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IHSS Care Provider Forms

Choose from the available forms below to provide information, keep your information current or request changes.

IHSS Provider Hiring Agreement

To Become Hired by a Recipient of IHSS Services

Your recipient will complete the IHSS Provider Hiring Agreement which includes the SOC 426A Recipient Designation of Provider. The IHSS Provider Hiring Agreement may be obtained by downloading from the link below or by calling the IHSS Provider & Recipient Call Center (PARCC) at (559) 600-6666 option 4.

IHSS-Provider-Hiring-Agreement.pdf(PDF, 176KB)

IHSS-Provider-Hiring-Agreement-Spanish.pdf(PDF, 2MB)

Important Things to Remember:

We cannot accept digital or e-signatures.
The IHSS Provider Hiring Agreement must be completed & signed by the Recipient of IHSS services (or their authorized representative).
Please allow 7-10 business days once the IHSS Provider Hiring Agreement is received for you to be linked to the IHSS Recipient’s case & timesheets to be available.
Once you are hired, timesheets are submitted & approved electronically via either the
- Electronic Services Portal (ESP) https://www.etimesheets.ihss.ca.gov/login
- Telephonic Timesheet System (TTS) 1-833-342-5388

Change of Address or Telephone Number

Now IHSS Care Providers can update their residential and/or mailing address and phone number online! Simply visit the Electronic Services Portal today!

If you would prefer to update your address and/or phone number by submitting the SOC 840, please submit your completed & signed form by USPS mail, fax or Secure Document Submission.

Change of Address or Phone (SOC 840) English

Change of Address or Phone (SOC 840) Spanish

As an IHSS Care Provider, you are required to inform us of any change in your contact information within ten (10) days.

Workweek & Travel Time Agreement

Providers who work for multiple recipients will need to complete and sign a Workweek & Travel Time Agreement. This agreement explains the workweek and travel time limitations, and includes areas for you to plan your workweek schedule and record the estimated travel time between recipients’ locations each week. Completing the SOC 2255 will help make sure that you do not work more or travel more than you are allowed to each workweek.

IHSS Provider Workweek and Travel Time Agreement (SOC 2255)

Once form is completed and signed, submit by:

USPS mail to:

Department of Social Services
IHSS - Public Authority
P.O. Box 1912
Fresno, CA 93718-1912

Fax to:

IHSS - Public Authority
(559) 600-7762

or online by Secure Document Submission!

Employment & Wage Verification

It is important to remember that the County of Fresno and Department of Social Services In-Home Supportive Services (IHSS) ARE NOT THE EMPLOYER. However, verification that the care provider is and/or has been employed by one or more recipients of the IHSS program can be provided.

Take me to the Employment & Wage Verification page!

Direct Deposit

Effective July 1st, 2022, all WPCS & IHSS Care Providers will be required to receive their paycheck by Direct Deposit.

Direct deposit is the way you will receive your IHSS/WPCS paycheck. 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. A pay card is a reloadable card you can use for direct deposit and to make purchases and withdrawals.Please visit https://www.cdss.ca.gov/inforesources/ihss-providers/resources/direct-deposit if you would like more information on Direct Deposit and pay cards.

Enroll Online!

1. You must be registered on the ESP Website
2. You must be actively working for an IHSS and/or WPCS recipient
3. Have an open checking or savings account
4. Have your Bank Name, Account Number and the Routing Number
5. IHSS Providers are eligible for direct deposit if they meet the following requirements:

If you would like to enroll via paper form you can Download Direct Deposit Forms. Please remember that you must submit a separate form for each IHSS Recipient that you want payments to be directly deposited for. If there are no timesheets submitted for 60 days, you will be dis-enrolled from direct deposit and will have to re-enroll.

Once all sections of the form are complete please sign, date and mail Direct Deposit forms to:

Provider Forms Processing Center
PO Box 1697
West Sacramento, CA 95691-6697

If you have questions about IHSS Direct Deposit, you can call the Provider Direct Deposit Help Desk during business hours at 1-866-376-7066 (select option 2 for Direct Deposit assistance).

W-4/DE 4

As an IHSS Care Provider, you have the option to complete a W-4 and DE 4 to have Federal & State taxes withheld from your wages. If you do not submit Form W-4 and DE 4, federal and state income taxes will not be withheld from your wages. Unfortunately, we cannot provide any tax advice, please contact the IRS or your tax preparer for questions regarding withholdings or exclusions. For more information, please visit the IRS website (www.irs.gov).

Do you have questions regarding how to complete your W-4 & DE 4? See below for instructions and helpful tips.

	W-4	DE 4	Instructions
English	Form W-4 (2024) English	DE 4 English	How to Complete the W-4 and DE 4(PDF, 242KB)
Spanish	Formulario W-4 (2024) Spanish	DE 4 Spanish	How to Complete the W-4 and DE 4 Spanish(PDF, 273KB)

Once completed and signed, W-4/DE 4 forms should be submitted by mail to:

IHSS Payroll Management Unit
PO Box 1660
West Sacramento, CA 95691-6660

Please do not submit to your local county IHSS office

Paid Sick Leave

Visit https://www.cdss.ca.gov/inforesources/ihss-providers/resources/sick-leave for more information regarding the Paid Sick Leave Program for IHSS Care Providers.

For More Information

Please contact the IHSS Public Authority Provider & Recipient Call Center (PARCC) at: (559) 600-6666 option 4

More Provider Resources

Resources for IHSS Care Providers

More About Payroll

Fresno County In-Home Supportive Services (IHSS) Payroll is dedicated to helping providers and recipients who need assistance with a variety of payroll related issues.

Payroll Information: Timesheets, EVV & ESP

IHSS Care Provider Forms

Choose from the available forms below to provide information, keep your information current or request changes.

IHSS Provider Hiring Agreement

Important Things to Remember:

Change of Address or Telephone Number

Workweek & Travel Time Agreement

Once form is completed and signed, submit by:

Employment & Wage Verification

Direct Deposit

W-4/DE 4

Paid Sick Leave

Visit https://www.cdss.ca.gov/inforesources/ihss-providers/resources/sick-leave for more information regarding the Paid Sick Leave Program for IHSS Care Providers.

For More Information

More Provider Resources

Resources for IHSS Care Providers

More About Payroll

W-2 Information

Where is my W-2 ?

IHSS Care Provider Forms

Choose from the available forms below to provide information, keep your information current or request changes.

IHSS Provider Hiring Agreement

Important Things to Remember:

Change of Address or Telephone Number

Workweek & Travel Time Agreement

Once form is completed and signed, submit by:

Employment & Wage Verification

Direct Deposit

W-4/DE 4

Paid Sick Leave

Visit https://www.cdss.ca.gov/inforesources/ihss-providers/resources/sick-leave for more information regarding the Paid Sick Leave Program for IHSS Care Providers.

For More Information

More Provider Resources

Resources for IHSS Care Providers

More About Payroll

W-2 Information

Where is my W-2 ?

Related Information