Form Soc 848 - Notice Of Provider Eligibility

Download a blank fillable Form Soc 848 - Notice Of Provider Eligibility in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Soc 848 - Notice Of Provider Eligibility with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE OF PROVIDER ELIGIBILITY
(ADDRESSEE)
COUNTY OF:
Notice Date:
Applicant Provider Name:
Recipient Name:
Recipient Case Number:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Applicant Provider
As of the date of this notice, you have been officially enrolled as an IHSS provider. You
can now begin providing services for an IHSS recipient(s) and receiving payment from
the IHSS program for providing services.
If you have already begun providing IHSS services to a recipient, you may be eligible to
receive retroactive payments for any authorized services you provided for 90 days prior
to the date of this notice.
If you have any questions about this notice, call the IHSS office at the telephone number
listed at the top of this document.
SOC 848 (5/16)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Soc 850 - Notice Of Provider Ineligibility Form Soc 850 - Notice Of Provider Ineligibility Legal
Form Soc 849 - Notice Of Incomplete Provider - Enrollment Form Form Soc 849 - Notice Of Incomplete Provider - Enrollment Form Legal
Form Soc 832 - Notice Of Child Abuse Central Index Listing Form Soc 832 - Notice Of Child Abuse Central Index Listing Legal
Form Soc 820 - Notice Of Involuntary Child Custody Proceedings For An Indian Child (juvenile Court) Form Soc 820 - Notice Of Involuntary Child Custody Proceedings For An Indian Child (juvenile Court) Legal
Form 2384-1 - Notice Of Basic Eligibility (nobe) Form 2384-1 - Notice Of Basic Eligibility (nobe) Business
Form Soc 870 - In-home Supportive Services Program Notice To Provider Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Form Soc 870 - In-home Supportive Services Program Notice To Provider Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Legal
Form Soc 857 - In-home Supportive Services Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Form Soc 857 - In-home Supportive Services Program Notice To Recipient Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Legal
Form Soc 854 - In-home Supportive Services Program Notice To Recipient Of Provider Eligibility Form Soc 854 - In-home Supportive Services Program Notice To Recipient Of Provider Eligibility Legal
Form Soc 851 - Notice To Applicant Provider Of Provider Ineligibility - Incomplete Provider Process Form Soc 851 - Notice To Applicant Provider Of Provider Ineligibility - Incomplete Provider Process Legal
Form Soc 852 - Notice To Applicant Provider Of Provider Ineligibility Tier I Crimes Form Soc 852 - Notice To Applicant Provider Of Provider Ineligibility Tier I Crimes Legal

Related Categories

Parent category: Legal
Download
Go