The California SOC 295 form is the official application for In-Home Supportive Services (IHSS) issued by the California Department of Social Services. Completing this form accurately is the first step toward receiving approved care in your home.
To qualify for IHSS, you must meet three basic conditions. You must be a California resident. You must be 65 or older, blind, or have a qualifying disability. You also must receive Medi-Cal or be eligible for it. A county social worker will conduct a home visit to assess your care needs and calculate your monthly approved service hours.
The form collects the following information:
The SOC 295 also includes a voluntary section for sexual orientation and gender identity. This section reflects California's commitment to inclusive and equitable services. You are not required to answer this part.
All information you provide is subject to verification by county workers. Details may be cross-checked with other public agencies. Incomplete or inaccurate entries can delay your eligibility determination. Review every section carefully before signing.
Once approved, you become the legal employer of your in-home support provider. You are responsible for hiring, supervising, and scheduling your provider. The SOC 295 prepares you for this responsibility before services begin. For related California IHSS paperwork, see the California SOC 450 form.
| Question | Answer |
|---|---|
| Form Name | California Form Soc 295 |
| Form Length | 8 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min |
| Other names | california application social, ca soc 295, form soc 295 social, soc 295 services |