Document icon
Email icon

SUPPORTING AND ENHANCING INDEPENDENCE

World icon

PASC Recipients

How To Join the Homecare Registry as a Recipient

Who can join the PASC Homecare Registry as a consumer?

  1. If you are a recipient and wish to join the PASC Homecare Registry you must meet the following:
  2. Must be a current approved IHSS consumer in Los Angeles County
  3. Must provide current personal information (i.e. name, address, telephone, etc.)
  4. Must submit a completed Registry Application Form as well as a completed Consumer’s Rights, Responsibilities, and Release Agreement
  5. Must submit a completed IHSS Information Release Form. Registry application forms can be obtained by calling 877-565-4477 or can be downloaded by clicking here:

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

Applications can be mailed, faxed, or emailed to PASC:

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

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

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

Consumer forms:

If you need assistance with completing any of these forms, please contact the IHSS Helpline at (888) 822-9622. If you would like any of these forms in one of the following languages, Armenian, Chinese, Cambodian, Farsi, Korean, Russian, Spanish, Tagalog, Vietnamese, click here.

SOC 321 – Request for Order and Consent Paramedical Services
To be completed by your Doctor to receive authorized IHSS hours for paramedical services.

SOC 332 IHSS Recipient Employee Responsibilities Checklist  
Must be signed by the recipient acknowledging their responsibilities as the employer.

SOC 426A IHSS Program Designation of Provider
Use this form every time you hire a provider, must be turned into the County IHSS office.

SOC 825 Protective Supervision 24-Hours-A-Day Coverage Plan

SOC 838 IHSS Recipient Request for Assignment of Authorized Hours to Provider SOC 839              

IHSS Recipient Timesheet Signature Authorization

SOC 840 IHSS Program Provider or Recipient Change of Address and/or Telephone

SOC 864 IHSS Back-Up Plan and Risk Assessment

SOC 873 IHSS Program Health Care Certification Form SOC 2256            

IHSS Program Recipient and Provider Workweek Agreement

SOC 2274 IHSS Program Accompaniment to Medical Appointment

SOC 2279 IHSS Program Live-In Family Care Provider Overtime Exemption

TEMP 3000 – IHSS Program Overtime and Workweek Requirements Recipient Declaration

Skip to content