Form Soc 2273 - In-Home Supportive Services Program State Administrative Review Request Of Third Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits Page 2

ADVERTISEMENT

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
To request a State Administrative Review, you must:
• Fill out and sign the third page of this form explaining the reason(s) you believe
the county should have overturned the violation.
• Return the completed third page of this notice to the California Department of
Social Services (CDSS). Also include a copy of the SOC 2258 or SOC 2259 that
the county sent you to notify you of your ineligibility to receive payment from the
IHSS program.
• Provide any documentation that supports your reasons for requesting that this
violation be rescinded. DO NOT SEND ORIGINAL DOCUMENTS, COPIES ONLY.
• Make a copy for your records of all pages of the State Administrative Review
Request form and supporting documents.
The CDSS IHSS Appeals Unit (AU), will review the information in this request and any
information provided by you and the county. CDSS will decide whether the county’s
decision to uphold the violation should be upheld or rescinded.
The AU has 15 business days from the date your State Administrative Review
Request is received to make a decision and will send you a letter with the decision.
o If the AU rescinds the violation, the AU will instruct the county that your
eligibility to provide and be paid for providing IHSS services shall not be
suspended due to the violation.
If you have any questions, call the CDSS AU at (916) 651-3488.
PAGE 2 OF 3
SOC 2273 (8/16)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Soc 2288 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Rescinding Third Violation Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2288 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Rescinding Third Violation Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2289 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Rescinding Provider's Third Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2289 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Rescinding Provider's Third Or Fourth Violation For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2286 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2286 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2291 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Fourth Violation Form Soc 2291 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Fourth Violation Legal
Form Soc 2290 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Fourth Violation Form Soc 2290 - In-home Supportive Services Program State Administrative Review Request Response Letter To Provider Upholding Fourth Violation Legal
Form Soc 2287 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Provider's Third Violation Form Soc 2287 - In-home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Provider's Third Violation Legal
Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2272a - In-home Supportive Services Program Notice To Provider Acknowledgement Of Receipt Of County Violation Review For Exceeding Workweek And/or Travel Time Limits Form Soc 2272a - In-home Supportive Services Program Notice To Provider Acknowledgement Of Receipt Of County Violation Review For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2267a - In-home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours Form Soc 2267a - In-home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours Legal
Form Soc 2267 - In-home Supportive Services Program Notice To Recipient Denial Of Exception To Exceed Weekly Hours Form Soc 2267 - In-home Supportive Services Program Notice To Recipient Denial Of Exception To Exceed Weekly Hours Legal

Related Categories

Parent category: Legal
Download
Go
Page of 3