To resign as an In-Home Supportive Services caregiver in Santa Clara County, you fill out the county’s Provider Self-Termination Form (SCI 502), sign it, and send it to the IHSS office in San Jose. The form is one page. It removes you from a specific recipient’s case, so if you work with more than one recipient you’ll submit one form per person you’re leaving. Get it wrong or leave a field blank and the county sends it back, which delays your removal and can create payroll problems.1County of Santa Clara Social Services Agency. Provider Self-Termination Form SCI 502
The PDF is posted on the Santa Clara County Social Services Agency’s IHSS forms page at stgenssa.sccgov.org, and paper copies are available at the IHSS office. The header on the form itself reads “Please complete this form to remove yourself as a provider,” which is how you know you’ve grabbed the right one and not an enrollment or change form.
What to Fill In
The form asks for a short list of items, all of which the county uses to match your resignation to the correct case file:
- Your full name as it appears in the IHSS system.
- Your Social Security number and/or Provider ID number. Either identifier works; if you’d rather not write your full SSN, the Provider ID assigned when you enrolled should be enough.
- The recipient’s name.
- The recipient’s IHSS case number. If you don’t have it, the recipient or the IHSS office can give it to you.
- Your last day worked. This is the final date you provided (or will provide) care, and it drives your last paycheck.
- Your signature and the date. An unsigned form is treated as incomplete.
If you care for more than one IHSS recipient and are only leaving one of them, fill out a separate form for each recipient you’re leaving. Terminating from one case has no effect on your other assignments.
Where to Send It
Mail or drop off the completed form at:
In-Home Supportive Services (IHSS)
353 W. Julian St.
San Jose, CA 951102County of Santa Clara Social Services Agency. In-Home Supportive Services
If you mail it, certified mail with return receipt gives you proof of delivery, which is useful if a later dispute turns on when you stopped providing care. Keep a photocopy of the signed form either way. To confirm receipt or ask questions, call the IHSS office at (408) 792-1600 or (408) 792-1601. No public fax number or online upload option for this form appeared on the county’s site, so plan on mail or in-person delivery unless the office tells you otherwise.
Submit Your Final Timesheet Too
The self-termination form changes your status in the system, but it doesn’t trigger your final pay. You still need to submit a timesheet for every hour you worked through your last day. Enter those hours through the Electronic Services Portal at etimesheets.ihss.ca.gov.3California Department of Social Services. IHSS Electronic Services Portal – Login The last date on your timesheet should match the “Last Day Worked” you entered on the SCI 502; a mismatch is the kind of small inconsistency that stalls payroll.
California law sets deadlines for that final paycheck. If you give at least 72 hours’ notice before your last day, your wages are due on that last day. If you quit with less than 72 hours’ notice, the employer has up to 72 hours after your last day to pay you.4California Department of Industrial Relations. Paydays, Pay Periods, and the Final Wages IHSS runs on a set payroll cycle, so in practice your final check may arrive on the next regular pay date. If it doesn’t show up, call the IHSS office.
Give the Recipient Notice
The SCI 502 goes to the county, not to the recipient. Nothing in state law requires a specific notice period from the provider, though the California Department of Social Services recommends two weeks as a best practice so the recipient has time to arrange replacement care.
If your recipient needs help finding a new caregiver, they can call the Santa Clara County Public Authority registry at (408) 350-3251 for a list of pre-screened providers available for hire.5Santa Clara County Social Services Agency. Who Do I Contact – For Independent Providers and Recipients of IHSS Passing along that number when you tell them you’re leaving is a small thing that matters, especially if they depend on daily care.
Taxes After You Leave
Leaving mid-year doesn’t change how your earnings for that year get reported. You’ll still receive a W-2 or 1099 covering the wages you earned through your last day.
If you lived in the same home as the recipient, some or all of your IHSS payments may be excludable from gross income under IRS Notice 2014-7, which treats qualifying Medicaid waiver payments as “difficulty of care” payments under Internal Revenue Code Section 131.6Taxpayer Advocate Service. Certain Medicaid Waiver Payments May Be Excludable From Income You may still get a W-2 reporting those payments even though they’re excludable; that’s normal. If you claim the Earned Income Tax Credit, you can elect to include those payments as earned income for EITC purposes while still excluding them from gross income.
Hold on to your timesheets, pay stubs, and a copy of the signed SCI 502 for at least four years after the tax year in question. The IRS requires employment tax records to be kept for that period.7Internal Revenue Service. Recordkeeping
Coming Back Later
Ending an assignment voluntarily doesn’t bar you from IHSS in the future. If you return, you go through enrollment again, including provider orientation and the enrollment agreement California law requires.8California Legislative Information. California Welfare and Institutions Code WIC 12301.24 Whether you’ll need a fresh background check depends on how long you’ve been away and whether your previous clearance is still on file. Call the IHSS office at (408) 792-1600 before starting over so you know which steps apply to you.