The SOC 839 “In-Home Supportive Services (IHSS) Designation of Authorized Representative” form is a document issued by Public Social Services for use specifically in Los Angeles County, California. This form is instrumental in the IHSS program, allowing recipients or applicants to designate an authorized representative who can act on their behalf in various capacities.
Purpose Of The Form
The SOC 839 form is used to officially designate an individual as an authorized representative for someone receiving or applying for In-Home Supportive Services. This designation enables the Representative to perform tasks such as applying for services, communicating with program officials, and making decisions related to the recipient's care and services on behalf of the recipient.
Why It's Needed
This form is necessary because some IHSS recipients may be unable to manage their affairs due to health issues, disabilities, or other reasons. By designating an authorized representative, recipients ensure that their needs are communicated and met, even if they cannot advocate for themselves directly.
Intended Audience
The intended audience for this form includes:
- IHSS applicants or recipients who wish to designate someone to act on their behalf.
- Individuals are willing and able to serve as an authorized representative for an IHSS recipient or applicant.
How To Fill Out The Form
Filling out the SOC 839 form typically involves:
- Personal information of the IHSS recipient or applicant, including their name, case number (if applicable), and contact details.
- Information about the designated authorized Representative, including their name, relationship to the recipient, and contact information.
- Specific authorizations granted to the Representative, detailing what they are allowed to do on behalf of the recipient.
- Signatures from the IHSS recipient/applicant and the designated authorized Representative acknowledge their roles and responsibilities.
Key Information Required
- Applicant/Recipient's full name, address, telephone number, and case number (if applicable).
- Authorized Representative's full name, address, telephone number, and their relationship to the applicant/recipient.
- Specific tasks or areas of representation the authorized Representative is permitted to handle.
- Signatures and dates from both parties involved.
Submission Deadlines
The form doesn't typically have a fixed deadline for submission. Still, it should be submitted as soon as an authorized representative is identified, especially if it coincides with applying for IHSS or when changes in representation are needed.
Where And How To Submit
The completed form can be submitted in several ways depending on the county's specific procedures. Common methods include:
- Mailing it to the local Public Social Services office that handles IHSS applications and services.
- Submitting it in person at the same office.
- Some counties may offer the option to submit forms online or via email, but this depends on the local IHSS program's policies.
Cost To Submit
There is typically no cost associated with submitting the SOC 839 form. The focus is on ensuring that IHSS recipients can designate a representative without facing financial barriers to this essential part of managing their care.