Form Soc 2265 - In-Home Supportive Services Program Notice To Provider Reduction Of Total Violation Count

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER
REDUCTION OF TOTAL VIOLATION COUNT
(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 one of the violations on your record has been removed
because you have not received an additional violation in the past twelve months.
Therefore, as of the date of this notice, the number of violations on your record has
been reduced to ______.
Although this violation has been removed, you could receive another violation at a later
time if you fail to follow the workweek and travel time limits for the IHSS program.
If you have any questions about this notice, you may contact your IHSS office at the
phone number above.
SOC 2265 (3/16)

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