Form Soc 2283 - In-Home Supportive Services Program Notice To Recipient Upholding Provider'S Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO RECIPIENT UPHOLDING PROVIDER’S THIRD VIOLATION (90-DAY
SUSPENSION OF ELIGIBILITY) FOR EXCEEDING WORKWEEK AND/OR TRAVEL
TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
This notice is to inform you that the Right to Dispute Violation form your provider,
______________________________________________________________________
filed after the third violation he/she received for the month of ___________________
has been reviewed. As of the date of this notice, the violation is upheld. The reason for
this decision is based on the county’s review of the information and/or documentation
provided by your provider on the Right to Dispute Violation form. The county has
determined that there was not enough information and/or documentation to show your
provider met the criteria required for him/her to exceed the hours on the workweek agreement.
Your provider will continue to have a third violation for the following reason(s):
Worked more than 40 hours in a workweek for a recipient without the recipient
getting approval from the county when that recipient’s maximum weekly hours
are 40 hours or less.
Worked more than a recipient’s maximum weekly hours without the recipient
getting approval from the county which caused your provider to work more
overtime hours in the month than your provider normally would.
Worked more than 66 hours in a workweek when your provider works for more
than one recipient.
Claimed more than 7 hours of travel time in a workweek.
If your provider requests a State Administrative Review, your provider may continue to
provide services until a final determination is made on his/her State Administrative
Review. If the outcome of the State Administrative Review is to uphold the violation
your provider will be terminated for a period of 90 days; 20 calendar days from the date
of that determination.
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SOC 2283 (7/16)
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