Form Na 1257l - Notice Of Action - In-Home Supportive Services (Ihss) (Page 2 of 2) in pdf

Form Na 1257l - Notice Of Action - In-Home Supportive Services (Ihss) Page 2

NOTICE OF ACTION IN-HOME SUPPORTIVE SERVICES (IHSS)

COUNTY OF

You must immediately tell the county about any changes that

might affect your eligibility or need for IHSS, including any

changes in income, property, living arrangements, medical

conditions or the ability to work. If you have any questions or

think more facts should be considered, call your social worker.

Rules: The rules noted above in parentheses apply; you may review

the Manual of Policy and Procedures (MPP) at your local IHSS

office.

Questions? Please contact your IHSS social worker.

State Hearing: If you think this action is wrong, you can ask for a

hearing. The State Hearing Rights insert included with this notice

tells how.

NA 1257L (3/15) IHSS MULTI

Case No:

Page 2 of 2

Form Na 1257l - Notice Of Action - In-Home Supportive Services (Ihss) Page 2