WebJan 6, 2024 · Placer County IHSS Recipients should mail the completed form: Placer County IHSS, 11512 B. Ave., Auburn, CA 95603. We will also accept the completed form via email or fax to: Email: [email protected] Fax: 530-886-3690. Remember, the form must be signed by both Provider and Recipient, digital/electronic signatures will … WebContact Us. MA & CHIP Renewals. Apply for Benefits. COVID-19. Report Fraud & Abuse. Licensing & Providers. Department of Human Services > Find a Document > Forms. …
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Webpa-100 (02-06) c o m m o n w e a lth of pennsylva n i a d e pa rt m e n tof revenue bureau of business t r u s tfund ta x e s po box 280901 harrisburg, pa1 7 1 2 8 - 0 9 0 1 pennsy lva … WebIf you receive Supplemental Security Income (SSI) or meet all Medi-Cal income eligibility requirements, you may be able to receive IHSS services. Phone: (415) 473-4636 Hours: 830am -4:30pm Fax: (415) 473-6465 Address: 10 North San Pedro San Rafael, CA 94903 Application Process: 1. stair railing and spindles painted black
Forms Contra Costa IHSS Public Authority
WebUse Get Form or simply click on the template preview to open it in the editor. Start completing the fillable fields and carefully type in required information. Use the Cross or Check marks in the top toolbar to select your answers in the list boxes. Utilize the Circle icon for other Yes/No questions. WebOct 23, 2024 · IHSS is a Statewide program that provides home care services to help eligible people with disabilities remain in their own homes. IHSS provides help with: Domestic and Related Services: meal preparation, cleaning, laundry Personal Care Services/Non–Medical Care: bathing, feeding, dressing, grooming and toileting. WebRecipient Documents. For Recipients, if you have any questions regarding your IHSS services or which form (s) may apply to you, please call the IHSS services Line: (916) 874-9471. Recipient Notice (Temp 3002) (notice sent to all Recipients) Recipient Declaration (Temp 3000) overtime and Workweek Requirements (Required of every Recipient ... stair railing and spindles