Sacramento County IHSS Public Authority

Implementation of overtime and travel pay require a number of new forms to be completed by both IHSS recipients and providers.

The below form(s) are required, depending on your circumstances.  Please review the descriptions after each form to help determine when to complete a form.

For information on the enrollment process for new providers (never been paid in IHSS), please select this link to take you to the New Provider Enrollment web page.

Provider Documents

For Providers, if you have any questions regarding which form(s) may apply to you, please call the IHSS Payroll Help Line: (916) 874-9805

• Provider Notice (Temp 3001) (notice sent to all Providers)
• Provider Enrollment Agreement (SOC 846) (required of every Provider)
• Provider Workweek & Travel Agreement (SOC 2255) (required if a Provider works for two or more Recipients)

Recipient Documents

•  Recipient Notice (Temp 3002) (notice sent to all Recipients)
•  Recipient Declaration (Temp 3000) overtime and Workweek Requirements (Required of every Recipient)
•  Recipient Designation of Provider (SOC 426A) (required to hire a provider)
•  Recipient and Provider Workweek Agreement (SOC 2256) (required if a Recipient has two or more providers)
•  Deleting Service Provider (SAS 426A-Supplement) (required when terminating employment of a provider)