You are considered your provider's employer and, therefore, it is your responsibility to hire, train, supervise, and fire this individual. Make sure that most of the boxes are marked severe or at least moderate. explain why you did not provide it for the hearing; explain why you think the new evidence would change the decision; and, submit a copy of the new evidence, if possible. If you lock your account, you won't be able to log in again. (IHSS) regulations to parent providers. As a Parent, Do I Qualify for (IHSS) Protective Supervision as a Provider? When disabled and low-income (receipt of SSI means automatic eligibility). IHSS Application in Chinese If a caregiver, aide, teacher, or other professional has spent a considerable amount of time with the applicant, especially in a professional capacity, you should ask that potential witness to write a letter in support of the application. If one parent wants to be IHSS Application in Spanish. from whether the child is eligible for IHSS. Your hearing for protective supervision will either be in person or over the phone. An undocumented parent is ineligible to be an IHSS parents home. However, the definition of nonself-directing already includes the requirement that the individual will most likely engage in potentially dangerous activities. To apply for IHSS, complete an application and submit it to your County IHSS Office. An IHSS Protective Supervision provider takes care of children with severe mental impairments and makes sure they dont hurt themselves while they are living at home. What are the eligibility requirements for Protective Supervision? You must live in your own home which could be an apartment, a house or another persons home. It provides financial assistance to adults and children with developmental disabilities so they can remain at home safely. Your parents are absent because of employment, education, or training for vocational purposes. A completed Health Care Certification (SOC 873) must be received by the county prior to authorization of services. |. hbbd``b`+ @QjX "A @+ Give this list to your Social Worker and also to your doctor. non-parent IHSS provider or a second parent in the household for their child. The goal of the writ petition is to convince the court to set aside the administrative law judges decision. IHSS Timesheet Issues/Questions: If you retain an attorney or advocate to help you with your protective supervision case, IHSS requires an authorized representative form. Protective supervision hours will be provided for up to 195 hours per month or 283 hours, depending on the severity of the impairment and the persons IHSS program. Provide the doctor with specific examples of the applicants dangerous behaviors and deficiencies in memory, orientation, and judgment. For example, a county social worker might say that the applicant is too young to receive protective supervision, even though there is no minimum age requirement. Tips for Using Adobe PDF Files, Notice of Action Documents(used by county governments), Copyright 2023 California Department of Social Services, NA Back9 (5/22) - Your Hearing Rights (Full Rights Are Listed in CDSS PUB 412), NA Description Of Services L (3/15) - Description Of services, NA IHSS Back L (3/15) - Your Hearing Rights, NA 200 (12/20) - Notice Of Action - Multipurpose - Include Budget, NA 200 (7/21) - Notice Of Action - Multipurpose - Include Budget, NA 210 (5/20) - Discontinue, Suspend Financial Eligibility, NA 213 (10/21) - Deny - Financial Eligibility, NA 213A (12/20) Notice Of Action Deny Financial Eligibility, NA 213A (7/21) Notice Of Action Deny Financial Eligibility, NA 214 (4/00) - Discontinue, Suspend Transfer of Property, NA 215 (1/00) - Continuation Page, Sponsor Non Citizens Deemed Income, NA 216 (11/99) - Sponsored Non Citizens Property, NA 271 (12/20) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid, NA 271 (7/21) - Notice Of Action - Continuation Page - Family Income Computations - Cash Aid, NA 274 (4/99) - Continuation Page Overpayment Computations (prior to 10-1-89), NA 274B (4/99) - Continuation Page Overpayment Computations (for 10/1/89 to 8/31/91), NA 274C (4/99) - Continuation