Steps to Enroll

Due to COVID-19, the enrollment process has changed.

As part of the enrollment process during COVID-19, you must complete the following steps, and mail in the items requested below:

Mail all forms and copies to:
Public Authority Provider Enrollment,
401 Mile of Cars Way, Suite 200,
National City CA 91950

  1. Call the Provider Enrollment Department at (866) 351-7722 to request an Enrollment packet or click here to submit your request online
  2. Complete and mail the SOC426 Provider Enrollment Form- do not e-mail
  3. Complete and mail the SOC426A IHSS Program Recipient Designation of Provider Form (the Consumer must sign this form) – do not e-mail
  4. Submit fingerprints and undergo a criminal background check by the California Department of Justice “DOJ”
  5. Provide a copy of your valid U.S. government issued photo identification card
    -The name on your photo ID and Social Security card must match
  6. Provide a copy of your original Social Security card
    -NO Social Security card receipts accepted
  7. Watch the Mandated Provider Orientation video

*A copy of your Social Security card and U.S. government issued ID can be emailed to