• ihss-pa-caregiver-boy-750

Caregiver Forms & Info

Below are links to several forms that IHSS in-home care providers may find helpful. You'll also find other documents, including important phone numbers and information that you received at orientation.

Care Provider Address, Live-in, Deposit & Tax Forms

Phone Numbers, Mandated Reporter, Fraud & Services

Other important documents:

Health & Dental Benefits

  • To be eligible for benefits, you must work 75 hours for three consecutive months and submit time-sheets by the 15th of each month for the prior month’s work.
  • If you meet this requirement and do not receive a packet in the mail, it is your responsibility to call Dublin Insurance Services to ask for an application packet. The phone number is listed above
  • There is currently a wait list for benefits
  • You must maintain the work requirements while on the wait list. Late time-sheets will disqualify your eligibility.

Service Employees International Union 2015 (SEIU)

  • IHSS providers are represented by SEIU 2015
  • Union dues are deducted from the 1st paycheck of the month.
  • If you work less than 15 hours a month, Union dues are not deducted.
  • Please call your Union Representative with any questions you may have. at (855) 810-2015

Contact Information

Adult and Aging Division
Human Services Department
Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
3725 Westwind Boulevard
First Floor
Santa Rosa, CA 95403
38.510185, -122.796579