California Department of Social Services*

Form SOC 426A is a crucial document within California's In-Home Supportive Services (IHSS) Program, which provides assistance to eligible aged, blind, and disabled individuals to remain safely in their own homes. This form is designed to facilitate the process of designating a provider to offer authorized services to the IHSS recipient. It gathers necessary information about the recipient and the chosen provider, outlines agreements, and ensures compliance with program rules.

This form, Form LIC 12, is used in California as an Alternative Plan (DAP) for the resource family approval process. Its main purpose is to outline an alternative plan for meeting specific requirements or standards when the standard approval process cannot be followed.

The form consists of sections where the applicant or resource family specifies the areas in which they are unable to meet the standard requirements and proposes an alternative plan to address those areas. It includes details about the alternative plan, the steps to be taken, and the timeline for completion.

The LIC 503 (Health Screening Report for Facility Personnel) is the form used by California health care facilities to determine the health of personnel prior to employment or assignment. It consists of three parts: health history, immunizations and health screening.