Provider Enrollment Form
 

Thank you for your interest in becoming a care provider with Sacramento County In-Home Supportive Services.

By completing this form, you are beginning the enrollment process to become an IHSS Provider.

There are two different application types (Provider types)

  • Individual Provider: You have an eligble IHSS Recipient that you want to work with.
  • Registry Provider: You want to be referred to IHSS Recipients in Sacramento County.

(To avoid processing delays, please select the correct application type.)

After you click "submit application" you will receive an “Invitation to Portal” email from noreply@jumpfaster.com with enrollment instructions. You will need to log in with the link to complete the online enrollment process. If this email does not appear in your inbox, please check your spam/junk folder.

(If you already have a PEARS portal account for Sacramento County, please login and use the message feature to request a new application.)

 

  *Application Type:   Provider Number:  

  *SSN (nnn-nn-nnnn)
*DOB (mm/dd/yyyy)
  *First Name
*Last Name
  *Email
*Confirm Email
  *Primary Language
*Gender
  *Address
Address 2
  *City
State
*Zip
   Home Phone
 Cell Phone
 Other Phone
Fax Number
   I opt in to recieve SMS messages
  Mobile Carrier:
 
  Submit Application
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