Form Soc 2271 - In-Home Supportive Services (Ihss) Program Provider Notification Of Recipient Authorized Hours And Services And 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
PROVIDER NOTIFICATION OF RECIPIENT AUTHORIZED HOURS AND SERVICES
AND MAXIMUM WEEKLY HOURS
Notification Date:
Provider Name:
You are receiving this notice because you are a provider of IHSS for ______________
____________________________________________________________________.
This notification is to inform you of your recipient’s monthly authorized hours and the
services you are allowed to perform for your recipient.
Your recipient’s monthly authorized hours are ______________.
Your recipient’s maximum weekly hours are his/her monthly authorized hours divided by
4.0, ____.
The chart on page 2 lists the services that have been authorized for your recipient (which
have been marked with an X), along with a brief description of the types of work that may
be performed as part of each service. You will only be paid for providing the authorized
services that have been marked.
Your recipient is responsible for creating a work schedule with you to accommodate his
or her maximum weekly hours and monthly authorized hours. Please note, if your recipient
has more than one provider, you may be limited in the amount of the services you provide
as your recipient may schedule other providers for these services. The total hours worked
by all the providers cannot be more than the recipient’s maximum weekly hours and
authorized monthly hours. You will not be paid by the IHSS program for any hours that
exceed your recipient’s authorized monthly hours.
If you are working for more than one recipient, you will be able to work up to 66 hours per
week. You are responsible for informing each of your recipients of the hours you will be
available to work for him/her, taking into account hours you may be working for other
recipients to make sure you do not exceed the 66 hours per week. If you work more than
your recipient’s authorized weekly hours without your recipient receiving county approval,
you may incur a violation. However, your recipient may adjust the weekly authorized
hours in specific circumstances without county approval.
If you are the only provider for your recipient, you will be able to work up to your recipient’s
maximum weekly hours and monthly hours.
SOC 2271 (11/15)
PAGE 1 of 3

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Form Soc 2271a - In-home Supportive Services (ihss) Program Recipient Notice Of Maximum Weekly Hours Form Soc 2271a - In-home Supportive Services (ihss) Program Recipient Notice Of Maximum Weekly Hours Legal
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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 2266a - In-home Supportive Services Program Notice To Provider Approval Of Exception To Exceed Weekly Hours Form Soc 2266a - In-home Supportive Services Program Notice To Provider Approval Of Exception To Exceed Weekly Hours Legal
Form Soc 857a - In-home Supportive Services Program Notice To Recipient Of Provider Ineligibility Acknowledgement Of Receipt Of Invalid Request For Provider Waiver Form Soc 857a - In-home Supportive Services Program Notice To Recipient Of Provider Ineligibility Acknowledgement Of Receipt Of Invalid Request For Provider Waiver Legal
Form Soc 2285 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2285 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2283 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2283 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits 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 2259a - In-home Supportive Services Program Notice To Recipient Of Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2259a - In-home Supportive Services Program Notice To Recipient Of Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Legal

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