To fill out the California IHSS application form (SOC 295), download the PDF from the California Department of Social Services, complete all ten sections with your personal, household, and service-request information, sign the affirmation in Section 9, and submit it to your county IHSS office along with a Health Care Certification (SOC 873) signed by a licensed health care professional.
Where to Get the Form
The SOC 295, officially titled “Application for In-Home Supportive Services,” is available as a PDF on the California Department of Social Services website or in person at your county IHSS office.1California Department of Social Services. In-Home Supportive Services Program It is published in English, Armenian, Chinese, and Spanish.2California Department of Social Services. IHSS for Children Print a copy, fill it out in ink, and keep a photocopy before you send it anywhere.
Before you start, know that IHSS is a Medi-Cal program. Every applicant needs a Medi-Cal eligibility determination before services can be authorized, and you must be a California resident who is aged (65 or older), blind, or disabled, living in your own home rather than a hospital, licensed community care facility, or long-term care facility.1California Department of Social Services. In-Home Supportive Services Program If your income sits above the free Medi-Cal threshold, you may still qualify through a Share-of-Cost arrangement, and payments you make to your IHSS caregiver count toward that monthly amount.3California Department of Social Services. Share-of-Cost Fact Sheet
Filling Out Each Section
The SOC 295 has ten numbered sections. Most are straightforward, but a few affect how your case is set up and how many hours you’re ultimately authorized, so they deserve close attention.4California Department of Social Services. Application for In-Home Supportive Services SOC 295
Section 1: Personal Information
Enter your full name, Social Security Number, date of birth, home address, and contact information. Use the address where you actually live, since your county of residence determines which IHSS office handles your case.
Section 2: Sexual Orientation and Gender Identity
This section is entirely optional. You can decline every question in it without affecting your application.
Section 3: Veteran Status
Answering yes here may connect you to additional resources for veterans, but it does not change your IHSS eligibility.
Section 4: SSI/SSP Status and Services Requested
This section does two things at once. First, it asks whether you receive Supplemental Security Income or State Supplementary Payment benefits and, if so, what type of living arrangement you have: independent living, board and care, or home of another. SSI/SSP recipients automatically meet the Medi-Cal eligibility requirement, which simplifies the financial side of the application.
Second, it asks you to describe the services you’re requesting. Be specific. If you need help bathing, meal preparation, or protective supervision, write that down. The social worker will make the final determination at the in-home assessment, but listing your needs on the application makes sure nothing gets overlooked at intake.
Section 5
Complete the fields on the form as printed.
Section 6: Household Information
List the name, date of birth, and Social Security Number of your spouse and any other people who live in your home. This isn’t just demographic. The county uses it to decide whether other household members can handle shared domestic tasks like cooking or cleaning. If everyone in the household has a disability, the county factors that in when allocating domestic-service hours. Report everyone accurately; errors here can lead to incorrect hour calculations or processing delays.
Section 7: Ethnic Origin and Language
Your answers here tell the county which language to use for notices and services. If you read or speak a language other than English at home, indicate that so future correspondence arrives in a form you can use.
Section 8: Communication Accommodations
If you are blind or visually impaired, you can request braille documents, audio CDs, or large-print notices in this section. The county is required to send notices in the format you check.
Section 9: Affirmation
By signing, you confirm the information is true and that you understand your responsibilities as the employer of your IHSS provider. Those responsibilities include hiring, training, and supervising your caregiver, making sure authorized hours aren’t exceeded, and notifying the county within 10 days of any changes.
Section 10: Signatures
Sign and date on the applicant line. If someone else is helping you manage the application, they sign the authorized representative line and add their relationship to you, their phone number, and their address.
The SOC 873 That Goes With It
California law requires every IHSS applicant to submit a Health Care Certification, the SOC 873, signed by a licensed health care professional.5California Legislative Information. California Code, Welfare and Institutions Code – WIC 12309.1 The SOC 295 alone is not a complete application. The SOC 873 provides medical evidence that your condition limits your ability to handle daily activities and that without in-home help, you would be at risk for out-of-home placement.
A “Licensed Health Care Professional” for this form means someone licensed in California by the appropriate regulatory agency who is acting within the scope of their license. The form lists these examples:6California Department of Social Services. In-Home Supportive Services IHSS Program Health Care Certification Form
- Physicians and physician assistants
- Psychiatrists and psychologists
- Occupational therapists and physical therapists
- Optometrists and ophthalmologists
- Public health nurses
- Regional center clinicians or clinician supervisors
The professional completing the form describes your condition, the functional limitations it causes, and why you need help with daily living activities. A vague or incomplete SOC 873 can slow your case considerably, because while it can’t be the sole basis for approving or denying services, the county treats it as a key indicator of need.5California Legislative Information. California Code, Welfare and Institutions Code – WIC 12309.1
You have 45 days from the date the county worker requests the certification to return the completed SOC 873.7California Department of Social Services. SOC 874 The county can extend that on a case-by-case basis if you show good cause.5California Legislative Information. California Code, Welfare and Institutions Code – WIC 12309.1 Don’t rely on that. Some medical offices take weeks to complete paperwork, so hand-deliver the blank SOC 873 to your provider’s office shortly after you submit the SOC 295.
Submitting the Application
Send your completed SOC 295 and SOC 873 to the IHSS office in the county where you live. You can mail, fax, or hand-deliver the forms. The California Department of Social Services maintains a directory of every county IHSS office with addresses and phone numbers.8California Department of Social Services. County IHSS Offices Some counties also accept applications by phone. Los Angeles County, for example, lets you call to apply, but you still need to submit the signed SOC 295 paperwork to complete the process.
If you mail the forms, use certified mail or another method that gives you a delivery receipt, and keep photocopies of everything you send. After the county receives your application, it sends a confirmation and assigns a social worker to your case. If no in-home assessment is scheduled within 30 days of your application, you have the right to request a state fair hearing to compel action.
What Happens After You Submit
A county social worker visits your home to evaluate your functional abilities in person. This assessment, not the paperwork, is the single biggest factor in how many hours you get. The social worker watches you perform or attempt everyday tasks like bathing, dressing, transferring in and out of a chair, and preparing food, and assigns a functional ranking to each activity based on how much help you need. Be honest about your worst days rather than your best. Point out safety hazards in the home. Walk through every category of service where you struggle, including nighttime needs. Have medical records, hospital discharge summaries, and therapy notes ready.
After the visit, the county mails you a Notice of Action listing each service category, the hours authorized for that category, the total monthly hours, and the start date, or explaining why the application was denied.9California Department of Social Services. NA 1250 – IHSS Approval Read the hour breakdown carefully. Individual categories sometimes come in lower than expected, and each category can be appealed separately by requesting a state hearing within 90 days of the notice.10California Department of Social Services. Public Appeal Request – ACMS