Form Soc 2270 - In-Home Supportive Services Program Notice To Recipient Failure To Complete Workweek Agreement

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO RECIPIENT
FAILURE TO COMPLETE WORKWEEK AGREEMENT (SOC 2256)
(ADDRESSEE)
County of:
Notice Date:
Recipient Name:
Recipient Case Number:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
You have been identified as a recipient who has or needs more than one IHSS
provider. Therefore, you are required to complete an IHSS Program Recipient/Provider
Workweek Agreement (SOC 2256) form. Our records indicate that you have not yet
completed this form. This form must be completed, signed by you and each of the
providers working for you, and returned to the county IHSS office listed above.
If you have any further questions about this notice or need assistance in completing the
SOC 2256 form, you may contact your county IHSS office at the phone number above.
SOC 2270 (2/16)

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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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