Form Soc 2288 - In-Home Supportive Services Program State Administrative Review Request Response Letter To Provider Rescinding Third Violation Or Fourth 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
STATE ADMINISTRATIVE REVIEW REQUEST RESPONSE LETTER TO PROVIDER
RESCINDING THIRD VIOLATION OR FOURTH VIOLATION FOR EXCEEDING
WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Recipient Name:
Recipient Case Number:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
This notice is to inform you that the violation you received for the month of __________
has been rescinded effective the date of this notice.
The reason for the withdrawal of this violation is because the California Department of
Social Services (CDSS) has determined that although you did violate the rule(s) indicated
on the SOC 2258 or SOC 2259 that you received from your county, the circumstances
that led to you working the additional hours met the Exception Criteria set by CDSS.
During our review it was determined that the circumstances on the Provider’s Right to
Dispute form (SOC 2272) that was previously provided to the county met the Exception
Criteria, therefore the violation has been rescinded.
Although this violation has been rescinded, you could receive another violation at a
later time if you fail to follow the workweek and travel time limits explained in the
Provider Enrollment Agreement (SOC 846).
If you have any questions regarding this notice, you may contact your county IHSS
office at the phone number listed above.
SOC 2288 (7/16)

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