Sacramento County In-Home Supportive Services (IHSS) fax number

Fax destination details

Department

In-Home Supportive Services (IHSS) – Senior and Adult Services Division, Sacramento County Department of Health and Human Services

Purpose

IHSS payroll-related communications and enrollment/provider designation forms (e.g., payroll verifications, provider enrollment and designation forms).

Form

SAS-426A — IHSS Recipient Designation of Provider

Address

9750 Business Park Drive, Sacramento, CA 95827

Voice phone

916-874-2888

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Fill out both sides of the form; print clearly in black or blue ink; provide the recipient and provider information; sign the declaration; return to the county.

Official form instructions are published as a downloadable file on the organization's website.