Skip to Content
In-Home Support Services Public Authority

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

Download, print and submit these forms from the California Department of Social Services: 

Phone Numbers, Mandated Reporter, Fraud & Services

Other important documents:

Health and 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