IHSS Care Provider Forms

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IHSS Recipient & Care Provider Request Form

As an IHSS Care Provider (or recipient) you can now request certain changes without having to come in to the office or call us!  Now you can:

  • Order Replacement Timesheets
  • Terminate a Care Provider
  • Reinstate (rehire) a Care Provider

Just complete the IHSS Recipient and Care Provider Request Form, sign, date and submit to:

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

Or fax to:

IHSS - Public Authority
(559) 600-7762 

Or email to:

FresnoCountyIHSSPublicAuthority@fresnocountyca.gov


Report a New Address or Telephone Number

As an IHSS Care Provider you are required to inform us of any change in your contact information by completing and signing the IHSS Change of Address and/or Telephone within ten (10) days. Once all sections of the Change of Address or Phone (SOC 840) English or Change of Address or Phone (SOC 840) Spanish form are complete, please sign, date and mail to:

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

Or fax to:

IHSS - Public Authority
(559) 600-7762 

Or email to:

FresnoCountyIHSSPublicAuthority@fresnocountyca.gov


Direct Deposit Online Enrollment Service is Now Available!

As an IHSS Care Provider you can request that your payments are automatically deposited into your checking or savings account instead of being sent to you through the mail.

What are the advantages of direct deposit? Your payroll checks can't get lost in the mail or stolen from your mailbox, purse or pocket. You may have access to your money sooner because you don't have to wait for the check to arrive through the mail.

And, beginning February 12th, 2018, IHSS Care Providers now have the option of enrolling for Direct Deposit Online! The new Online Direct Deposit Enrollment Service allows current, active IHSS/WPCS providers in all California counties the ability to electronically enroll, change or dis-enroll by using the website, instead of using a paper form. 

All IHSS Providers are eligible for direct deposit if they meet the following requirements:

  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

I want more information on Electronic Direct Deposit Service

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 to:

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

If you have additional 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).


Workweek & Travel Time Agreement

Providers who work for multiple recipients will need to complete and sign an IHSS Provider Workweek and Travel Time Agreement (SOC 2255). 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. Once all applicable sections of the form are complete, please sign, date and mail to:

Department of Social Services
Public Authority
PO Box 1912
Fresno, CA 93718-1912

Workweek & Travel Time Agreement (SOC 2255) English

Workweek & Travel Time Agreement (SOC 2255) Spanish


Informational Notices

SOC 847 - Important Information For Prospective Providers - IHSS Provider Enrollment Process

SOC 847 English 

SOC 847 Spanish

 

 

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