Form SOC2310A "Notice to Recipient of Ineligibility for Exemption From the in-Home Supportive Services Program Workweek Limits for Extraordinary Circumstances - in-Home Supportive Services (Ihss) Program" - California

What Is Form SOC2310A?

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 SOC2310A 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 SOC2310A "Notice to Recipient of Ineligibility for Exemption From the in-Home Supportive Services Program Workweek Limits for Extraordinary Circumstances - 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 INELIGIBILITY FOR EXEMPTION FROM THE
IN-HOME SUPPORTIVE SERVICES PROGRAM WORKWEEK LIMITS FOR
EXTRAORDINARY CIRCUMSTANCES
County of:
(ADDRESSEE)
Notice Date:
IHSS Office Address:
IHSS Office Telephone:
Provider Name:
… Initial Exemption
Provider Number:
… Exemption Renewal
The ________________________ gathered information from you and your provider to
evaluate the provider’s need for an Extraordinary Circumstance Exemption (Exemption
2). Based on our evaluation of this information, the requirements for granting an
Exemption 2 have not been met. This provider has been determined ineligible for the
following reasons:
… The case does not meet basic Exemption 2 criteria:
… Your provider does not provide services for two or more IHSS recipients.
… One or all of the recipients applying under Criteria A do not live in the same home
as your provider.
… The total number of authorized hours for all of your provider’s active recipients
does not exceed 264 hours per month; therefore, an exemption is not needed.
… One or all of the recipients applying under Criteria C do not speak a primary
language other than English.
… You were evaluated for an Exemption 2 and it was determined that:
… The recipients/authorized representatives (AR) have not explored the following
options for finding an additional provider(s) so that all of their authorized services
can be provided within the IHSS program workweek limits:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
SOC 2310A (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 INELIGIBILITY FOR EXEMPTION FROM THE
IN-HOME SUPPORTIVE SERVICES PROGRAM WORKWEEK LIMITS FOR
EXTRAORDINARY CIRCUMSTANCES
County of:
(ADDRESSEE)
Notice Date:
IHSS Office Address:
IHSS Office Telephone:
Provider Name:
… Initial Exemption
Provider Number:
… Exemption Renewal
The ________________________ gathered information from you and your provider to
evaluate the provider’s need for an Extraordinary Circumstance Exemption (Exemption
2). Based on our evaluation of this information, the requirements for granting an
Exemption 2 have not been met. This provider has been determined ineligible for the
following reasons:
… The case does not meet basic Exemption 2 criteria:
… Your provider does not provide services for two or more IHSS recipients.
… One or all of the recipients applying under Criteria A do not live in the same home
as your provider.
… The total number of authorized hours for all of your provider’s active recipients
does not exceed 264 hours per month; therefore, an exemption is not needed.
… One or all of the recipients applying under Criteria C do not speak a primary
language other than English.
… You were evaluated for an Exemption 2 and it was determined that:
… The recipients/authorized representatives (AR) have not explored the following
options for finding an additional provider(s) so that all of their authorized services
can be provided within the IHSS program workweek limits:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
SOC 2310A (2/18)
Page 1 of 2
State of California – Health and Human Services Agency
California Department of Social Services
… Recipient(s) do not have complex medical and/or behavioral needs.
… Recipient(s) do not live in a rural/remote area.
… Recipient(s) do not meet Language/Communication Barrier criteria.
… Recipient(s) did not demonstrate that services could not be provided with initial
interpretive assistance.
… Recipients and/or their authorized representative(s) failed to provide sufficient
justification as to why all the authorized service hours of the recipients could not
be worked by additional providers when there are other providers associated with
the case.
… Recipient(s) have exhibited an ability to work with other providers.
… The authorized hours for all recipients have been assigned to active providers;
therefore, an exemption is not needed.
Because your provider has been determined ineligible for an exemption, he/she will be
subject to the existing workweek limits. Therefore, the maximum number of hours he/
she may work in a workweek for two or more recipients combined is 66 hours. Either
you or one of the other recipients 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.
Pursuant to Welfare and Institutions Code section 12300.4 (d)(3)(E)(iii)(I), the provider
and recipients may request an independent review of this determination within 30
calendar days of this notice date. An administrative review request form has been
attached to this notice for your convenience.
If you have any questions, please contact your IHSS County Social Worker at the IHSS
office telephone number above.
SOC 2310A (2/18)
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