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Form Soc 2267a - In-Home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

IN-HOME SUPPORTIVE SERVICES PROGRAM

NOTICE TO PROVIDER

DENIAL OF EXCEPTION TO EXCEED WEEKLY HOURS

(ADDRESSEE)

County of:

Notice Date:

Provider Name:

IHSS Office Address:

IHSS Office Telephone Number:

To: In-Home Supportive Services (IHSS) Provider

This notice is to inform you that your recipient’s request for an exception to exceed

his/her maximum weekly hours has been denied for the service month of

_________________. Therefore, do not work these additional hours.

MONTH

If you have already worked these additional hours, you will be paid for the time worked,

but you will receive a violation. The penalty for this violation will be based on the number

of violations you have received. You will receive a notification informing you of the

violation and any penalty given. You will also receive information about how you can

request a county review of your violation.

Further, if you already worked these hours, your recipient will need to adjust your work

hours, before the end of the month, by the number of exception hours worked, but not

approved. This is to make sure you and any other provider(s) that the recipient may

have, do not exceed his/her monthly authorized hours. If your recipient does not adjust

your work hours before the end of the month, you will not be paid for the excess hours

by the IHSS Program. Instead, your recipient will be responsible for the payment of

any service hours you work beyond his/her authorized monthly hours.

If you have any further questions about this notice, you may contact your county IHSS

office at the phone number above.

SOC 2267A (1/16)

Form Soc 2267a - In-Home Supportive Services Program Notice To Provider Denial Of Exception To Exceed Weekly Hours