Print, Complete, and Bring These Required Enrollment Documents to Your Appointment

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IMPORTANT REMINDER:

Bring your ORIGINAL, VALID Social Security card (work permit if applicable) and ID card to your scheduled appointment.  Otherwise, you will be turned away and MUST reschedule your appointment.

Provider Enrollment Checklist

Lista de Verificación de Inscripción de Proveedores

Recipient Designation of Provider Form (SOC 426A)

English SOC 426A

Spanish SOC 426A

Vietnamese SOC 426A

SOC 426A Translations: Armenian | Cambodian | Chinese | Farsi | Korean | Russian | Tagalog

(The SOC 426A Form is applicable only if you are already providing services or planning to work for an IHSS Recipient.)

Note: If you are not working for an IHSS Recipient yet, you will be given a blank SOC 426A Form at your appointment for completion with your information. A return envelope will be provided so that you may submit the completed SOC 426A Form once you find an IHSS Recipient to work for.

Get fingerprinted before your appointment and bring the copy of your Live Scan Form

Live Scan Form

Live Scan Form Example

Live Scan Locations

If you do not have access to a printer, please call the Provider Enrollment Hotline at 714-825-3195 and the necessary enrollment paperwork will be mailed to you.

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You cannot continue without required enrollment documents

Are all enrollment documents obtained?

CLICK HERE to Continue Online Enrollment