Form SOC 839. In-Home Supportive Services (IHSS) Designation Of Authorized Representative

Form SOC 839, In-Home Supportive Services (IHSS) Designation Of Authorized Representative, is a legal form used in California to designate an authorized representative for an IHSS recipient. The main purpose of this form is to allow an authorized representative to act on behalf of an IHSS recipient in matters related to their IHSS benefits.

The form consists of several parts, including a section for the IHSS recipient's information, a section for the authorized representative's information, and a section for the IHSS recipient's signature.

Some of the important fields that need to be carefully considered when completing the form include the IHSS recipient's name, address, and IHSS case number, as well as the authorized representative's name, address, and relationship to the IHSS recipient.

The parties involved in completing the form include the IHSS recipient and their authorized representative.

When filling out the form, the IHSS recipient will need to provide detailed information about their authorized representative, including their name, address, and relationship to the recipient. Additionally, they may need to attach additional documents, such as proof of the authorized representative's identity or legal authority to act on behalf of the recipient.

Application examples of Form SOC 839 include situations where an IHSS recipient is unable to manage their own IHSS benefits due to physical or mental limitations, or where they have designated someone else to act on their behalf. One strength of the form is that it provides a formal process for designating an authorized representative, which can help prevent misunderstandings or disputes about who is authorized to act on behalf of the IHSS recipient. However, one weakness is that it can be a complex legal process, especially for those who are not familiar with the IHSS system.

Related forms include SOC 840, which is used to revoke an authorized representative's designation, and SOC 846, which is used to designate an authorized representative for Medi-Cal purposes.

To fill and submit the form, the IHSS recipient will need to download the form from the California Department of Social Services website, complete it, and submit it to their local IHSS office. The form is stored in the IHSS recipient's file and can be accessed by authorized parties involved in the IHSS program.