STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FREQUENTLY ASKED QUESTIONS (FAQ’S) ABOUT THE IHSS

PROGRAM PROVIDER ENROLLMENT FORM (SOC 426)

****PLEASE READ THIS INFORMATION CAREFULLY BEFORE YOU

BEGIN TO COMPLETE THE SOC 426****

1. WHO MUST COMPLETE THE PROVIDER 5. WHY DO I HAVE TO SIGN THE SOC 426?
ENROLLMENT FORM (SOC 426)?
You have to sign the SOC 426 to show that you fully
An IHSS provider is someone who gets paid from the understand and agree to all of the statements listed in
IHSS program for providing supportive services for an the declaration in PART C. You are signing the
IHSS recipient (someone who gets services through SOC 426 under penalty of perjury.
the IHSS program).
6. WHAT DOES “UNDER PENALTY OF PERJURY”
Any person who is already an IHSS provider OR who MEAN?
wants to become an IHSS provider has to complete
and sign the SOC 426. The words, “under penalty of perjury,” mean that you
swear that all of the information you are giving is true
2. WHEN DO I HAVE TO COMPLETE THE SOC 426? and correct. If you intentionally give false information
or hold back information so you can get a benefit or
If you are already an IHSS provider, you have to payment that you are not entitled to, you can be
complete, sign and return the SOC 426 BY JULY 1, prosecuted for fraud under federal and state law. If
2010. If you do not submit the SOC 426 BY JULY 1, you are convicted of fraud, you can be fined, jailed
2010, you will no longer be eligible to be an IHSS and/or disqualified from becoming an IHSS provider.
provider.
As part of the provider enrollment process, you will
If you want to become an IHSS provider, you have to also have to be fingerprinted and go through a
complete, sign and return the SOC 426 BEFORE you criminal background check. The criminal background
can be enrolled as an IHSS provider and get paid for check will show whether you have provided any false
providing services. information on the SOC 426.

3. WHERE DO I RETURN THE SOC 426? 7. WHAT KIND OF ID DO I HAVE TO PROVIDE?

After you have completed and signed the SOC 426, You must provide two original pieces of ID.
you must return it IN PERSON to the county IHSS Photocopies of ID are not acceptable. You must
office or county Public Authority. provide:

You will have to show identification (ID) when you • An unexpired Driver’s License or ID card issued by the
return the SOC 426. See Question #7 on this page for California (or another state’s) Department of Motor
information about what kind of ID is required. Vehicles, OR
• Some other unexpired ID issued by a government
4. WHAT ITEMS ON THE SOC 426 DO I HAVE TO agency (e.g., military ID, passport, permanent resident
COMPLETE? card, etc.); AND
• A Social Security Card; OR
You have to complete all of the items in PART A and • Other official correspondence from the Social
you must also answer all part of #9 (a., b. and c.) in Security Administration verifying your Social Security
PART B. If you answer “YES” to any part of item #9 Number.
(a., b., or c.) in PART B., you must also answer all the
remaining questions in PART B (#’s 10, 11, 12 and If you are under the age of 18, you also have to provide a
13). You have to read and sign the declaration in PART valid Work Permit.
C. If you do not answer all of the required questions
and sign the SOC 426, you will not be eligible to be
enrolled as an IHSS provider.

SOC 426B (10/09) PAGE 1

8. WHY DO I HAVE TO COMPLETE THE SOC 426? 11. WHAT HAPPENS TO THE INFORMATION I
PROVIDE?
You have to complete the SOC 426 to let the county
know if you have been convicted of OR in prison for a The county will review the information you provide on
crime that would disqualify you from being an IHSS the form to make sure it is complete, and will
provider. determine whether you are eligible to be an IHSS
provider. They will also check to see if your name
9. WHAT CRIMES WOULD MAKE ME INELIGIBLE TO appears on the Medi-Cal Suspended and Ineligible
BE AN IHSS PROVIDER? (S&I) Providers list, which includes the names of
persons who have been:
Under state law, any person WHO WITHIN THE LAST
10 YEARS has been convicted of OR in prison for one 1) Convicted of a crime involving fraud or abuse of
of the following crimes is not eligible to be an IHSS the Medi-Cal Program, or
provider or to received payment from the IHSS 2) Suspended from the federal Medicare program for
program for providing supportive services: any reason.

• A crime involving fraud against a government If your name is on the S&I Providers list, you will not
health care of supportive services program; or be able to be an IHSS provider. The county will send
• Abuse of a child, elder or dependent adult. you a letter informing you that you are ineligible to be
an IHSS provider.
Also, any person who has EVER been convicted of or
in prison for a felony crime OR certain serious If you are determined to be ineligible to be an IHSS
misdemeanor crimes is not eligible to be an IHSS provider, and your name is not already on the S&I
provider or to receive payment from the IHSS program Providers list, the county will ask to have your name
for providing supportive services. added to the list.

Generally, misdemeanor crimes involving violence or 12. CAN I APPEAL IF I’M FOUND INELIGIBLE TO BE
threats of violence would disqualify a person from AN IHSS PROVIDER?
being an IHSS provider.
Yes. The letter the county sends you if you are found
Minor infractions, such as traffic violations, would not ineligible to be an IHSS provider will tell you how to
disqualify a person from being an IHSS provider. request an appeal. You will need to ask for an appeal
IN WRITING WITHIN 60 DAYS OF THE DECISION.
10. WHAT HAPPENS IF I’M CONVICTED OF A CRIME You must send your request for appeal to the following
AFTER I’M ENROLLED AS AN IHSS PROVIDER? address:

You must let the county know of any changes to the California Department of Social Services
information you reported on the SOC 426 within 10 Adult Programs Branch
calendar days of the change. If you get convicted of IHSS Provider Enrollment Appeals, MS 19-04
one of the disqualifying crimes, you will no longer be PO Box 944243
eligible to be an IHSS provider. The county will receive Sacramento, CA 94244-2430
information about any criminal convictions through the
criminal background check process that you must also If you have questions about an appeal, call
go through to be enrolled as a provider. (916) 556-1156.

If you have any other questions about the SOC 426,

ask your county IHSS Office or IHSS Public Authority.

SOC 426B (10/09) PAGE 2