Individual Provider Notification Instructions Stop Work Notice Dshs printable pdf download

Individual Provider Notification Instructions Stop Work Notice Dshs

Individual Provider Notification Instructions

Stop Work Notice

Use this notice to inform IPs:

• Of the action the department is planning to take or has taken to deny or terminate their payment or contract;

• Not to work after the effective date on their notice.

Date of Notice: This is the date the Stop Work Notice is completed and mailed. The Date of Notice is the same as the

Effective Date only when denying a contract or when immediate notice is required.

Effective Date: The date the IP’s payment or contract is being denied or terminated. Except in cases where immediate

notice is required, provide the IP with adequate notice before taking the action. This means allowing enough time for mail

delivery, at least three business days, before terminating the payment or contract.

Do not use this form to inform IPs about:

• Termination of payment or contract related to training and certification. Use the IP Planned Action Notice.

• Termination of payment or contract related to work week limits. Use DSHS form 15-483.

INDIVIDUAL PROVIDER NOTIFICATION

DSHS 16-198 (REV. 03/2017)

Individual Provider Notification Instructions Stop Work Notice Dshs