Ihss butte county application

Provider Enrollment

Public Authority facilitates provider orientation and manages the enrollment process for new and inactive IHSS providers.

Step 1: Enroll Online

You must have a Recipient that has been approved for IHSS services or your Registry Application has been approved before enrolling online. Ensure your name matches your government-issued ID and Social Security card.

1. Create an online enrollment account by clicking Enroll Now (Step 5)
   • Write down your username, password and security questions.
2. Watch the mandatory orientation videos (online).
3. Review the required documents (online).
   • SOC 426 IHSS Provider Enrollment: sign electronically
   • SOC 846 IHSS Provider Enrollment Agreement: sign electronically
   • Request Live Scan Service (Department of Justice (DOJ) background check).
4. Schedule your in-person enrollment appointment.

Step 2: Attend Your In-person Enrollment Appointment

Please bring the following to your appointment:

1. An original and valid government-issued photo ID, Driver's License or Passport.
2. An original Social Security Card with the name as it appears on your government-issued ID, Driver's License or Passport.

Both documents are required for enrollment and the names must match.

Step 3: Complete Your Background Check

1. You must use the Butte County Live Scan form. You can print the form by accessing your online enrollment account or the form will be available at your in-person enrollment appointment.
2. Bring the Live Scan form to an approved location to submit your fingerprints.
   • Fees will include the approved locations rolling fee and a DOJ fee.
   • Check on your Live Scan request status.
   • Additional details about Tier 1 and Tier 2 exclusionary crime .

Step 4: To Become an Eligible IHSS Provider

1. To be designated as a provider your IHSS Recipient must complete the SOC 426A form and return it to the Butte County IHSS office. The SOC 426A will be provided to you at your in-person enrollment appointment. To print the SOC 426A in advance, click on the link below.
   • Form SOC 426A – Recipient Designation of Provider Form (English) (PDF)
   • Form SOC 426A – (Espanol/Spanish) (PDF)
2. To complete the payroll process and receive electronic timesheets, the IRS Form W-4 is required for each Recipient you provide IHSS services for.
   • IRS Form W-4 - Employee Withholding Certificate (English) (PDF)
   • IRS Form W-4 (Espanol/Spanish) (PDF)

Step 5: Enrollment

You are required to enter the IHSS Client’s name and IHSS case number you are enrolling for.

** Your appointment will be canceled until this information has been entered and verified. **

• Provider Enrollment
• Provider Registry