Form SOC2312 "Notice to Provider of Change in Extraordinary Circumstances Exemption Eligibility - in-Home Supportive Services (Ihss) Program" - California

What Is Form SOC2312?

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 February 1, 2018;
  • 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 SOC2312 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 SOC2312 "Notice to Provider of Change in Extraordinary Circumstances Exemption Eligibility - in-Home Supportive Services (Ihss) Program" - California

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State of California – Health and Human Services Agency
California Department of Social Services
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO PROVIDER OF CHANGE IN EXTRAORDINARY
CIRCUMSTANCES EXEMPTION ELIGIBILITY
County of:
(ADDRESSEE)
Notice Date:
IHSS Office Address:
IHSS Office Telephone:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Provider
As of ________________, you were granted an Exemption from Workweek Limitations
for Extraordinary Circumstances (Exemption 2) for the IHSS recipients listed below:
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
This notice is to inform you that at the end of service month _____________________,
your Exemption 2 is being ended due to the following:
… You are no longer providing services for one or more of the recipients for which the
exemption was granted.
… You no longer reside with one or more of the recipients for which the exemption was
granted.
… One or more of the recipients for which the exemption was granted has had a
reduction in authorized IHSS hours, which allows you to work within the workweek
limitations.
… One or more of the recipients for which the exemption was granted no longer meets
the criteria for an Exemption 2.
SOC 2312 (2/18)
Page 1 of 2
State of California – Health and Human Services Agency
California Department of Social Services
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO PROVIDER OF CHANGE IN EXTRAORDINARY
CIRCUMSTANCES EXEMPTION ELIGIBILITY
County of:
(ADDRESSEE)
Notice Date:
IHSS Office Address:
IHSS Office Telephone:
Provider Name:
Provider Number:
To: In-Home Supportive Services (IHSS) Provider
As of ________________, you were granted an Exemption from Workweek Limitations
for Extraordinary Circumstances (Exemption 2) for the IHSS recipients listed below:
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
Recipient Name: _________________ Case Number: _________________
This notice is to inform you that at the end of service month _____________________,
your Exemption 2 is being ended due to the following:
… You are no longer providing services for one or more of the recipients for which the
exemption was granted.
… You no longer reside with one or more of the recipients for which the exemption was
granted.
… One or more of the recipients for which the exemption was granted has had a
reduction in authorized IHSS hours, which allows you to work within the workweek
limitations.
… One or more of the recipients for which the exemption was granted no longer meets
the criteria for an Exemption 2.
SOC 2312 (2/18)
Page 1 of 2
State of California – Health and Human Services Agency
California Department of Social Services
… One or more of the recipient(s) have hired an additional provider(s) and therefore,
you are able to comply with the workweek limitations.
… You did not submit to the county a signed copy of the Exemption from Workweek
Limits for Extraordinary Circumstances Approved Exemption Provider Agreement
(SOC 2308).
… OTHER REASON:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The change in Extraordinary Circumstances Exemption eligibility means you will be
subject to comply with the existing workweek limitations. Therefore, the maximum
number of hours you may work in a workweek for two (2) or more recipients combined
is 66 hours. Once you work the maximum weekly hours your IHSS recipients must hire
another IHSS provider to work their remaining authorized IHSS hours.
If you submit timesheets that report working hours that exceed the 66-hour workweek
limitations for pay periods after the exemption end date, you will accrue a violation.
If you have any concerns regarding your change in exemption eligibility, please contact
your recipient’s IHSS County Social Worker at the IHSS office telephone number
above.
SOC 2312 (2/18)
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