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An Authorized Representative is responsible for acting on the behalf of the IHSS recipient for purposes of the IHSS program. This form is only for the IHSS program.  \nIf you are going to choose an Authorized Representative, here is some important information about the rules of the IHSS program:  \n● If you are a legal representative for the applicant/recipient, you can serve as the Authorized Representative for the applicant/recipient without the need to complete this form. However, an SOC 839A must be submitted for a legal representative to authorize and sign Timesheets or other Provider-Related Documents (TPRD) . A legal representative for the purposes of the IHSS program is a court-ordered conservator of an adult or a parent/guardian or legally-authorized decisionmaker of a minor.  \n● If your Authorized Representative will be responsible for signing TPRD, you or your legal representative must submit a SOC 839A – Designation of Signatory for Timesheets and Other Provider-Related Documents form to designate the Authorized Representative as the TPRD signatory. However, if your provider is your Authorized Representative, they cannot sign their own TPRD unless they are also your legal representative.  \n● You or your legal representative can choose a new or add an IHSS Authorized Representative at any time by completing a new SOC 839 and submitting it to the IHSS County Office.  \n● Your Authorized Representative must be 18 years or older.  \n● You cannot designate an individual, who is not a legal representative, as an Authorized Representative if they have been convicted of or incarcerated following a conviction for certain crimes within the past 10 years.  \nThere are two categories of exclusionary crimes:  \n○ Tier 1 crimes, as set forth in Welfare and Institutions Code (WIC) section 12305.81, include the following:  \n1. Specified abuse of a child (Penal Code [PC] section 273a[a]);  \n2. Abuse of an elder or dependent adult (PC section 368); and  \n3. Fraud against a government health care or supportive services program.  \n○ Tier 2 crimes, as set forth in WIC section 12305.87, include the following:  \n1. A violent or serious felony, as specified in PC section 667.5(c) and PC section 1192.7(c);  \n2. A felony offense for which a person is required to register as a sex offender pursuant to PC section 290(c); and  \n3. A felony offense for fraud against a public social services program, as defined in WIC sections 10980(c)(2) and 10980(g)(2) .  \nA complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority.  \nThis form does not designate an authorized representative for purposes of state administrative hearings. For more information on how to choose an authorized representative to represent you at a state administrative hearing, call the state hearings division at 800-952-5253.  \n● Your Authorized Representative may perform all tasks stated on this form. However, you are still responsible for providing all needed information to the county for program eligibility.  \n● Choosing an Authorized Representative does not exclude you from being actively involved in your own care. County IHSS program staff will still need to meet with you, as the applicant/recipient, in person to ask questions related to your care and services although the Authorized Representative may also be present.  \nResponsibilities of an Authorized Representative  \nBy choosing an Authorized Representative, you or your legal representative agree your Authorized Representative can act on your behalf for the IHSS program. The Authorized Representative listed on this","cbCaidXOnVH16xdd","https://ap.wps.com/l/cbCaidXOnVH16xdd","pdf",252516,"English","# Designation of Authorized Representative\n## When a Legal Representative May Not Need SOC 839\n## Authorized Representative Eligibility and Exclusions\n## Responsibilities of an Authorized Representative\n## How to Complete and Submit the Form\n# Part A: Designation of Authorized Representative","[{\"question\":\"Who can serve as an IHSS Authorized Representative?\",\"answer\":\"The Authorized Representative must be 18 years or older. The form also restricts designation of individuals convicted of or incarcerated for certain crimes within the past 10 years.\"},{\"question\":\"When is SOC 839A required for timesheets or provider-related documents?\",\"answer\":\"If the Authorized Representative will be responsible for signing TPRD, the applicant or legal representative must submit SOC 839A to designate the Authorized Representative as the TPRD signatory.\"},{\"question\":\"What responsibilities can an Authorized Representative perform?\",\"answer\":\"The Authorized Representative may perform tasks such as scheduling with county IHSS staff, completing and submitting application or eligibility-related forms, reporting eligibility changes within 10 days, and managing hiring/firing of IHSS providers, while acting in the recipient’s best interest.\"}]","IN-HOME SUPPORTIVE SERVICES (IHSS) - DESIGNATION OF AUTHORIZED REPRESENTATIVE - Form | PDF",1789841542]