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SUPPORTING AND ENHANCING INDEPENDENCE

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PASC Providers

PASC Homecare Registry

Who can join the Registry as a Provider?

PASC Registry provider applicants must be “eligible” to do In-Home Supportive Services (IHSS) work pursuant to current state laws. In other words, Registry provider applicants must have already a) attended the county orientation meeting for IHSS providers and b) cleared a criminal background investigation conducted by the California Department of Justice. Provider applicants who have never worked for the IHSS Program or who have stopped working for one or more years should call the IHSS Helpline to comply with the above requirements before contacting PASC.

How can an individual join the Registry as a provider?

There are three ways in which an “eligible” IHSS provider can join the PASC Homecare Registry. Regardless of the option chosen, Registry applicants must submit a copy of their valid Driver License/California ID, a copy of their social security card, and, when applicable, a copy of any document showing a legal right to work in the USA. We also encourage applicants to submit copies of any certificates or documents they may possess related to their experience and/or training in-home care or nursing duties.

Attend a Registry Information & Recruitment Meeting:

PASC Homecare Registry conducts information/provider recruitment meetings in different cities throughout the year.  At these 2-hour long meetings, provider applicants learn about the Registry’s expectations, required code of conduct on the job, and generalities about the IHSS program. At the end of the meeting, applicants will be given the registry application form, which solicits information on the applicants’ experience and willingness to do the different IHSS tasks. Eligible providers interested in this option should call 877-565-4477, then press 2 followed by 1 for further information, or send an email to Lgonzalez@pascla.org.

Apply in Person at PASC Office:

Eligible providers can apply to the Registry in person by visiting PASC Headquarters in Pasadena Monday to Friday, between 9am and 4pm. To avoid any misunderstanding, we advise those applicants who choose this option to verify their eligibility to do IHSS work before arrival. Applicants will be served on a first-come, first-served basis, and should plan on spending up to an hour at our office. Due to space limitations, in case other adults accompany the applicant, we recommend that these adults remain in their cars.

Click here to fill out and submit the application electronically

 

You can also download and fill out the application by clicking on one of the languages below. Once filled, you can mail, email, or fax us the application.

 

English      Spanish

Registry applicants must submit a copy of their valid Driver’s License/California ID, a copy of their social security card, and, when applicable, a copy of any document showing a legal right to work in the USA. By downloading the new provider application, you can submit it to PASC by email to info@pascla.org or by mail or fax. Applicants should make sure the application is completed, signed and dated, and that all required documents are attached before submitting the application.

Mail to:
Personal Assistance Services Council
3452 E Foothill Blvd, Suite 900
Pasadena, CA 91107
Attn: Registry Services

Fax to:
818-206-8000
Attn: Registry Services

Email to:
info@pascla.org
Attn: Registry Services

Very important: Providers with Tier 2 convictions are not eligible to join the Registry. Also, if Registry staff concludes, based upon information from any reliable sources, including DPSS, APS, or law enforcement, that a Provider/applicant’s past services or character are such that no well-advised Consumer would be likely to consider the applicant for hire, the Registry may exclude or deny Registry participation to the Provider applicant.

Frequently requested forms:

DE-4 Employees Withholding Allowance Certificate (State)
Use this to have state taxes taken out of your paycheck.

W-4Employees Withholding Allowance Certificate (Federal)
Use this to have Federal taxes taken out of your paycheck.

SOC 426IHSS Provider Enrollment Form 
To be signed by all individuals wanting to become an eligible IHSS provider. Must be turned in to the County in person.

SOC 829IHSS Provider Direct Deposit Enrollment/Change/Cancellation Form
To be used to start, stop or change a provider’s paycheck is deposited directly into a bank account.

SOC 840HSS Program Provider or Recipient Change of  Address and/or Telephone Form
To be used when a provider has a change in address or telephone number.

SOC 846 IHSS Provider Enrollment Agreement
To be signed at the County Orientation sessions by prospective providers.

SOC 847Important Information For Prospective Providers – IHSS Provider Enrollment Process

SOC 2255IHSS Program Provider Workweek & Travel Time Agreement
Providers working for more than one consumer and providers working for more than one consumer who will be traveling between consumers home on the same day for purpose of delivering IHSS services need to fill this form out.

SOC 2279IHSS Program Live-In Family Care Provider Overtime Exemption
Providers who provide IHSS services to two or more recipients and those recipients live with the provider and are the provider’s parents, step-parent, grandparent or the provider is the legal guardian of, fill this form out to work more than the allowed 66 hours per week.

SOC 2298IHSS Program and Waiver Personal Care Services (WPCS) Live-In Self-Certification Form for Federal and State Wage Exclusion

Use this form if you are an IHSS provider and live with the recipient you provide care for, to have your IHSS wages excluded from your federal and state personal income taxes.

 

To submit documentation to your district office via secure fax:

Lancaster
661-424-7849

Chatsworth
818-450-0241

Pomona
909-752-9402

El Monte
626-380-4960

Metro
213-947-4591

Hawthorne
310-943-2125

Rancho Dominguez
310-943-0361

Burbank
562-286-8422

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