Form Soc 2257c - In-Home Supportive Services Program Notice To Provider Of Second Violation 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 SECOND VIOLATION
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
In the service month of _________________, you exceeded your workweek and/or
MONTH
travel time limits for a second 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.
Because you previously incurred a second violation and took advantage of the one-
time option to review instructional materials and submit a verification notice to remove
the violation, this option cannot be offered again.
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 make a decision.
SOC 2257C (3/16)

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Form Soc 2272 - In-home Supportive Services Program Notice To Provider Of Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2272 - In-home Supportive Services Program Notice To Provider Of Right To Dispute Violation For Exceeding Workweek And/or Travel Time Limits Legal
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Related Categories

Parent category: Legal
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