IHSS Payroll Forms

CDSS IHSS Program Online Forms

SOC 829 Provider Direct Deposit Enrollment/Change/Cancellation Form (PDF, 45 KB)
SOC 829 Provider Direct Deposit Enrollment/Change/Cancellation Form in Spanish (PDF, 32 KB)
SOC 831 Direct Deposit Fact Sheet (PDF, 64 KB)
SOC 831 Direct Deposit Fact Sheet in Spanish (PDF, 158 KB)
SOC 840 Provider or Recipient Change of Address and/or Telephone (PDF, 94 KB)
SOC 840 Provider or Recipient Change of Address and/or Telephone in Spanish (PDF, 28 KB)
- Mail to: IHSS Fiscal, P.O. Box 1320, Santa Cruz, CA 95060.
- For counties other than Santa Cruz, please go to http://www.cdss.ca.gov/inforesources/County-IHSS-Offices to contact your county.
SOC 846 Provider Enrollment Agreement (PDF, 51 KB)
SOC 846 Provider Enrollment Agreement in Spanish (PDF, 46 KB)
SOC 2255 Provider Workweek and Travel Time Agreement (PDF, 83 KB)
SOC 2255 Provider Workweek and Travel Time Agreement in Spanish (PDF, 79 KB)
SOC 2256 Recipient and Provider Workweek Agreement (PDF, 44 KB)
SOC 2256 Recipient and Provider Workweek Agreement in Spanish (PDF, 35 KB)
TEMP 3000 Overtime and Workweek Requirements Recipient Declaration (PDF, 39 KB)

Requesting Tax Forms

• IHSS providers should not download or use blank W-4 or DE-4 tax forms from external sources. These forms must be pre-filled by the county with recipient-specific information (e.g., recipient name, case number, and start date) to ensure accurate processing.

• Santa Cruz County IHSS Providers should contact the IHSS Fiscal Unit at (831) 454-7315 to request tax forms. The appropriate forms, along with instructions and a pre-addressed return envelope, will then be mailed to the provider.

Submitting Completed Forms

• Do not drop off W-4, DE-4, or SOC 2298 forms at county offices or in county drop boxes. Counties do not process these forms and are not responsible for documents left at county locations.

• Completed W-4 and DE-4 forms must be mailed directly by the provider to:
IHSS Payroll Management Unit
P.O. Box 1660
West Sacramento, CA 95691-6660

• SOC 2298 (Live-In Provider Certification) forms may be downloaded and should be mailed directly to the State using the address indicated on the form.

• If providers are unsure where to send their forms, they should contact IHSS Fiscal for guidance prior to mailing.

IHSS Fiscal Contact Info:

Phone: (831) 454-7315

Email: HSDIHSSFISCAL@santacruzcountyca.gov