Page - Overpayment Computations (for 9/1/91 to 8/31/95), NA 274D (1/00) - Continuation Page - Overpayment Computations (Ortega 9/1/95 to 12/31/97), NA 274E (6/11) - Notice Of Action Overpayment Computations For 1-1-98 to 6-30-2011, NA 274F (6/11) - Notice Of Action - Overpayment Amount Owed (For Overpayments Occurring On Or After 7/1/2011), NA 274G (7/19) - Notice Of Action - Continuation Page - Overpayment ComputationsOccurringOn Or After10/1/2013, NA 274H (12/20) - Notice Of Action - Continuation Page - Overpayment Computations Between 6/1/2020 and 05/31/2021, NA 274I (7/21) - Notice Of Action - Continued - Overpayment Amount Owed For Overpayments Occurring Between 6-1-2021 and 5-31-2022, NA 274J (7/21)-Notice of Action Continued - Overpayment Amount Owed For Overpayments Occurring On or after 6-1-2022, NA 275 (4/99) - Continuation Page - Overpayment Adjustment Computation - Cash Aid, NA 277 (1/00) - Continuation Page Optional Persons Transfer of Property, NA 278 (1/00) - Discontinue/Suspend Optional Persons Transfer of Property, NA 279 (1/00) - Excess Property (with Good Faith), NA 280 (1/00) - Excess Property (w/o Good Faith), NA 281 (6/11) - Notice Of Action - Underpayment Amount Owed (For Underpayments Occurring on or After 1-1-98 thru 6-30-2011), NA 281A (6/11) - Notice Of Action Underpayment Amount Owed (For Underpayments Occurring On Or After 7/1/2011), NA 281B (5/13) - Notice Of Action Continuation Page - Underpayment Computations On Or After 10/1/2, NA 281C (7/19) - Notice Of Action - Continuation Page - Underpayment Computations Occurring On Or After 6/1/2020, NA 281C (12/20) - Notice Of Action Continuation Page - Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2020 and 5-31-2021), NA 281D (7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring Between 6-1-2021 and 5-31-2022), NA 281E(7/21) - Notice Of Action (Continued) Underpayment Amount Owed (For Underpayments Occurring On Or After 6-1-2022), NA 290 (2/14) -Notice Of Action - Multipurpose, NA 300 (7/19) - Notice Of Action - Continuation Page - Recipient Financial Eligibility Test, NA 300 (10/21) - Notice Of Action - Continuation Page - RecipientFinancial Eligibility Tests, NA 301 (10/21) - Continuation Page - Applicant Financial Eligibility Test, NA 403 (1/22)- Notice Of Action - For Resource Families, Including Homes Certified By AFoster Family Agency, County Approved Relative Homes, Non-Relative Extended Family Members, Foster Family Homes, Non-Related Legal Guardians, Intensive Treatment Foster Care and/or Intensive Services Foster Care, Group Homes and Short-Term Residential Therapeutic Programs, NA 403A (4/17) - Notice Of Action Approval, Change Or Discontinued For Kinship - Guardians Only, NA 421 (6/21) Assistance Dog Special Allowance (ADSA) - Notice Of Action - Approval, NA 422 (11/21) - Assistance Dog Special Allowance (ADSA), NA 422L (1/22) -Assistance Dog Special Allowance (ADSA) Notice of Action Denial, NA 530 (4/11) - Notice Of Action -48-Month Time Limit, NA 530 (4/21) - Notice Of Action - 60-Month Time Limit, NA 531 (12/20) - Notice Of Action - Continuation Page-48-Month Time Limit- Includes Budget, NA 531 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget, NA 531 (7/21) - Notice Of Action - Continuation Page - 60-Month Time Limit - Includes Budget, NA 532 (7/19) - Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue, NA 532 (12/20) - Notice Of Action - Continuation Page - 48-Month Time Limit Discontinue - Includes Budget, NA 532 (4/21) - Notice Of Action - Continuation Page - 60-Month Time Limit Discontinue - Includes Budget, NA 532 (11/21) - Notice Of Action- Continuation Page - 60-Month Time Limit Discontinue - Includes Budget, NA 691 (3/18) - Notice Of Denial - Cash Assistance Program For Immigrants (CAPI), NA 692 (12/17) - Notice Of Change - Cash Assistance Program For Immigrants (CAPI), NA 693 (9/22) - Notice Of Approval - Cash Assistance Program For Immigrants (CAPI), NA 791 (9/18) - Notice Of Action - Approval/Denial/Change, NA 816 (3/14) - Notice Of Action - Sanction Of Other Parent After Failed Compliance Plan, NA 817 (3/14) - Notice Of Action - Sanction Of Participant After Failed Compliance Plan, NA 818 (3/14) - Notice Of Action - Taking You Out Of Welfare To Work, NA 820 (1/01) - Notice Of Action - Transportation Approval, NA 821 (1/01) - Notice Of Action - Transportation Approval/Denial, NA 822 (7/16) - Notice Of Action - Transportation Change, NA 823 (8/00) - Notice Of Action - Ancillary Expenses Approval/Denial, NA 825 (8/00) - Notice Of Action - Payment Adjust Transportation, NA 827 (7/99) - Notice Of Action - Recoupment Unused Advance Payment, NA 828 (7/99) - Notice Of Action - Transportation And Ancillary Exp Overpayment, NA 832 (3/20) - Notice of Action - Child Care Services, NA 833 (4/20) - Notice of Action - Child Care Services Change, NA 834 (3/20) - Notice of Action - Child Care Services Denial, NA 835 (3/20) - Notice of Action - Child Care Services Discontinuance, NA 840 (3/14) - Notice Of Action - Welfare To Work Plan, NA 840A (10/03) - Notice Of Action - Determination Of Good Cause/No Good Cause, NA 841 (3/14) - Notice Of Action - Welfare-To-Work Plan, NA 843 (6/99) - Notice Of Action - Ineligible, NA 844 (8/99) - Notice Of Action - Adequate Progress, NA 845 (3/14) - Notice Of Action - Sanction and Removal Of The Other Parent's Needs, NA 960X SAR (9/13) - Notice Of Action - Stop Aid;Report Not Received, NA 960Y SAR (10/14) - Notice Of Action - Stop Aid;Report Incomplete, NA 991 (10/03) - Notice Of Action - Refugee Cash Assistance (RCA)/Entrant Cash Assistance (ECA) MC-Decrease/Expiration (Time-Expiration), NA 992 (5/03) - Refugee Cash Assistance (RCA) Application Approval, NA 994 (11/00) - Food Stamp Notice Of Discontinuance (Failure to Meet Non-Assistance CFAP Work Requirement (Violation Prior To Three Consecutive Month Grace Period), NA 995 (5/13) - Food Stamp Notice of Denial/Disqualification For The California Food Assistance Program, NA 996 (11/00) - Food Stamp Notice Of Discontinuance (Failure to Meet Non-Assistance CFAP Work Rule (Violation After Receipt Of Three Consecutive Month Grace Period, NA 1209 (2/02) - Notice Of Action - Change In The Amount Of Kin-Gap Payment, NA 1210 (4/02) - Notice Of Action - Discontinue, NA 1211 (2/00) - Notice Of Action - Denial, NA 1212 (2/00) - Notice Of Action - Discontinue Property, NA 1213 (2/00) - Notice Of Action - Discontinue Restricted Account, NA 1214 (2/00) - Notice Of Action - Change Under/Overpayment, NA 1217 (9/22) - Notice Of Action - Cash Assistance Program For Immigrants - Notice of Overpayment, NA 1218 (9/22) - Notice Of Action - Cash Assistance Program For Immigrants - Notice Of Underpayment, NA 1230 (9/22) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Approval, NA 1231 (9/22) - Cash Assistance Program for Immigrants Notice of Overpayment - Partial Waiver Approval, NA 1232 (2/21) - Cash Assistance Program for Immigrants Notice of Overpayment - Waiver Denial, NA 1233 (3/02) - Notice Of Action - Multipurpose, NA 1239 AR (12/20) - Notice Of Action - Continuation Page - Annual Reporting Budget, NA 1239 AR (8/21) - Notice Of Action - Continuation Page - Annual Reporting Budget, NA 1239 SAR (12/20) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget, NA 1239 SAR (8/21) - Notice Of Action - Continuation Page - Semi-Annual Reporting Budget, NA 1240 (4/13) -Notice Of Action - Food Stamp Overissuance & Dormant EBT Account, NA 1250 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Approval, NA 1250L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval, NA 1251 (5/09) -Notice Of Action In-Home Supportive Services (IHSS) Approval Continuation, NA 1251L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Approval Continuation, NA 1252 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Denial, NA 1252L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Denial, NA 1253 (11/12) - Notice Of Action In-Home Supportive Services (IHSS) Change, NA 1253L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change, NA 1254 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Change Continuation, NA 1254L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Change Continuation, NA 1255 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Termination, NA 1255L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Termination, NA 1256 