly HoursSOC 2267A (1/16) - In-Home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours, 16-039SOC 2268 (1/16) - In-Home Supportive Services Program Notice To Recipient Approval For Provider To Work Alternate Schedule Due To Recurring EventSOC 2268A (1/16) - In-Home Supportive Services Program Notice To Provider Approval To Work Alternate Schedule Due To Recurring EventSOC 2269 (1/16) - In-Home Supportive Services Program Notice To Recipient Cancellation Of Alternate Schedule Due To Recurring Event 16-038CW 2213 (10/15) - Response To Request To Inspect Case Record CalWORKs, CalFresh, TCVAP, And Refugee Programs, 16-034LIC 9194 (3/11) - Live Scans Instructions For State Licensed Facilities (Obsolete), 16-033LIC 9215 (3/04) - Application For Administrator Re-Certification (Obsolete), 16-032TLR 9163 (12/15) - Request For Live Scan Service For Subsidized TrustLine Registry Applicants, 16-031TLR 4 (2/16) - TrustLine Registry "The California Registry Of In-Home and License-Exempt Child Care Providers" Ancillary Day Care Center, 16-030TLR 2 (12/15) - TrustLine Registry "The California Registry Of In-Home Child Care Providers"-In-Home/License exempt Child Care Provider Application, 16-029TLR 1 (12/15) - TrustLine Registry "The California Registry Of In-Home Child Care Providers"-Subsidized Application, 16-028LIC 9058 (12/15) - Applicant/Licensee Rights, 16-027LIC 809 (12/15) - Facility Evaluation ReportLIC 9099 (12/15) - ComplaintInvestigation Report, 16-026LIC 613C-2 (1/16) - Personal Rights In Privately Operated Residential Care Facilities For The Elderly, 16-025LIC 613B (1/16) - Personal Rights-Children's Residential Facilities, 16-024LIC 9163 (12/15) - Request Live Scan Service-Community Care Licensing, 16-023LIC 178 (12/15) - Deficiency/Penalty Review, 16-022LIC 421B (12/15) - Civil Penalty Assessment-Background Check/Child CareLIC 421C (12/15) - Civil Penalty Assessment-Immediate $150, 16-021LIC 421D (12/15) - Civil Penalty Assessment-DeathLIC 421E (12/15) - Civil Penalty Assessment-Serious Bodily Injury/Physical Abuse, 16-020LIC 421 (12/15) - Civil Penalty Assessment, 16-019SOC 886 (12/15) - Social Worker Disclosure Report, 16-018LIC 9142A (1/16) - Roster Of Participants-For Vendor Use Only-ICTP Or CEU Courses-Administrator Certification Program, 16-017LIC 9141 (1/16) - Vendor Application/Renewal-Administrator Certification Program, 16-016LIC 9140A (1/16) - Request To Add Or Replace Instructor-Administrator Certification ProgramLIC 9214 (1/16) - Application For Administrator Initial Certification-Administrator Certification, 16-015LIC 9140 (1/16) - Request For Course Approval-Administrator Certification Program, 16-014LIC 9139 (1/16) - Renewal Of Continuing education Course Approval-Administrator Certification, 16-013SR 10 (5/15) - Certification Of Audited Cost Data, 16-012SR 9 (5/15) - Federal Expenditure Certification, 16-011SR 8 (5/15)- Financial Audit Report Transmittal, 16-010TEMP 3007 (2/16) - In-Home Supportive Services (IHSS) Program Live-In Provider Overtime Exemption - Recipient NoticeTEMP 3008 (2/16) - In-Home Supportive Services (IHSS) Program Live-In Provider Overtime Exemption - Provider, 16-009SOC 2279 (1/16) - In-Home Supportive Services (IHSS) Program Live-In Family Care Provider Overtime ExemptionTEMP 3007 (1/16) - In-Home Supportive Services (IHSS) Program Live-In Provider Overtime Exemption - Recipient NoticeTEMP 3008 (1/16) - In-Home Supportive Services (IHSS) Program Live-In Provider Overtime Exemption - Provider, 16-008PUB 428 (1/16) - It's Your Money - Get It - The State and Federal Earned Income Tax Credit (EITCs) PUB 429 (1/16) - California EITC is Here! 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