Form Soc 2282 - In-Home Supportive Services Program Notice To Provider Upholding Third Violation (90-Day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER UPHOLDING THIRD VIOLATION (90-DAY SUSPENSION OF
ELIGIBILITY) 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 we have reviewed the Right to Dispute Violation form
you filed after receiving a third violation for the month of ______________. As of the
date of this notice, the violation is upheld. The reason for this decision is based on our
review of the information and/or documentation you provided on the dispute form. We
have determined there was not enough information and/or documentation to show you
met the criteria required for you to work more hours than your workweek agreement
allows for. You 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 you to work more overtime hours
in the month than you normally would.
You are a provider for multiple recipients and you worked more than 66 hours in a
workweek.
Claimed more than 7 hours of travel time in a workweek.
If you disagree with this determination and would like to request a State Administrative
Review, you have 10 calendar days from the date on this notice to submit the enclosed
State Administrative Review Request form. If you file a State Administrative Review
Request, you will be able to continue to provide services until a final decision has been
made on your request.
If you do not file a State Administrative Review Request within 10 calendar days from
the date of this notice, you will be suspended from providing IHSS services 20 calendar
days from the date on this notice, for a period of 90 days.
If you are unsure of the date that you are eligible to resume providing services or you
have any questions about this notice, please contact your IHSS office at the phone
number listed above.
SOC 2282 (6/16)
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