Form SOC2272B "In-home Supportive Services Program Notice to Recipient Acknowledgement of Provider's Request for County Violation Review for Exceeding Workweek and/Or Travel Time Limits" - California

What Is Form SOC2272B?

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 April 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 printable version of Form SOC2272B 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 SOC2272B "In-home Supportive Services Program Notice to Recipient Acknowledgement of Provider's Request for County Violation Review for Exceeding Workweek and/Or Travel Time Limits" - 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 RECIPIENT
ACKNOWLEDGEMENT OF PROVIDER’S REQUEST FOR COUNTY VIOLATION
REVIEW FOR EXCEEDING WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Recipient Name:
Recipient Case Number:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
This notice is to inform you that the IHSS office has received your provider’s request to
review the violation he/she received.
The county now has ten (10) business days to conduct the county review and issue a
decision on the provider’s request to review the violation. If the provider is requesting
the review of his/her third or fourth violation, his/her ineligibility to provide and be paid
to provide authorized IHSS to you or any other recipient will not begin until after the
county has made a decision on his/her request. You will receive notification of the
outcome of the dispute request.
If you have any questions about this notice, you may contact your IHSS office at the
phone number above.
SOC 2272B (4/16)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
NOTICE TO RECIPIENT
ACKNOWLEDGEMENT OF PROVIDER’S REQUEST FOR COUNTY VIOLATION
REVIEW FOR EXCEEDING WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Recipient Name:
Recipient Case Number:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
This notice is to inform you that the IHSS office has received your provider’s request to
review the violation he/she received.
The county now has ten (10) business days to conduct the county review and issue a
decision on the provider’s request to review the violation. If the provider is requesting
the review of his/her third or fourth violation, his/her ineligibility to provide and be paid
to provide authorized IHSS to you or any other recipient will not begin until after the
county has made a decision on his/her request. You will receive notification of the
outcome of the dispute request.
If you have any questions about this notice, you may contact your IHSS office at the
phone number above.
SOC 2272B (4/16)