Looking for a California Department Of Social Services Forms And Templates? Download it for free!

Form Soc 2266 - In-Home Supportive Services Program Notice To Recipient Approval 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 RECIPIENT

APPROVAL OF EXCEPTION TO EXCEED WEEKLY HOURS

(ADDRESSEE)

County of:

Notice Date:

Recipient Name:

Recipient Case Number:

IHSS Office Address:

IHSS Office Telephone Number:

To: In-Home Supportive Services (IHSS) Recipient

This notice is to inform you that your request for an exception to exceed your maximum

weekly hours has been approved for the service month of _____________________.

MONTH

You may have your provider(s) work these additional hours.

You will need to adjust your providers’ work hours by reducing an amount equal to the

number of approved exception hours before the end of the month to make sure your

monthly authorized hours are not exceeded. If you do not adjust your providers’ work

hours before the end of the month, your provider(s) will not be paid for the excess

hours by the IHSS program, and you will be responsible for the payment of any service

hours beyond your 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 2266 (1/16)

Form Soc 2266 - In-Home Supportive Services Program Notice To Recipient Approval Of Exception To Exceed Weekly Hours