IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT FORM - Eligibility Exclusion Guidance and Waiver Instructions

Sep 19, 2026

IN-HOME SUPPORTIVE SERVICES (IHSS) program provider enrollment guidance explains exclusionary criminal offenses and eligibility limits for providers of supportive services. It distinguishes Tier 1 and Tier 2 crimes under specified Welfare and Institutions Code provisions, and describes how a criminal background check and fingerprint submission affect enrollment and payment eligibility within the past 10 years. It further details waiver and general exception pathways for Tier 2 exclusions, including confidentiality requirements, required IHSS forms, county submission rules, and limits for providers acting as authorized representatives.

LanguageEnglish

CategoryForms

FormatPDF

Pages5

Reading Time2 min

AccessFree to download

Program Eligibility and Exclusion Categories

Tier 1 exclusionary crimes

Tier 2 exclusionary crimes

Enrollment Process Requirements

Fingerprints and criminal background check

Effect of convictions within 10 years

Waiver and Exception Options for Tier 2

Individual waiver for a specific recipient

General exception for registry listing

IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ENROLLMENT FORM READ THE INFORMATION BELOW CAREFULLY BEFORE YOU BEGIN TO COMPLETE THIS FORM Under state law, if you have been convicted of or incarcerated following a conviction for certain exclusionary crimes within the past 10 years, you are not eligible to be enrolled as a provider or to receive payment from the IHSS program for providing supportive services except as specified below. There are two categories of exclusionary crimes. • Tier 1 crimes, as set forth in Welfare and Institutions Code (W&IC) section12305.81 , include the following: 1. Specified abuse of a child (Penal Code [PC] section 273a[a]*), 2. Abuse of an elder or dependent adult (PC section 368*), and 3. Fraud against a government health care or supportive services program. • Tier 2 crimes, as set forth in W&IC section 12305.87, include the following: 1. A violent or serious felony, as specified in PC section 667.5(c)*, and PC section 1192.7(c)*, 2. A felony offense for which a person is required to register as a sex offender pursuant to PC section 290(c)*, and 3. A felony offense for fraud against a public social services program, as defined in W&IC sections 10980(c)(2)* and (g)(2)* . A complete listing of Tier 2 crimes is available upon request from the County IHSS Office or IHSS Public Authority. *See attached form SOC 426C for the text of these PC and W&IC sections. – As part of the IHSS provider enrollment process, you must submit fingerprints and undergo a criminal background check conducted by the California Department of Justice. – If your responses on this form or the results of the criminal background check show that you have been convicted of, or incarcerated following a conviction for, either a Tier 1 or Tier 2 crime within the last 10 years, you will not be eligible to be enrolled as an IHSS provider or to receive payment from the IHSS program for providing supportive services. – For Tier 2 crimes, if you have obtained a certificate of rehabilitation or an expungement (dismissal pursuant to PC section 1203.4), the conviction will not disqualify you from working as an IHSS provider. – If your conviction is for a Tier 2 crime, you may qualify for an individual waiver or a general exception under certain circumstances which are described below. – There are no waivers or exceptions allowed for Tier 1 crimes. GO ONTO THE NEXT PAGE SOC 426 (6/16) PAGE 1 OF 5 CONTINUE READING THE INFORMATION BELOW CAREFULLY BEFORE YOU BEGIN TO COMPLETE THIS FORM Individual Waiver of an Exclusion for Conviction for a Tier 2 Crime If you are found ineligible based on a conviction for a Tier 2 exclusionary crime but an IHSS recipient (or his/her authorized representative) wishes to hire you as his/her provider in spite of your criminal background, you may obtain a waiver as follows: • The IHSS recipient who wishes to hire you (or his/her authorized representative) will be informed of your conviction and will be directed to keep the information confidential. • The recipient who wishes to hire you as his/her provider (or his/her authorized representative) must submit an IHSS Recipient Request for Provider Waiver (SOC 862) to the County IHSS Office or IHSS Public Authority. • The waiver will allow you to be enrolled to provide services only for the recipient who requested the waiver and only in the county in which the waiver was filed. • If you, as the provider, are also the recipients’ authorized representative, you are NOT allowed to sign the waiver on behalf of the recipient to waive crimes for which you have been convicted. In this case, the waiver must either be signed directly by the recipient or, if that is not possible, another individual must be declared an authorized representative for purposes of signing this waiver. • For more information about requesting a waiver, the IHSS recipient who wishes to hire you as his/her provider should contact the County IHS

FAQs

What happens if my Tier 1 or Tier 2 conviction is within the last 10 years?

If your responses or your criminal background check show you were convicted of, or incarcerated following a conviction for, a Tier 1 or Tier 2 crime within the last 10 years, you will not be eligible to be enrolled as an IHSS provider or to receive payment for providing supportive services.

Are waivers available for Tier 1 crimes?

No. The document states there are no waivers or exceptions allowed for Tier 1 crimes.

How can a Tier 2 conviction be waived so I can work for a specific recipient?

If you are found ineligible due to a Tier 2 exclusionary crime but the IHSS recipient wants to hire you, the recipient (or authorized representative) must submit an IHSS Recipient Request for Provider Waiver (SOC 862) to the county IHSS office or IHSS Public Authority. The waiver enrolls you only for the requesting recipient and only in the county where the waiver was filed.

Sep 19, 2026

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