Form HCS9184 Home Care Organization Disassociation Request - California

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Form HCS9184 Home Care Organization Disassociation Request - California

What Is Form HCS9184?

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.

FAQ

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.

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Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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.

Download Form HCS9184 Home Care Organization Disassociation Request - California

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