[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-305366-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-305366-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","ihss-provider-designation-form-soc-426-recipient-designation-of-provider-instructions","IHSS Provider Designation - Form SOC 426 - Recipient Designation of Provider Instructions","","California IHSS program form SOC 426 records a recipient’s designation of an authorized provider and sets out recipient obligations under the California Department of Social Services. It instructs recipients (or authorized representatives) to complete Part A with provider identity details and sign acknowledgements in Part C, using clear black or blue ink. Part B explains provider enrollment requirements before federal/state payment, county notice procedures, repayment if services begin before eligibility, and limits on authorized weekly hours including approval rules and maximum combined hours.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/ihss-provider-designation-form-soc-426-recipient-designation-of-provider-instructions/305366/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/ihss-provider-designation-form-soc-426-recipient-designation-of-provider-instructions/305366.png","ImageObject",442,249,{"name":42,"@type":43},"Graffin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-11","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What information must be completed in Part A of SOC 426?","Question",{"text":62,"@type":63},"Part A requires the recipient to enter the provider’s name, address, telephone number, date of birth, Social Security number, gender, relationship to the recipient, and the provider’s start date.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"When can the provider be paid under SOC 426?",{"text":67,"@type":63},"The chosen provider cannot be paid federal and/or state money until the provider completes all enrollment requirements, including the enrollment form, fingerprints and clearance through a background check, orientation, and returning a signed enrollment agreement.",{"name":69,"@type":60,"acceptedAnswer":70},"What are the rules for adjusting and tracking provider weekly work hours?",{"text":71,"@type":63},"Total monthly authorized hours are divided by 4 to guide maximum weekly hours. The recipient must ask the county for approval to adjust the maximum weekly hours under specified overtime and workweek threshold conditions, and the provider must not exceed total authorized monthly service hours.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},305366,1790283412,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,113,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},18,30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},3573418547284,"https://eur-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES  \n\n| IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM RECIPIENT DESIGNATION OF PROVIDER\u003Cbr>INSTRUCTIONS:\u003Cbr>• Use black or blue ink. Print information clearly.\u003Cbr>• You (or your authorized representative) must complete PART A of this form to let the county know who you have chosen to provide your authorized services.\u003Cbr>• If you have multiple providers, you must fill out a separate form for each person who will be providing authorized services for you.\u003Cbr>• You must sign the acknowledgement in PART C of this form.\u003Cbr>• Please return this completed and signed form to the county. The county will keep the original form and give you a copy. |  |\n| --- | --- |\n| PART A. RECIPIENT DESIGNATION OF PROVIDER |  |\n| 1. Recipient’s Name: |  |\n| 2. County IHSS Case \\#: |  |\n| 3. Provider’s Name: |  |\n| 4. Provider’s Address: |  |\n| City, State, ZIP Code: |  |\n| 5. Provider’s Telephone Number: |  |\n| 6. Provider’s Date of Birth |  |\n| 7. Provider’s Social Security \\#* : |  |\n| 8. Provider’s Gender (check box): | □ Male □ Female |\n| 9. Provider’s Relationship to Recipient (if any): | □ Parent □ Child □ Spouse/Domestic Partner\u003Cbr>□ Conservator □ Guardian\u003Cbr>□ Other   |\n| 10. Provider’s Start Date: |  |\n\n*NOTE: The collection of the Social Security Number is required by the Immigration Reform and Control Act of 1986, Public Law 99-603 (8 USC 1324a), for the purposes of verifying the individual’s identity and authorization to work in the United States.  \nI choose the person listed above to be my IHSS provider. This person will provide some or all of the services authorized by the county.  \nSTATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES  \nPART B. RECIPIENT AGREEMENT  \nI UNDERSTAND AND AGREE THAT:  \n• The person I have chosen to be my provider cannot be paid federal and/or state money for providing services to me until he/she completes all of the provider enrollment requirements. These requirements include completing, signing, and returning (in person) the Provider Enrollment Form (SOC 426), submitting fingerprintsand being cleared of disqualifying crimes through a criminal background check, completing a provider orientation, and returning a signed Provider Enrollment Agreement (SOC 846) .  \n• The county will send me a notice telling me if the person I have chosen as my provider does not complete the provider enrollment requirements or if he/she is not eligible to be an IHSS provider.  \n• If I choose to have this person provide services for me before he/she is enrolled asan IHSS provider, and the county sends me a notice telling me that he/she is not eligible to be an IHSS provider, I will have to pay him/her with my own money for the services that he/she provided before he/she was determined ineligible to be a provider and for any services he/she provides after the county notifies me that  \nhe/she is ineligible.  \n• Neither the county nor the State will be held responsible for any claims and/or losses caused by the above-named person I choose to hire as my IHSS provider. I agree to hold harmless the State and county, their officers, agents, and employees, and to take responsibility for any and all claims and/or losses to any person caused by the named person I choose to hire as my IHSS provider.  \n• The county can provide information about my authorized services and service hours to the person I have chosen as my provider. The county will send my provider the IHSS Provider Notice of Recipient Authorized Hours and Services (SOC 2271) .  \n• My total monthly authorized hours will be divided by 4 to determine my maximum weekly hours. The maximum weekly hours is a guideline telling me the highest number of hours my provider(s) will be able to work for me during a workweek. However, since most months are slightly longer than 4 weeks, I will work with my provider(s) to spread his/her hours throughout the month in order ","cbCail5D3XFrqFOe","https://ap.wps.com/l/cbCail5D3XFrqFOe","pdf",39891,"English","# PART A. RECIPIENT DESIGNATION OF PROVIDER\n## Provider identity and relationship details\n# PART B. RECIPIENT AGREEMENT\n## Provider enrollment before payment\n## County notices and recipient responsibilities\n## Authorized hours and approval rules","[{\"question\":\"What information must be completed in Part A of SOC 426?\",\"answer\":\"Part A requires the recipient to enter the provider’s name, address, telephone number, date of birth, Social Security number, gender, relationship to the recipient, and the provider’s start date.\"},{\"question\":\"When can the provider be paid under SOC 426?\",\"answer\":\"The chosen provider cannot be paid federal and/or state money until the provider completes all enrollment requirements, including the enrollment form, fingerprints and clearance through a background check, orientation, and returning a signed enrollment agreement.\"},{\"question\":\"What are the rules for adjusting and tracking provider weekly work hours?\",\"answer\":\"Total monthly authorized hours are divided by 4 to guide maximum weekly hours. The recipient must ask the county for approval to adjust the maximum weekly hours under specified overtime and workweek threshold conditions, and the provider must not exceed total authorized monthly service hours.\"}]","IHSS Provider Designation - Form SOC 426 - Recipient Designation of Provider Instructions | PDF",1789824112]