Fresno County In-Home Supportive Services (IHSS)

Request for Application

Daim ntawv thov kev pab

If you live in Fresno County and are interested in receiving IHSS services, please provide contact information below and a social worker will contact you to begin the application process.

Please use this form ONLY to receive IHSS, not to become a provider or other reasons. After you submit this information, a social worker will contact the applicant by phone. If unable to reach them by phone, a letter will be sent. Please do not submit the same information again unless there has been no contact within one week.

Please provide as much information as possible.

Yog hais tias koj nyob rau hauv Fresno County thiab xav tau kev pabcuam ntawn IHSS, thov teb cov lus nug tiv tauj hauv qab no cev ib tug social worker mam hu rau koj pib daim ntawv thov kev pab.

Thov siv daim ntawv no rau tus thov IHSS, tsis yog rau tus tu los siv lwm yam.  Tom qab koj ua tiav thiab nias xa cov ntaub ntawv no, ib tus Social Worker mam hu rau tus neeg thov kev pab.  Yog tias hu tsis tauj, mam xa ib tsab ntawv.  Thov tsis txhob ua dua ntaub ntawv, yog tias tsis hnov tiv toj thiab tsis tau dhau ib lub lis piam.

Thov teb cov lus nug kom tau ntau li tau.



Contact Information for the Person to Receive Services:

Ntaub ntawv rau tus neeg xav tau kev pab:

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Primary contact phone number
Primary (Thawj tus) xov tooj
Secondary contact phone number
Secondary (Thib ob) xov tooj
Do not enter spaces or dashes (-)
Tsis txhob nrug los yog ua ka (-)
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By clicking Submit, you are agreeing to the Terms of Use. Yog koj nyem Xa, koj pom zoo rau cov lus thiab ntawv siv (Terms of Use).