Notice to Provider Templates
Are you a provider in the In-home Supportive Services (IHSS) Program in California? Stay informed and up to date with important notices and updates through our Notice to Provider collection. Also known as Notice to Providers, this collection of documents includes various forms and notifications related to changes, exemptions, violations, and approvals within the IHSS Program.
Our Notice to Provider collection ensures that you are aware of any reduction in total violation count, changes in extraordinary circumstances exemption eligibility, approval of exceptions to exceed weekly hours, non-acceptance of subsequent requests for exemption, and second violation no record of completion of instructional materials review.
Stay in compliance and stay informed with our comprehensive Notice to Provider collection. Don't miss out on important updates and changes that may impact your participation in the IHSS Program. Browse through our collection of forms and notifications and access the information you need to navigate the program successfully.
Documents:
22
PDF 
Word
This form is used for acknowledging the receipt of a county violation review in the In-home Supportive Services Program in California.
This form is used for notifying the service provider in the In-home Supportive Services Program in California about their failure to complete the workweek and travel agreement.
This form is used for notifying providers in California's In-home Supportive Services program about the approval to work an alternate schedule due to a recurring event.
This form is used for notifying providers in California of their fourth violation in exceeding workweek and/or travel time limits within a one-year period. The violation results in a one-year period of ineligibility for the In-home Supportive Services Program.
This form is used for notifying providers in California's In-home Supportive Services Program of their third violation, resulting in a 90-day suspension of eligibility. The violations may include exceeding workweek and/or travel time limits.
This form is used for sending a notice to the provider in the In-home Supportive Services program in California who is found to be ineligible due to a subsequent conviction for Tier 2 crimes.
This form is used for notifying the providers of the In-home Supportive Services Program in California about the expiration of their exemption from workweek limits.
This form is used for providers in California to clarify liability for Medi-Cal services. It is available in both English and Spanish.
This document is used for notifying providers in California's Home Supportive Services Program about their ineligibility due to a failed criminal background check.
This form is used for notifying the provider of violations for exceeding workweek and/or travel time limits in the In-Home Supportive Services Program in California.
This form is used to notify the provider of the approval of an exemption from the in-Home Supportive Services (IHSS) program workweek limits for extraordinary circumstances in California.
This form is used for notifying providers in the In-Home Supportive Services Program in California about the approval of an exception to exceed weekly hours.
This form is used for notifying the provider of the In-home Supportive Services Program in California about the non-acceptance of a subsequent request for exemption from workweek limits due to extraordinary circumstances (Exemption 2).
