San Francisco Department of Disability and Aging Services fax number

Fax destination details

Department

In-Home Supportive Services (IHSS) – Department of Disability and Aging Services (DAS), San Francisco Human Services Agency (SFHSA)

Purpose

Submit IHSS Referral Form (Form 3012) for DAS intake; ensure Health Certification Form (SOC 873) is completed; health certification can be faxed to 415-355-2463; for questions call (415) 355-6700 ext. 3

Form

Form 3012 — In-Home Supportive Services Referral Form

Address

P.O. Box 7988, San Francisco, CA 94120

Voice phone

(415) 355-6700

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.

Complete IHSS Referral Form 3012, provide consent for release of information, and attach Health Certification Form SOC 873. Fax SOC 873 to 415-355-2463. For questions, call (415) 355-6700 ext 3.

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