Personal Care Services Forms for Santa Clara
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FAQ
What Is Form SOC 873? Form SOC 873, In-Home Supportive Services (IHSS) Program Health Care Certification Form, is a medical certification form filled out by a licensed health care professional to enable disabled, blind, or elderly individuals to receive services from the In-Home Supportive Services (IHSS) program.
Beginning January 2017, you have the option to self-certify your living arrangements to exclude IHSS/WPCS wages from FIT and SIT by sending the Live-In Self-Certification Form (SOC 2298). All requested information on the form must be provided and the form must include your signature and the date you signed the form.
The SOC 873 form must be filled out by a licensed health care professional and returned to the county within 45 days of the date of your assessment. Unless this form is completed and returned, your client will lose authorization for IHSS services.
To be eligible, you must be over 65 years of age, or disabled, or blind. Disabled children are also potentially eligible for IHSS.
IHSS can be reached at (408) 792-1600. For instructions about how to apply for IHSS services visit the IHSS Website. If you want to work (or work more hours) as an IHSS care provider and want help finding IHSS consumers that could hire you please apply to join our Registry.
The Assessment of Need for Protective Supervision, also known as SOC 821, is an In-Home Supportive Services (IHSS) form that asks the applicant's health care professional to assess the applicant's memory, orientation, and judgment.