Form Na 1253l - Notice Of Action - In-Home Supportive Services (Ihss) Change Page 5
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5NOTICE OF ACTION IN-HOME SUPPORTIVE SERVICES (IHSS)
COUNTY OF
HOURS YOU CAN
GET
SERVICES
HRS:MINS
NOW
WAS
+/-
TIME LIMITED SERVICES (per MONTH)
Heavy Cleaning
Yard Hazard Abatement
Remove Ice, Snow
Teaching and Demonstration
Questions? Please contact your IHSS social worker. See top of
page 1 for phone number.
State Hearing: If you think this action is wrong, you can ask for a
hearing. The State Hearing Rights included in this notice tells how.
NA 1253L (3/15) IHSS CHANGE
Case No.
PAGE 5 of 5
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