Recipient Designation of Provider Form (SOC 426A)

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(The SOC 426A Form is applicable only if you are already providing services to 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.

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.