Form Soc 2271a - In-Home Supportive Services (Ihss) Program Recipient Notice Of Maximum Weekly Hours

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
RECIPIENT NOTICE OF MAXIMUM WEEKLY HOURS
Notification Date:
Recipient Name:
Recipient Case Number:
Social Worker Name:
Social Worker Number:
Social Worker Telephone:
Social Worker Address:
You are receiving this notification to inform you of your authorized maximum weekly
hours.
You were sent a notice of action indicating, as of __________________, your monthly
DATE
authorized hours are ____________________.
Your maximum weekly hours are your monthly authorized hours divided by 4.0
_____________.
If your monthly hours change, you will receive a notice of action of the change in your
monthly authorized service hours. You will also receive another notification reflecting
the change in weekly authorized hours.
Your provider(s) will not be paid by the IHSS program for any hours exceeding your
maximum monthly hours. If you have your provider(s) work additional hours or provide
services that are not allowed by IHSS, then you must pay the provider(s) for those
additional hours or services.
As a recipient, you are responsible for creating a work schedule for your provider(s) to
ensure that he/she does not work in excess of your maximum number of weekly hours
and your monthly authorized hours. If your provider is working for more than one
recipient, your provider will only be able to work up to 66 hours each week for you or
total combined for you and the other recipients. Each provider is responsible for
informing you of the hours he/she will be available to work for you.
Should you have any questions regarding this notification, please contact your IHSS
social worker at the number listed on this notification.
SOC 2271A (11/15)

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