Call the Provider Enrollment Department at (866) 351-7722 to request an Enrollment packet or click here to submit your enrollment packet request online. Please have your recipient’s case number available when you request an enrollment packet.
NOTE! If you are a provider looking for work and would like to be referred to IHSS recipients by the Public Authority Registry, you must call (866) 351-7722 to begin their registration process before proceeding to request an enrollment packet.
IHSS Individual Provider Steps to Enroll
- Schedule an in-person appointment to start the enrollment process.
-The link to schedule an appointment is provided in the enrollment packet
- Bring the following documents to your in-person appointment:
– Original IHSS Program Provider Enrollment form (SOC 426). No boxes should be blank. You MUST include an email address
– Social Security card (unaltered and no copies)
– Official unexpired U.S. federal or state government issued valid photo identification. Examples: Drivers License or ID from DMV, United States Military ID card, Permanent Resident Card (Green Card), or U.S. Passport. The full official name on your social security card and proof of identity must match, including suffixes
– If minor work permit or other work authorization documents are required depending on your status
– Original IHSS Program Designation of Provider form (SOC 426A) completed by the IHSS recipient
– Request For Live Scan Service form for fingerprinting background check.
Complete the yellow highlighted area only
$40.00 in Cash, Money Order, or Cashier’s check payable to “Kingdom Security”
- Schedule an online video session appointment.
– To schedule an online video session appointment, the link will be provided after you have completed Step 1 and 2
– The online video session is done through Zoom
– Audio and video are required for your online video session
- Sign and return the Provider Enrollment Agreement.
– Upon completing the online video session, you will sign and return the Provider Enrollment Agreement form (SOC 846) electronically via AdobeSign
– The SOC 846 form will be emailed to your email address you provided us during Step 1
Information about Steps 3 – 4 will be provided during your in-person appointment
Failure to complete any of the steps outlined above will delay enrollment.
If a provider has questions or needs a replacement form, we ask that they call the Public Authority’s Provider Enrollment and Training Department at: (866) 351-7722.