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CA CDSS SOC 838 2012-2025 free printable template

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I further requested be assigned to him/her on this form. This request will remain in effect until I submit a new request form to the county IHSS program. DATE RECIPIENT SIGNATURE RELATIONSHIP TO RECIPIENT AUTHORIZED REPRESENTATIVE IF RECIPIENT CANNOT SIGN ON THEIR OWN BEHALF TELEPHONE NUMBER SIGNATURE OF AUTHORIZED REPRESENTATIVE PROVIDER SIGNATURE COUNTY USE ONLY COMMENTS SOCIAL WORKER NAME SOC 838 10/12 SOCIAL WORKER IDENTIFICATION NUMBER. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES...
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How to fill out CA CDSS SOC 838

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How to fill out CA CDSS SOC 838

01
Start with the applicant's basic information, including name, address, and contact details.
02
Indicate the type of provider for which you are applying.
03
Provide information about the services offered and the intended population served.
04
Complete the criminal record section, detailing any relevant background checks and disclosures.
05
Fill in the licensing and certification details, if applicable.
06
Include financial information as required, demonstrating fiscal responsibility.
07
Review your answers for accuracy and completeness before submission.
08
Sign and date the form where indicated.

Who needs CA CDSS SOC 838?

01
Individuals or agencies looking to provide community care or social services in California.
02
Organizations that require certification or licensing to operate under the California Department of Social Services guidelines.
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CA CDSS SOC 838 is a form used by the California Department of Social Services to collect data regarding the services provided to children and families in licensed community care facilities.
Licensed community care facilities that provide services to children and youth are required to file the CA CDSS SOC 838.
To fill out CA CDSS SOC 838, facilities must provide accurate information regarding their services, including staff qualifications, child demographics, and the types of services offered. Detailed instructions are provided with the form.
The purpose of CA CDSS SOC 838 is to gather data that helps in monitoring and improving the quality of care provided in community care facilities for children and families.
The information reported on CA CDSS SOC 838 includes the number of children served, staff qualifications, types of services provided, and demographic information about the children in care.
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