It has come to our attention that some counties are asking providers to sign a new form SOC 426 (Provider Enrollment Form) that includes a question about whether the provider “has ever been convicted of a serious crime or misdemeanor.”

COUNTIES SHOULD NOT BE USING THIS NEW FORM. In a letter to all counties (ALL-COUNTY LETTER NO. 09-78) last November, the Department of Social Services instructed the counties to:

• STOP using IHSS provider enrollment forms or other documents requiring individuals to declare that they never have been convicted of a felony crime or serious misdemeanor and/or state that persons convicted of such crimes are not eligible to be IHSS providers; and

• STOP disqualifying or finding individuals ineligible to be IHSS providers on the basis that they have been convicted of a felony or a serious misdemeanor at some point in their life and who are otherwise not disqualified.

If you are asked to sign a Form 426 which includes the question about whether you have ever been convicted “of a serious crime or misdemeanor”, respectfully refuse to sign the document and refer the county official to All County Letter No. 09-78.

Copy of All-County Letter No. 09-78