Form Na 1251l - Notice Of Action - In-Home Supportive Services (Ihss) Approval Continuation Page 2

STATE OF CALIFORNIA HEALTH AND

HUMAN SERVICES AGENCY

NOTICE OF ACTION

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 1251L (3/15) IHSS APPROVAL CONT.

Case No.

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