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Form Soc 2266a - In-Home Supportive Services Program Notice To Provider 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 PROVIDER

APPROVAL 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 approved for the service month of _______________.

MONTH

Your recipient will authorize you or any other of his/her providers to work these hours.

Do not work these hours without first obtaining permission from your recipient.

Your recipient will need to adjust your work hours by reducing an amount equal to the

number of approved exception hours before the end of the month. This is to make sure

you, and any other providers 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.

Also, please note that if you work for more than one recipient, you cannot work more

than 66 hours in a workweek. Therefore, if the adjustment to your recipient’s maximum

weekly hours would result in you working more than 66 hours in a workweek, you will

not be able to work those additional hours or you may have to adjust the hours you

work for another recipient.

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

office at the phone number above.

SOC 2266A (1/16)

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