Form Soc 2257b - In-Home Supportive Services Program Notice To Provider Of Second Violation No Record Of Completion Of Review Of Instructional Materials

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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
NO RECORD OF COMPLETION OF REVIEW OF INSTRUCTIONAL MATERIALS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
On ____________________, you received an IHSS Notice to Provider of First/Second
Violation for Exceeding Workweek and/or Travel Time Limits (SOC 2257) and were
informed that you were assessed a second violation for exceeding your workweek
and/or travel time limits within the service month of __________________.
At that time, you were given the opportunity to review instructional materials and
submit a verification notice to the IHSS office within 14 calendar days after the date of
the notice to avoid being given the second violation. County records show that you
have not submitted the verification notice within 14 calendar days. Therefore, the
second violation is now in effect.
If you received this notice in error and you have reviewed the instructional materials
and submitted the verification to the IHSS office within 14 calendar days after the date
of the notice, contact your IHSS office at the telephone number above to receive credit
for the instructional review and to have the second violation removed.
SOC 2257B (3/16)

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