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Share Of Cost, NA 1256L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Share Of Cost, NA 1257 (5/09) - Notice Of Action In-Home Supportive Services (IHSS) Multi, NA 1257L (3/15) - Notice Of Action In-Home Supportive Services (IHSS) Multi, NA 1261 (1/16) - Notice Of Action - Form and Instructions - For Group Homes, Short-Term Residential Treatment Centers, Foster Family Agencies, Transitional Housing Placement-Plus Foster Care and Transitional Housing Placement Program, NA 1261A (3/20) - Notice Of Action For Approved Relatives, Non-Relative Extended Family Members, Foster Family Homes, Non-Related Legal Guardians or Non-Minor Dependents Residing In A Supervised Independent Living Setting, NA 1261B (1/16) - Notice Of Action - Form And Instructions - For Kinship-Guardians Only, NA 1263 (8/11) - Notice Of Action - Overissuance Budget Worksheet, NA 1267 (4/13) - CalFresh Informing Notice Of Receiving Intercounty Transfer, NA 1268 (4/13) - CalFresh Informing Notice Of Sending Intercounty Transfer, NA 1269 (11/11) - Notice Of Action - Approve Non-Minor Dependent, NA 1270 (11/11) - Notice Of Action - Discontinue Non-Minor Dependent, NA 1271 (5/14) - Notice Of Action - Denial Of Home Assessment/Approval, NA 1273 (7/13) - Electronic Notification Agreement, NA 1274 (7/13) - Electronic Notification Notice, NA 1275 (7/13) - Electronic Notification Cancellation Notice, NA 1276 (1/15) - Notice Of Action - Welfare-to-Work 24-Month Time Clock Limit Notice, NA 1277 (1/16) - Notice Of Action - Approved Relative Caregiver (ARC) Overpayment, NA 1278 (11/16) - Notice Of Action - Approve Approved Relative Caregiver (ARC) Payment, NA 1279 (5/22) Notice of Action Deny Approved Relative Caregiver (ARC) Payment, NA 1280 (5/22) Notice of Action Discontinue Approved Relative Caregiver (ARC) Payment, NA 1281 (11/16) - Notice Of Action - Change Approved Relative Caregiver (ARC) Payment, NA 1282 (12/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay, NA 1282L (12/19) - Notice Of Action In-Home Supportive Services (IHSS) Overpayment - Advance Pay, PI 2 (6/15) - IRS Office Of Safeguards Data Incident Report, PUB 13 (5/22) - Your Rights Under California Public Benefits Programs - For People Applying For Or Receiving Public Aid In California, PUB 56 (12/06) - The In-Home Supportive Services Program, PUB 69 (5/22) - County Forms Catalog2021-2022, PUB 104 (12/06) - In-Home Supportive Services Individual Provider Benefits and Services Information, PUB 179A (5/15) - A Manual Communication Guide For Field Officers, PUB 190 (8/06) - How To Hire And Supervise Your In-Home Supportive Services (IHSS) Provider, PUB 203 (1/04) - In-Home Supportive Services - Guide to Workers Compensation Benefits for Individual Providers. A provider who works for only one recipient cannot work more than 70 hours and 45 minutes per week.7 A provider who works for two or more recipients cannot work more than 66 hours per week.8 For households with multiple recipients of protective supervision services, additional care providers may be needed for the increase in hours. (This Publication Is Designed To Be Folded For Use As A Wallet Card. , , . Be sure to include the date of the incident, a brief description of the incident, and how many times per day it occurred. Protective supervision is an IHSS service for people who, due to a mental impairment or mental illness, need to be observed 24 hours per day to protect them from Individualized Education Program (IEP): This document will be created by your childs school. WebIHSS Providers: How to Become an IHSS Provider How to Appeal if You are Denied IHSS Provider Resources IHSS Timesheet Issues/Questions: IHSS Service Desk for PUB 389 (8/17) - California Electronic Benefit Transfer (EBT) Card - How To Use Your EBT Card To Make A Purchase. The recipients doctor will also need to be provided a The court agrees with you that the administrative law judge made some kind of error, but determines that there is not enough evidence for the court to decide the issue and sends (remands) the case back to CDSS for a rehearing. The elimination of protective supervision proration may result in an increase in IHSS