General Contact Number: (530) 621-5567

IHSS Public Authority


In-Home Support Network Services

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Forms and Publications

Some of the forms and publications used by the IHSS Public Authority are listed below and available for downloading in .pdf format.

Provider Rx Pick-Up Form

Direct Deposit Form

Provider State Benefit Brochure

Provider State Benefit Brochure (Spanish)

Workers' Compensation Brochure
Workers' Compensation Brochure (Spanish) 

Change of Address Form 

W4 Form

Recipient Designation of Provider Form

Provider Enrollment Form

Provider Paid Sick Leave Request Form

Provider Workweek/Travel Time Agreement

Recipient/Provider Workweek Agreement

Informational brochures available upon request, courtesy of the County of El Dorado IHSS Advisory Committee. Topics include Seniors and Driving, Bathing and Personal Care, Managing Bladder and Bowel Problems, Creating a Safe Environment, and The Basics of Daily Care. To obtain a copy of any of the above brochures, please contact the IHSS Public Authority office at (530) 621-6287.