Form Na 1254l - Notice Of Action - In-Home Supportive Services (Ihss) Change Continuation Page 2

STATE OF CALIFORNIA HEALTH AND

NOTICE OF ACTION

HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF

SOCIAL SERVICES

COUNTY OF:

Notice Date:

Case Name:

Case Number:

You must immediately tell the county about any changes that

might affect your eligibility or need for IHSS, including changes

in income, property, living arrangements, medical conditions or

the ability to work. If you have any questions or think more

facts should be considered, call your social worker.

Rules: The applicable Manual of Policies and Procedures (MPP)

sections are shown above and may be reviewed at your local IHSS

office.

Questions? Please contact your IHSS social worker.

State Hearing: If you think this action is wrong, you can ask for a

hearing. The State Hearing Rights included with this notice tells how.

NA 1254L (3/15) IHSS CHANGE CONT.

Case No.

Page 2 of 2

0 votes

Parent category: Legal