Form Na 1251 - Notice Of Action - In-Home Supportive Services (Ihss) Approval Continuation
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1NOTICE OF ACTION
COUNTY OF
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS)
APPROVAL (CONTINUED)
Notice Date:
Case Name:
Case Number:
You must immediately tell the county about any changes that might affect your eligibility or need
for IHSS, including 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 applicable Manual of Policies and Procedure (MPP) sections are shown above and on the
previous page in parentheses. You may review the 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 back of the first page of
this notice tells how.
Page 3 of ____
NA 1251 (5/09) IHSS APPROVAL CONTINUATION
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