Form Ihss-E 006 - In-Home Supportive Services Program - Notice To Provider Of Expiration Of Exemption From Workweek Limits

Download a blank fillable Form Ihss-E 006 - In-Home Supportive Services Program - Notice To Provider Of Expiration Of Exemption From Workweek Limits in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ihss-E 006 - In-Home Supportive Services Program - Notice To Provider Of Expiration Of Exemption From Workweek Limits with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER OF EXPIRATION OF
EXEMPTION FROM WORKWEEK LIMITS
COUNTY OF:
(ADDRESSEE)
IHSS Office Address:
IHSS Office Telephone:
Notice Date:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Provider
As of ___________, you were approved for an Exemption from Workweek Limits for
Date
Extraordinary Circumstances (Exemption 2) for the IHSS recipients listed below:
Recipient Name: ___________________
Recipient Name: ____________________
Case Number: ____________________
Case Number: ______________________
Recipient Name: ___________________
Recipient Name: ____________________
Case Number: ____________________
Case Number: ______________________
This notice is to inform you that your Exemption 2 will be expiring on ______________.
Prior to the expiration of your Exemption 2, we will review the recipients’ cases to
determine whether the circumstances the exemption was based on continue to exist
and, if so, we will request a renewal of the Exemption 2 on your behalf.
If your exemption is not renewed timely, the maximum number of hours you would be
able to work in a workweek for two or more recipients combined would be 66 hours.
If you have any questions about this notice, please contact the IHSS Office at the
telephone number listed above.
IHSS-E 006 (4/17)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Ihss-e 005 - In-home Supportive Services Program - Notice Of Ineligibility To Request Exemption From Workweek Limits For Extraordinary Circumstances (exemption 2) - Provider Form Ihss-e 005 - In-home Supportive Services Program - Notice Of Ineligibility To Request Exemption From Workweek Limits For Extraordinary Circumstances (exemption 2) - Provider 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 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 2257 - In-home Supportive Services Program Notice To Provider Of First/second Violation For Exceeding Workweek And/or Travel Time Limits Form Soc 2257 - In-home Supportive Services Program Notice To Provider Of First/second Violation For Exceeding Workweek And/or Travel Time Limits 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 Temp 2262 - In-home Supportive Services Program Notice To Provider Of Provider Ineligibility Form Temp 2262 - In-home Supportive Services Program Notice To Provider Of Provider Ineligibility 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 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

Related Categories

Parent category: Legal
Download
Go