Form Soc 2293 - In-Home Supportive Services Program Notice To Recipient Of Provider'S 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 RECIPIENT OF PROVIDER’S 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:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
The Notice to Provider of Right to Dispute Violation for Exceeding the Workweek and/or
Travel Time Limits (SOC 2272) form that your provider submitted for review cannot be
accepted by the county for one or more of the reasons below:
The dispute was received more than 10 calendar days from the date indicated
on the violation notice informing him/her of the violation.
The dispute was not signed and/or dated by you or another recipient of your
provider.
The dispute was not signed and/or dated by your provider.
As a result, your provider’s 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 2293 (7/16)

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