Form TEMP2262 "In-home Supportive Services Program Notice to Provider of Provider Ineligibility Failure to Submit Soc 846" - California

What Is Form TEMP2262?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2016;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form TEMP2262 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form TEMP2262 "In-home Supportive Services Program Notice to Provider of Provider Ineligibility Failure to Submit Soc 846" - California

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER OF PROVIDER INELIGIBILITY
FAILURE TO SUBMIT SOC 846 (REV. 11/15)
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
In December 2015, you received the Important Information for the In-Home Supportive
Services (IHSS) provider mailer (TEMP 3001) which instructed you to return the signed
IHSS Program Provider Enrollment Agreement (SOC 846 [rev. 11/15]) form to the
county in order to avoid being determined ineligible to work and be paid by the IHSS
program as an IHSS provider.
Effective July 1, 2017, you are no longer eligible to work and be paid by the IHSS
program as an IHSS provider. The reason for this determination of ineligibility is
because you did not submit the signed SOC 846 (rev. 11/15) form by April 29, 2017.
How to Return to Active Status as an IHSS Provider
If you wish to be placed back on active status in order to work and be paid as an IHSS
provider, you must complete and sign the SOC 846 (rev. 11/15) form and return it to the
county IHSS office. If you do not have the SOC 846 (rev. 11/15) form, please find an
enclosed blank SOC 846 for you to sign and submit to your county office.
If you believe you signed and submitted the SOC 846 prior to the April 29, 2017,
required due date or if you have any other questions regarding the SOC 846 form
requirement, you may call the county at the telephone number above.
TEMP 2262 (9/16)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO PROVIDER OF PROVIDER INELIGIBILITY
FAILURE TO SUBMIT SOC 846 (REV. 11/15)
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Provider
In December 2015, you received the Important Information for the In-Home Supportive
Services (IHSS) provider mailer (TEMP 3001) which instructed you to return the signed
IHSS Program Provider Enrollment Agreement (SOC 846 [rev. 11/15]) form to the
county in order to avoid being determined ineligible to work and be paid by the IHSS
program as an IHSS provider.
Effective July 1, 2017, you are no longer eligible to work and be paid by the IHSS
program as an IHSS provider. The reason for this determination of ineligibility is
because you did not submit the signed SOC 846 (rev. 11/15) form by April 29, 2017.
How to Return to Active Status as an IHSS Provider
If you wish to be placed back on active status in order to work and be paid as an IHSS
provider, you must complete and sign the SOC 846 (rev. 11/15) form and return it to the
county IHSS office. If you do not have the SOC 846 (rev. 11/15) form, please find an
enclosed blank SOC 846 for you to sign and submit to your county office.
If you believe you signed and submitted the SOC 846 prior to the April 29, 2017,
required due date or if you have any other questions regarding the SOC 846 form
requirement, you may call the county at the telephone number above.
TEMP 2262 (9/16)