IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM PROVIDER ...
• Fill out, sign and return this form in person to the office or location designated by the county. Bring original federal or state government-issued identification and your original Social Security card when returning this form. • Complete all items in PART A, answer the questions in PART B, and read and sign the declaration in PART C.
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SOC 873 (Rev 10-2016) EN - Los Angeles County, California
dpss.lacounty.govTitle: SOC 873 (Rev 10-2016) EN.xps Created Date: 2/9/2017 4:02:52 PM
APPLICATION FOR IN-HOME SUPPORTIVE SERVICES
dpss.lacounty.govthe County in which I receive services. The purpose of the visits and letters is to ensure that program requirements are being followed and that the authorized services are necessary for you to remain safely in your home. The visit will also verify that the authorized services are being provided, that the
SOC 426A - Los Angeles County, California
dpss.lacounty.govTitle: SOC 426A.pdf Created Date: 5/4/2016 10:31:25 AM
County of Los Angeles Department of Public Social Services ...
dpss.lacounty.govCalWORKs is a public assistanceprogram that gives cash aid and services to eligible families. If a family has little or no cash and needs housing, food, utilities, clothing or , medical care, they may be eligible to receive immediate short-term help. Families that apply and qualify for ongoing assistance receive money each month to help pay for
CW 42 Statement of Facts - Homeless Assistance
dpss.lacounty.govCW 42 (9/19) Required Form - Substitutes Permitted Page 3 of 3. 13. What day did you get a pay rent or quit notice? 14. How many months of back rent do you owe? 15. How much is your monthly rent? 16. Why didn’t you pay your rent? 17. Is your Landlord evicting you? Why?
INFORMATION SHEET GENERAL RELIEF
dpss.lacounty.govIf you are eligible for GR, you may be able to get emergency aid while your application is being processed. Emergency Aid can include: o Payments* to prevent eviction or utility shut-off. o Payments* to restore utilities. o Meal and housing vouchers if you are homeless. o Transportation funds for seeking jobs and for verified medical appointments.
Applying for Cash Aid (Apps-Forms) Eng1
dpss.lacounty.govNote: If you are interested in applying for Refugee Cash Assistance (RCA), access the RCA webpage. to get details on how to apply for RCA. CalWORKs Forms . There are various forms that may be needed when applying for CalWORKs. Below is a description as to when each form is needed as well as a link to access the form .
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