Form Soc 2257 - In-Home Supportive Services Program Notice To Provider Of First/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 FIRST/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 travel
MONTH
time limits 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 exceeded your workweek and/or travel time limits, you have now received
your:
First Violation
This is a warning notice only; no action will be taken against you at this time.
•
Second Violation
You have the one-time option of reviewing the enclosed instructional materials
•
and submitting the verification notice to the IHSS office to avoid a second violation.
If you choose not to review the instruction materials and submit the verification
•
notice within 14 calendar days, you will automatically be given your second violation.
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 2257 (3/16)

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Related forms

Form Soc 2257a - In-home Supportive Services Program Notice To Recipient Of Provider's First/second Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2257a - In-home Supportive Services Program Notice To Recipient Of Provider's First/second Violation For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2280 - In-home Supportive Services Program Notice To Provider Upholding First Or Second Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2280 - In-home Supportive Services Program Notice To Provider Upholding First Or Second Violation For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2257c - In-home Supportive Services Program Notice To Provider Of Second Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2257c - In-home Supportive Services Program Notice To Provider Of Second Violation For Exceeding Workweek And/or Travel Time Limits Legal
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
Form Soc 2259 - In-home Supportive Services Program Notice To Provider Of Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2259 - In-home Supportive Services Program Notice To Provider Of Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Legal
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 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 Legal
Form Soc 2257b - In-home Supportive Services Program Notice To Provider Of Second Violation No Record Of Completion Of Review Of Instructional Materials Form Soc 2257b - In-home Supportive Services Program Notice To Provider Of Second Violation No Record Of Completion Of Review Of Instructional Materials Legal
Form Soc 2292 - In-home Supportive Services Program Notice To Provider Of Failure To Timely Form Soc 2292 - In-home Supportive Services Program Notice To Provider Of Failure To Timely Legal
Form Soc 870 - In-home Supportive Services Program Notice To Provider Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Form Soc 870 - In-home Supportive Services Program Notice To Provider Of Provider Eligibility Acknowledgement Of Receipt Of Waiver Legal
Form Soc 881 - In-home Supportive Services Program Notice To Provider Of Inactivity Form Soc 881 - In-home Supportive Services Program Notice To Provider Of Inactivity Legal

Related Categories

Parent category: Legal
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