Form Ihss-E 007 - In-Home Supportive Services (Ihss) Program - Notice To Recipient Of Provider'S Expiration Of Exemption From Workweek Limits

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO RECIPIENT OF PROVIDER’S EXPIRATION OF
EXEMPTION FROM WORKWEEK LIMITS
COUNTY OF:
(ADDRESSEE)
IHSS Office Address:
IHSS Office Telephone:
Notice Date:
Recipient Name:
Case Number:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Recipient
As of _____________, your provider listed above was approved for an Exemption from
Date
Workweek Limits for Extraordinary Circumstances (Exemption 2).
This notice is to inform you that your provider’s Exemption 2 will be expiring on
_____________.
Prior to the expiration of your provider’s Exemption 2, we will review your case to
determine whether the circumstances the exemption was based on continue to exist
and, if so, we will request a renewal of the Exemption 2 on your provider’s behalf.
If your provider’s exemption is not renewed timely, the maximum number of hours
he/she would be able to work in a workweek for two or more recipients combined would
be 66 hours.
If you have any questions about this notice, please contact the IHSS Office at the
telephone number listed above.
IHSS-E 007 (4/17)

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