Transcription of PROVIDER NUMBER IN-HOME SUPPORTIVE …
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PROVIDER NUMBER IN-HOME SUPPORTIVE …
STATE OF CALIFORNIA HEALTH AND HUMAN services AGENCY CALIFORNIA DEPARTMENT OF SOCIAL services . PROVIDER NUMBER _____. IN-HOME SUPPORTIVE services (IHSS) PROGRAM. PROVIDER WORKWEEK & TRAVEL TIME AGREEMENT. (To be completed by a PROVIDER who provides authorized services to multiple recipients). PROVIDER NAME: PROVIDER NUMBER : PART A. WORKWEEK SCHEDULE. PROVIDER REQUIREMENTS: State law (Welfare and Institutions Code section ) limits providers in the IHSS and Waiver Personal Care services (WPCS) programs to working a maximum weekly NUMBER of hours providing IHSS and WPCS. A. PROVIDER who works for multiple recipients is limited to providing 66 hours per workweek. The maximum weekly workweek does not include travel time as described in Part B of this form. The workweek starts on Sunday at 12:00 (midnight) and ends at 11:59 on the following Saturday. Recipients are authorized services on a monthly basis and, based on state law, are limited to receiving a set amount of those services on a weekly basis.
state of california − health and human services agency california department of social services soc 2255 (11/15) page 1of 7 provider name: provider number:
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