Form Soc 2258 - In-Home Supportive Services Program Notice To Provider Of Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits

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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 OF THIRD VIOLATION (90-DAY SUSPENSION OF ELIGIBILITY)
FOR EXCEEDING WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
Effective twenty (20) days from the date of this notice, you are no longer eligible to
receive payment from the IHSS program for providing authorized services to your
current recipient(s) or to any other person for a period of 90 days.
In the service month of ______________, you violated your workweek and travel time
MONTH
limits, for a third time, by doing one or more of the following:
Working more than 40 hours in a workweek for a recipient without the recipient
getting approval from the county when that recipient’s maximum weekly hours
are 40 hours or less.
Working more than a recipient’s maximum weekly hours without the recipient
getting approval from the county which caused you to work more overtime hours
in the month than you normally would.
Working more than 66 hours in a workweek when you work for more than
one recipient.
Claiming more than seven (7) hours of travel time in a workweek.
If you disagree with this decision you may submit the attached county request form to
the IHSS office at the address above. You have ten (10) calendar days from the date of
this notice to request a county review. The county then has ten (10) business days to
review and investigate and decide whether to rescind the violation.
SOC 2258 (3/16)

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Parent category: Legal
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