This version of the form is not currently in use and is provided for reference only. Download this version of Form HCS9184 for the current year.
This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form HCS9184?
A: Form HCS9184 is a Home Care Organization Disassociation Request form used in California.
Q: What is a Home Care Organization?
A: A Home Care Organization is an agency or organization that provides in-home care services.
Q: What is a Disassociation Request?
A: A Disassociation Request is a formal request to terminate the relationship between a client and a Home Care Organization.
Q: Who can use Form HCS9184?
A: Any client of a Home Care Organization in California can use Form HCS9184 to request disassociation.
Q: How can I obtain Form HCS9184?
A: Form HCS9184 can be obtained from the California Department of Social Services or the Home Care Organization itself.
Q: What information is required on Form HCS9184?
A: Form HCS9184 requires information such as the client's name, address, date of birth, and the name of the Home Care Organization.
Q: What happens after submitting Form HCS9184?
A: After submitting Form HCS9184, the Home Care Organization will process the request and terminate the client's affiliation with their services.
Q: Are there any fees for submitting Form HCS9184?
A: There are no fees associated with submitting Form HCS9184.
Q: Is there a deadline for submitting Form HCS9184?
A: There is no specific deadline for submitting Form HCS9184, but it is recommended to submit it as soon as possible to initiate the disassociation process.
Form Details:
Download a fillable version of Form HCS9184 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.