Form IHSS-E007 "In-home Supportive Services (Ihss) Program Notice to Recipient of Provider's Expiration of Exemption From Workweek Limits" - California

What Is Form IHSS-E007?

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, 2017;
  • 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 IHSS-E007 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form IHSS-E007 "In-home Supportive Services (Ihss) Program Notice to Recipient of Provider's Expiration of Exemption From Workweek Limits" - California

589 times
Rate (4.8 / 5) 41 votes
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO RECIPIENT OF PROVIDER’S EXPIRATION OF
EXEMPTION FROM WORKWEEK LIMITS
COUNTY OF:
(ADDRESSEE)
IHSS Office Address:
IHSS Office Telephone:
Notice Date:
Recipient Name:
Case Number:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Recipient
As of _____________, your provider listed above was approved for an Exemption from
Date
Workweek Limits for Extraordinary Circumstances (Exemption 2).
This notice is to inform you that your provider’s Exemption 2 will be expiring on
_____________.
Prior to the expiration of your provider’s Exemption 2, we will review your case to
determine whether the circumstances the exemption was based on continue to exist
and, if so, we will request a renewal of the Exemption 2 on your provider’s behalf.
If your provider’s exemption is not renewed timely, the maximum number of hours
he/she would be able to work in a workweek for two or more recipients combined would
be 66 hours.
If you have any questions about this notice, please contact the IHSS Office at the
telephone number listed above.
IHSS-E 007 (4/17)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO RECIPIENT OF PROVIDER’S EXPIRATION OF
EXEMPTION FROM WORKWEEK LIMITS
COUNTY OF:
(ADDRESSEE)
IHSS Office Address:
IHSS Office Telephone:
Notice Date:
Recipient Name:
Case Number:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Recipient
As of _____________, your provider listed above was approved for an Exemption from
Date
Workweek Limits for Extraordinary Circumstances (Exemption 2).
This notice is to inform you that your provider’s Exemption 2 will be expiring on
_____________.
Prior to the expiration of your provider’s Exemption 2, we will review your case to
determine whether the circumstances the exemption was based on continue to exist
and, if so, we will request a renewal of the Exemption 2 on your provider’s behalf.
If your provider’s exemption is not renewed timely, the maximum number of hours
he/she would be able to work in a workweek for two or more recipients combined would
be 66 hours.
If you have any questions about this notice, please contact the IHSS Office at the
telephone number listed above.
IHSS-E 007 (4/17)