Form SOC2312A "Notice to Recipient of Change in Extraordinary Circumstances Exemption Eligibility - in-Home Supportive Services (Ihss) Program" - California

What Is Form SOC2312A?

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 SOC2312A 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 SOC2312A "Notice to Recipient 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 RECIPIENT 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) Recipient
This notice is to inform you that at the end of service month _________________, the
Exemption from Workweek Limitations for Extraordinary Circumstances (Exemption 2)
will be ended for your IHSS provider listed above because:
… Your provider is no longer providing services for one or more of the recipient(s) for
which the exemption was granted.
… Your provider no longer resides with one or more of the recipient(s) for which the
exemption was granted.
… One or more of the recipient(s) for which the exemption was granted has had a
reduction in authorized IHSS hours, which allows your provider to work within the
workweek limitations.
… One or more of the recipient(s) for which the exemption was granted no longer
meets the criteria for an Exemption 2.
… One or more of the recipient(s) have hired an additional provider(s) and therefore,
your provider is able to comply with the workweek limitations.
… Your provider did not submit a signed copy of the Exemption from Workweek Limits
for Extraordinary Circumstances Approved Exemption Provider Agreement
(SOC 2308) to the county.
SOC 2312A (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 RECIPIENT 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) Recipient
This notice is to inform you that at the end of service month _________________, the
Exemption from Workweek Limitations for Extraordinary Circumstances (Exemption 2)
will be ended for your IHSS provider listed above because:
… Your provider is no longer providing services for one or more of the recipient(s) for
which the exemption was granted.
… Your provider no longer resides with one or more of the recipient(s) for which the
exemption was granted.
… One or more of the recipient(s) for which the exemption was granted has had a
reduction in authorized IHSS hours, which allows your provider to work within the
workweek limitations.
… One or more of the recipient(s) for which the exemption was granted no longer
meets the criteria for an Exemption 2.
… One or more of the recipient(s) have hired an additional provider(s) and therefore,
your provider is able to comply with the workweek limitations.
… Your provider did not submit a signed copy of the Exemption from Workweek Limits
for Extraordinary Circumstances Approved Exemption Provider Agreement
(SOC 2308) to the county.
SOC 2312A (2/18)
Page 1 of 2
State of California – Health and Human Services Agency
California Department of Social Services
… OTHER REASON:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The change in Extraordinary Circumstances Exemption eligibility means your provider
will be subject to comply with the existing workweek limitations. Therefore, the
maximum number of hours that your provider may work in a workweek for two (2) or
more recipients combined is 66 hours. If your provider submits timesheets that report
working hours that exceed the 66-hour workweek limitations after the exemption end
date, your provider will accrue a violation.
Either you or one of the other recipient(s) your provider works for will need to hire
another IHSS provider(s) to work any remaining authorized IHSS hours above the 66
hour per workweek limit. Please discuss and make arrangements with your provider to
ensure that workweek limits are not exceeded.
If you have any questions regarding the Change in Extraordinary Circumstances
eligibility, please contact your IHSS County Social Worker at the IHSS office telephone
number above.
SOC 2312A (2/18)
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