Form Na 1257l - Notice Of Action - In-Home Supportive Services (Ihss)

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COUNTY OF
STATE OF CALIFORNIA, HEALTH
NOTICE OF ACTION
AND HUMAN SERVICES AGENCY
IN-HOME SUPPORTIVE
CALIFORNIA DEPARTMENT OF
SERVICES (IHSS)
SOCIAL SERVICES
(ADDRESSEE)
NOTE: This notice relates ONLY to your In-Home Supportive
Services. It does NOT affect your receipt of SSI/SSP, Social
Security, or Medi-Cal. KEEP THIS NOTICE WITH YOUR
IMPORTANT PAPERS.
Notice Date:
Case Name:
Case Number:
Social Worker Name:
Social Worker Number:
Social Worker
Telephone:
Social Worker Address:
NA 1257L (3/15) IHSS MULTI
Case No:
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