Form Soc 2281 - In-Home Supportive Services Program Notice To Recipient Upholding Provider'S First Or Second 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
NOTICE TO RECIPIENT UPHOLDING PROVIDER’S FIRST OR SECOND VIOLATION
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 of the outcome of the Right to Dispute Violation form your
provider,
_____________________________________________________________________
filed after the violation he/she received for the month of ______________. The county
has reviewed the request and has decided that the violation is upheld. 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 work more than his/her workweek agreement allows for. As a
result, your provider will continue to have a 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 you have any questions about this notice, you may contact your county IHSS office at
the phone number listed above.
SOC 2281 (6/16)

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