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Printable Form 1040-ES Roseville California: What You Should Know
IT Services will need to identify you. Use a valid identification document for the person providing services. (Please ask when you call) • The total amount you must pay depends on the service provided. If you are receiving medical or nursing care, please notify your service provider when you pay. • For services provided during the calendar year of the voucher purchase, the voucher expiration date is in the first line. • If you are under 18, you (or your designated representative) must provide a signed copy of your birth certificate showing your date of birth.• For services provided by someone who is not an Indian and whose payment is not made through the IHSS program, follow the guidelines described at the end of this section. FORM 709: IHSS Application, Payment and Certification If you are the service provider identified in part (A) of the form 809, you may also be required to complete a separate Form 709. Your service provider will submit this form along with the other forms. This form is not needed to process payments for services provided during the calendar year of the voucher purchase. The IHSS program can process a voucher for the calendar year of your voucher purchase if the vouchers are valid through June 30 of the following year. This form provides information to help you complete the IHSS program. You must complete this form and attach payment in order to receive services during the calendar year of the voucher purchase. This document must be signed and dated, with the signature appearing on the face of the form. You will complete a personal account (PAM) statement to keep accurate and current records regarding your participation in the IHSS program. You must certify that the information on this form is true and correct in all material respects. Each participant is responsible for completing a payment summary report, providing current contact information, and other information required by the IHSS program. If you choose to make additional statements to the IHSS program, they must be properly accompanied by the documents required as described in the instructions for forms 809, 810, and 819. If you are an ineligible individual, you must report income and provide correct information in the PAM statement. If you complete and submit this form, you may be required by the IHSS program to provide medical or nursing service vouchers. Please use the following procedure to submit Form 709: Review Form 709 carefully to ensure that it meets your program requirements.
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