How to Fill Out SOC 295 for In-Home Supportive Services (IHSS)

To apply for IHSS in California, you file a signed SOC 295 application with the In-Home Supportive Services office in the county where you live, prove you qualify for Medi-Cal, and then host a county social worker for an in-home assessment that sets your authorized hours of care. The program is authorized under California Welfare and Institutions Code Section 12300 and is run county by county, so your local office is where everything begins and ends.¹

Who Can Apply

IHSS is for aged, blind, or disabled Californians who could not safely stay in their own homes without help. Three baseline conditions have to be true before the county will move forward: you live in California, you have a current Medi-Cal eligibility determination, and you have a functional need for help with daily activities such as bathing, meal preparation, or housework.²

Medi-Cal is the financial gate. If you already receive Supplemental Security Income, you automatically qualify for Medi-Cal and skip the separate financial screening. If you do not receive SSI, the county measures your income against Medi-Cal thresholds. California fully eliminated its Medi-Cal asset limit for older adults and people with disabilities in January 2025, so the old $2,000 individual and $3,000 couple resource caps no longer apply. Income still matters, and applicants above the standard income threshold may qualify only with a monthly share of cost.

Documents to Gather Before You Start

Missing documents are the most common reason an application stalls. Pull these together before you fill in anything:

A Social Security card, which is required under federal law for the eligibility determination, plus a California driver’s license, state ID, or other government-issued photo ID.³
Recent income records: Social Security benefit statements, SSI award letters, pension distribution notices, and pay stubs for any working household member.
The most recent statements for every checking and savings account in your name or jointly held.
Your lease or mortgage statement, recent utility bills, and receipts or statements for recurring medical expenses.
Award letters for any other public benefits you receive, which speed up the county’s cross-referencing.

Filling Out the SOC 295

The SOC 295 is the standard statewide application. You can download the PDF from the California Department of Social Services or pick one up in person at any county office.² Every section has to be completed. A blank field can send the whole package back to you rather than into processing.

The first section is personal identifying information: full legal name, date of birth, Social Security number, address, and the names of everyone in your household. If someone is filling out the form on your behalf as an authorized representative, their information goes here too.

The income section asks for every source of monthly income, including Social Security retirement or disability benefits, SSI, pensions, annuities, wages, rental income, and support payments from family members. Report gross amounts, not net. The county applies the correct deductions on its end, and reporting net income is a common mistake that slows processing because your numbers will not match what the county pulls from federal databases.

You also list assets: real property, vehicles, bank balances, and investment accounts. Even though California no longer applies an asset limit for most Medi-Cal categories, the county still collects this information for program records and to determine whether a share of cost applies.

The last page is a signature under penalty of perjury certifying that everything you reported is true and complete. The authorized representative, if there is one, signs the same page. This is a legal certification, not a formality.

Where to Send It

Submit the completed SOC 295 and your supporting documents to the IHSS office in the county where you live. California has 58 counties, each with its own office, and contact information is listed on the CDSS website.² You have three options:

Walk the application in. Ask the clerk to date-stamp a copy for your records. This is the fastest way to confirm receipt and catch obvious issues on the spot.
Mail it certified with return receipt requested, so you have proof of delivery and a mailing date.
Fax it, if your county accepts faxed applications. Call first to confirm the fax number and whether originals need to follow by mail.

Once the county logs your application, a caseworker reviews the financial information and cross-references it against federal databases, including Social Security Administration records.

The In-Home Assessment

If your financial eligibility checks out, the county schedules a social worker to come to your home. The county is expected to complete this assessment within 30 days of your request. If 30 days pass without one, you have the right to request a state fair hearing.⁴

During the visit, the social worker observes your living situation and evaluates how well you can handle daily tasks on your own. The assessment uses a Functional Index Scale that ranks each task category, such as bathing, grooming, meal preparation, laundry, and mobility, on a 1-to-5 scale, where 1 means fully independent and 5 means you cannot do the task at all.⁵ Each ranking corresponds to a range of authorized weekly hours. The totals across all task categories become your monthly authorized hours, the number of hours a paid provider can work for you through the program.

Be specific about what you actually struggle with. If you have good days and bad days, describe the bad days. The assessment is meant to capture the help you need, not what you can push through on your best afternoon.

If Your Income Is Above the Medi-Cal Limit

You can still receive IHSS if your income exceeds the standard Medi-Cal limit but you qualify with a share of cost. You pay a set monthly amount before the state covers the rest, similar in function to a deductible. The share-of-cost amount appears on your provider’s timesheet each pay period, and if you have not already met it through other medical expenses like pharmacy bills or doctor visits, the county subtracts the remaining balance from your provider’s paycheck. You then owe your provider that amount directly.⁶

If you have more than one provider, you cannot choose which one absorbs the share of cost. The county deducts it from whichever provider’s timesheet processes first that pay period.⁶ Keep every medical receipt from the month. Out-of-pocket payments to a pharmacy, doctor, or other provider count toward your share of cost before the IHSS deduction kicks in.

If the County Denies You or Cuts Your Hours

If the county denies your application, reduces authorized hours, or takes another action you disagree with, you can request a state hearing. You have 90 days from the date the county mails or hands you the Notice of Action to file.⁷ If you missed that window for a legitimate reason, you can still ask and explain the delay.

File online through the CDSS Appeals Case Management System, or call the toll-free hearing line at 1-800-743-8525 (TDD: 1-800-952-8349).⁷ One timing detail matters: if you file your hearing request before the county’s proposed action takes effect, your current IHSS services can continue at the existing level while you wait. This is called “aid paid pending.”⁸ You have the right to see the county’s hearing file and get its written position at least two days before the hearing, and you can bring a friend, family member, or legal representative.

Keeping Your Eligibility After Approval

IHSS is not a one-time determination. The county conducts annual reassessments that include another in-home visit to confirm your needs have not changed.² If your condition worsens or your living situation changes between reviews, you can request a reassessment at any time instead of waiting.

Report changes in income or household composition to your county promptly. A new pension, a spouse moving in or out, or losing SSI can all affect your Medi-Cal status and, in turn, your IHSS eligibility.

Because you signed the application under penalty of perjury, the accuracy of what you reported carries real consequences. Under Welfare and Institutions Code Section 10980, knowingly making a false statement to obtain public aid is a misdemeanor punishable by up to six months in county jail, a fine of up to $500, or both. More serious fraud, such as filing duplicate applications, using a fake identity, or applying on behalf of a person who does not exist, can be charged as a felony carrying 16 months to three years in county jail and a fine of up to $5,000.⁹ The county’s verification process is designed to catch discrepancies between what you report and what federal databases show, so errors that look intentional surface quickly.

1
California Legislative Information. California Code WIC 12300 – In-Home Supportive Services
2
California Department of Social Services. In-Home Supportive Services (IHSS) Program
3
California Department of Social Services. Application for In-Home Supportive Services
4
Disability Rights California. IHSS In-Home and Self-Assessment Guide
5
California Department of Social Services. In-Home Supportive Services Assessment and Authorization
6
California Department of Social Services. In-Home Supportive Services (IHSS) Program Share-of-Cost
7
California Department of Social Services. Public Appeal Request – ACMS
8
California Department of Social Services. Hearing Requests
9
California Legislative Information. California Code WIC 10980 – Welfare Fraud