19-030. 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. The IHSS Accounting Inbox is managed daily by the IHSS Accounting Representatives who specialize in handling and resolving IHSS Provider's payroll inquiries, hour discrepancies, earning verifications, tax questions, Electronic Timesheet enrollment, and any Provider change requests. Protective Supervision is part of the IHSS program in California. How to: Complete the new timesheet correctly. 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. Help Stop Medi-Cal Fraud and Abuse Preparing for Power Outages - Recipient Opens in New Window launch. Print this Publication. With Direct Deposit, your IHSS/WPCS paycheck is deposited directly into your checking or savings account, or onto a pay card of your choice, instead of being mailed to you through the U.S. Post Office. User Name. 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 Provider Change of Address and/or Telephone. 1. Visit IRS's Certain Medicaid Waiver Payments May Be Excludable from Income for more information. The maximum weekly hours are 283 4 = 70.75. The agency along with the participant will help train the caregiver to personalize the care. 19-002 Temp WI 10072 (8/13)- Has been obsoleted. 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. Scroll way down to the end - Less Common Income. IHSS Remittance Statements and California State Controller's Office Envelope Issue. ICF/IID Tracking Form. 2021-18 revoked Ann. 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 2001-33 instead of in accordance with certain form instructions. close. Provider Fraud and Elder Abuse complaint line: Select Language. IHSS is available to qualified participants on the following three HCBS Waivers: A new address and/or phone number are required to be reported within 10 days of the change. 1137, provided tax-exempt organizations with reasonable cause for purposes of relief from the penalty imposed under section 6652(c)(1)(A)(ii) if they reported compensation on their annual information returns in the manner described in Ann. Claim Your 2015 State And Federal Credits - You Earned It - It's Your Money, 16-007PUB 438 (11/15) - TrustLine Parent Pamphlet PUB 439 (11/15) - License Exempt Provider Pamphlet, 16-006TEMP 3002 (11/15) - Important Information for the In-Home Supportive Services (IHSS) Recipient TEMP 3006 (1/15) - Recipient/Provider Mailer Regarding Overtime Implementation Halt, 16-005SOC 2271 (11/15) - In-Home Supportive Services (IHSS) Program Provider Notification Of Recipient Authorized Hours And Services And Maximum Weekly Hours SOC 2271A (11/15) - In-Home Supportive Services (IHSS) Program Recipient Notice Of Maximum Weekly Hours TEMP 3000 (1/16) - In-Home Supportive Services (IHSS) Program Overtime And Workweek Requirements Recipient Declaration TEMP 3001 (11/15) - Important Information for the In-Home Supportive Services (IHSS) Provider, 16-004SOC 426A (1/16) - In-Home Supportive Services (IHSS) Program Recipient Designation Of Provider SOC 846 (11/15) - In-Home Supportive Services (IHSS) Program Provider Enrollment Agreement SOC 2255 (11/15) - In-Home Supportive Services (IHSS) Program Provider Workweek & Travel Time Agreement SOC 2256 (11/15) - In-Home Support Services Program Recipient And Provider Workweek Agreement, 16-002TLR 4 (12/15) - TrustLine Registry "The California Registry Of In-Home and License-Exempt Child Care Providers" Ancillary Day Care Center, Copyright 2023 California Department of Social Services. 2021-18, 2021-52 I.R.B . 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 The paper enrollment form is available on the CDSS website for those who want to use it. If you enrolled in Medicaid . SOC 2302 (5/19) - In-Home Supportive Services (IHSS) Program Provider Paid Sick Leave Request Form. SOC2279 - In-Home Supportive Services (IHSS) Program Live-In Family Care . With IHSS, you select who the agency hires or can choose to utilize an agency caregiver. M3430 (Medicaid Form Release) 3430 Serious Occurence Report. 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. It really is very easy to complete the soc829 ihss. IHSS Service Desk for Providers & Recipients, (866) 376-7066, Suspect Fraud? 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 SOC 846 (10/19) - In-Home Supportive Services (IHSS) Program Provider Enrollment Agreement .pdf Author: e520995 Created Date: 12/23/2019 4:57:21 PM . 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. The appropriate CDSS form to download and fill out is the SOC 840 IHSS Program Provider or Recipient Change of Address and/or Telephone. 2001-33. Arnold Schwarzenegger's proposed budget for the 2009-10 fiscal year was released last week, suggesting tax hikes coupled with billi 2001-33, 2001-17 I.R.B. For more information and forms, go to the Live-In Provider Self-Certification Information webpage. Then make an entry on 1040 line 21 Other Income to offset it by going to Federal on left. Scroll down to locate the Less Common Income section. 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. Blog most successful club in the world ihss statement of reporting changes. Owner Documents. ; ; ; ###toto ldsml075augfz1a 2 750 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. 260 4 = maximum 65 hours/week. Violations are penalties IHSS providers will receive for exceeding workweek or travel time limits. It is for children and adults with a mental impairment that have self-harming and or dangerous behaviors that they engage in without regard to consequences. They'll tell you what documents they require, and they'll let you know if this changes your eligibility. Wages and Income. Our software was built to be easy-to-use and help you fill out any document swiftly. ihss statement of reporting changes. A pay card is a reloadable card you can use for direct deposit and to make purchases and withdrawals. 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. Register for the IHSS Website to: View your timesheet and payment statuses; Enter and . January 9, 2022; funny things to accomplish; jimmy butler nba finals stats; COUNTY OF SAN DIEGO IN-HOME SUPPORTIVE SERVICES . The 2022 Form W-2 includes warrants/payments with issue dates of January 1, 2022 through December 31, 2022. 19-029. IHSS Payroll Department if you require additional W-4s, need to change your withholding, or need to determine the status of your withholding. The paper enrollment form is available on the CDSS website for those who want to use it. On the next page, click Start next to Other Reportable Income. The accompanying financial statements report on the financial activities of the Authority In response to a 1999 State mandate requiring the establishments of an employer of record for the In-Home Supportive Services program, the Board of Supervisors approved appropriations and . 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. 2023 DE4. Enter the W2 as normal wages on line 7. Owner Briefing Packet (4.41 MB) Declaration of Ownership (127.2 KB) Direct Deposit Instructions (215.6 KB) HQS Form (704.4 KB) Notice: Carbon Monoxide Detectors Required Effective July 1, 2011 (173.6 KB) Rent Increase Housing Survey Form (938.6 KB) Request For Tenancy Approval (289.9 KB) Public Notices / Public Hearings. 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. The Form W-2 contains all wages and tax information for an employee regardless of the . 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. All new IHSS providers (i.e., providers who are not currently working for any consumers) must be enrolled with the county before they are eligible for payment through the IHSS Program. Nursing Facilities Forms. 2021 DE4. This guide is to help you prepare for the county IHSS worker's initial intake assessment or the annual review. 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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