CA SOC 873 2016-2025 free printable template

CALIFORNIA DEPARTMENT OF SOCIAL SERVICESSTATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYINHOME SUPPORTIVE SERVICES (IHSS) PROGRAM HEALTH CARE CERTIFICATION FORM A. APPLICANT/RECIPIENT INFORMATION

How to fill out soc 873 form

How to fill out CA SOC 873

1. Start with your personal information at the top of the form, including your name, address, and contact information.
2. Provide the date of the application.
3. In the next section, indicate the purpose of your request for the SOC 873.
4. Fill out the specific details required for your situation, following the prompts on the form carefully.
5. Review your information to ensure all fields are completed accurately.
6. Sign and date the form at the bottom.
7. Submit the completed form as per the instructions provided, either by mail or electronically as required.

Who needs CA SOC 873?

1. Individuals who are applying for a Social Security Number (SSN) or a Taxpayer Identification Number (TIN).
2. People who require proof of income or other financial information as part of their applications.
3. Residents in California who are completing the formalities to certify their status for tax purposes.

People Also Ask about health care certification form soc 873

Who can complete SOC 873?

You must have a physician or other licensed health care professional fill out a Health Care Certification (SOC 873) form and you must return it to the county before care services can be authorized.

What is soc 874?

The certification must state that you are not able to do some activities of daily living (ADLs) on your own and that without help to do these activities you would be at risk of placement in out-of-home care. Basic ADLs are: eating, bathing, dressing, using the toilet, walking, and getting out of bed or a chair.

What disqualifies you from being an IHSS provider?

Under the law, you are ineligible to work in the IHSS program ONLY if you have been convicted within the last 10 years of: 1) fraud against a government health care or supportive services program; 2) child abuse; or 3) abuse of an elder or dependent adult.

What is a SOC 873 form?

What Is Form SOC 873? Form SOC 873, In-Home Supportive Services (IHSS) Program Health Care Certification Form, is a medical certification form filled out by a licensed health care professional to enable disabled, blind, or elderly individuals to receive services from the In-Home Supportive Services (IHSS) program.

What disqualifies you from being an IHSS provider?

Generally, misdemeanor crimes involving violence or threats of violence would disqualify a person from being an IHSS provider. Minor infractions, such as traffic violations, would not disqualify a person from being an IHSS provider. 10. WHAT HAPPENS IF I'M CONVICTED OF A CRIME AFTER I'M ENROLLED AS AN IHSS PROVIDER?

What qualifies a person for IHSS?

To be eligible, you must be 65 year of age and over, or disabled, or blind. Disabled children are also potentially eligible for IHSS. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities.

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What is CA SOC 873?

CA SOC 873 is a form used by the California State Controller's Office for reporting unclaimed property and assets. It is part of the administrative process to manage and track unclaimed funds held by various entities in California.

Who is required to file CA SOC 873?

Entities such as corporations, partnerships, and other organizations that hold unclaimed property and assets exceeding a certain threshold are required to file CA SOC 873 with the California State Controller's Office.

How to fill out CA SOC 873?

To fill out CA SOC 873, entities should provide information such as the identity of the property owner, a description of the property, any known contact information for the owner, and relevant financial details. It is advisable to follow the specific instructions provided on the form and refer to the official guidelines.

What is the purpose of CA SOC 873?

The purpose of CA SOC 873 is to facilitate the reporting and remittance of unclaimed property to the state of California, ensuring that rightful owners have an opportunity to reclaim their assets and that the state can maintain accurate records.

What information must be reported on CA SOC 873?

CA SOC 873 requires reporting of information such as the owner's name and last known address, the type and amount of property being reported, the date the property became unclaimed, and the reporting entity's contact information.