Form Soc 2280 - In-Home Supportive Services Program Notice To Provider Upholding First Or Second Violation 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 FIRST OR SECOND VIOLATION 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 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 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 this is your second violation, you can review the informational materials regarding the
workweek and travel time limits within 14 calendar days from the date of this notice. If you
review the informational materials and return the certification form to the county at the
address listed above within 14 calendar days from the date of this notice, your second
violation will be removed and you will only have one violation. Please remember that this
is the only opportunity to remove your second violation and it will not be offered again in
the future, even if you receive another second violation.
If you have any questions about this notice, you may contact your county IHSS office at
the phone number listed above.
SOC 2280 (6/16)
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