Form Soc 2292 - In-Home Supportive Services Program Notice To Provider Of Failure To Timely

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER OF FAILURE TO TIMELY OR COMPLETELY SUBMIT THE
RIGHT TO DISPUTE VIOLATION FOR EXCEEDING WORKWEEK AND/OR TRAVEL
TIME LIMITS FORM (SOC 2272)
(ADDRESSEE)
COUNTY OF:
Notice Date:
Recipient Name:
Recipient Case Number:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
The Notice to Provider of Right to Dispute Violation for Exceeding the Workweek and/or
Travel Time Limits (SOC 2272) form that you submitted for review cannot be accepted
by the county for one or more of the reasons below:
Your dispute was received more than 10 calendar days from the date indicated
on the violation notice informing you of the violation.
Your dispute was not signed and/or dated by you.
Your dispute was not signed and/or dated by your recipient.
As a result, your violation will remain active. If you have any questions about this
notice, you may contact your county IHSS office at the phone number listed above.
SOC 2292 (7/16)

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