Form Temp 3000 - In-Home Supportive Services (Ihss) Program Overtime And Workweek Requirements Recipient Declaration

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Case Number : _____________________
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
OVERTIME AND WORKWEEK REQUIREMENTS
RECIPIENT DECLARATION
This document provides information about overtime and workweek requirements as
mandated by state law (Welfare and Institutions Code sections 12300.4 and 12301.1)
for the IHSS program. I must read the information and sign this form to show that I
understand and agree to follow these requirements.
• Under state law, the maximum amount of time an IHSS provider can work in a
workweek providing authorized services is the maximum weekly hours. My total
monthly authorized hours will now be divided by 4 to determine my maximum weekly
hours. The workweek starts at 12:00 a.m. (midnight) on Sunday and ends at 11:59
p.m. on the following Saturday.
• I can authorize my provider to adjust his/her schedule to work more than his/her
normal work hours during the workweek without asking the county for approval as
long as it does not cause my provider to:
1. Work more overtime hours in the month than he/she would normally work;
2. Work more than 40 hours in a workweek if the maximum weekly hours are
40 hours or less in a workweek; and
3. Work more than 66 hours in a workweek if my provider is working for multiple
recipients.
• Each time my provider does any of the following, he/she will get a violation:
1. My provider only has me as a recipient and works more than 40 hours in a
workweek for me without getting approval from the county when my maximum
weekly hours are 40 hours or less per workweek;
2. My provider has more than one recipient, and he/she works more than 66 hours
in a workweek;
TEMP 3000 (1/16)
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