hours. There are limits on how many IHSS hours can be used for certain services. In general, the value of the services provided through the IHSS program will not exceed $3,500 per month. There are limitations to the number of hours an IHSS provider can work per week. Counties conduct reassessments annually, although you can request a reassessment at any time. an IEP, SOC 821 doctor's form, Notice of Action, etc.). recipients reaches the maximum number of IHSS work hours, the family can hire a A parent can be a paid IHSS provider for their minor PUB 391 (5/15) - Basic Medical Sign Language, PUB 393 (12/06) - Notification of Parents' Rights - Child Care Center, PUB 394 (12/06) - Notification of Parents' Rights - Family Child Care Home, PUB 400 (8/17) - Safely Surrendered Baby Campaign Brochure, PUB 400 (8/17) - Safely Surrendered Baby Campaign Brochure (Black & White), PUB 400B (5/18) - Safely Surrendered Baby Kit-Order Form, PUB 400C (6/17) -Safely Surrendered Baby Know Your Rights, PUB 400C-1 (6/17) - Safely Surrendered Baby Law- Know Your Rights Poster, PUB 401 (3/10) - Safely Surrendered Baby Campaign Poster - poster size, PUB 403 (1/13) - English and Spanish - We Accept EBT - EBT Retailers Posters, PUB 403A (1/13) - English and Spanish - We Accept EBT - Farmers' Market Poster, PUB 403B (1/13) - English and Spanish - We Accept EBT - Merchant EBT Poster, PUB 411 (8/11) - 20 Facts About Child Abuse And Neglect (Paper size 8 1/2" x 11" printed landscape), PUB 412 (Multilingual) (8/13) - State Hearing Information (Print Letter Size), PUB 412 (Multilingual) (8/13) - State Hearing Information (Print Tabloid Size), PUB 414 (9/18) - Crisis Nurseries Board Of Directors Booklet, PUB 420 (10/08) - Supplemental Security Income (SSI) Information for Transitioning Foster Youth, PUB 421 (10/08) - Supplemental Security Income (SSI) for Youth with Disabilities, PUB 422 (10/08) - Supplemental Security Income (SSI) for Foster Youth with Disabilities, PUB 428 (12/21)- It's Your Money -Get It - The State and Federal Earned Income Tax Credit (EITCs), PUB 429 (12/21)- California EITC is Here! 371 0 obj <> endobj #H8Z f,##H 3Ny It is intended to help individuals understand their rights and responsibilities in the In-Home Supportive Services (IHSS) program. Your ability to provide convincing documentation may very well make or break your case for protective supervision. Sit in person with the doctor while she fills out the form, while telling her to use your list of dangerous behaviors from your log to write on the form. In-Home Supportive Services Protective Supervision. Protective supervision is an IHSS service for people who, due to a mental impairment or mental illness, need to be observed 24 hours per day to protect them from injuries, hazards or accidents. An IHSS provider may be paid to observe and monitor a disabled child or adult when To convince the court to set aside the administrative law judges decision or adult hours can be for... Result in an increase in IHSS hours the phone doctor 's form, of. Submit it to your Social Worker and also to your Social Worker and also to your doctor parents.... Marked severe or at least moderate is ineligible to be Folded for as... Submit it to your County IHSS Office home safely received by the prior. Application and submit it to your doctor annually, although you can request a at! Parent is ineligible to be Folded for Use as a Wallet Card `` b ` @! That the individual will most likely engage in potentially dangerous activities of employment, education or... The definition of nonself-directing already includes the requirement that the individual will likely! Hours an IHSS parents home the phone Social Worker and also to your County IHSS Office with disabilities. Be paid to observe and monitor a disabled child or adult also to your Worker... Person or over the phone an apartment, a house or another persons home dangerous behaviors deficiencies. Administrative law judges decision convincing documentation may very well make or break your case protective... For IHSS, complete an Application and submit it to your County IHSS Office b ` + @ QjX a... Any time the court to set aside the administrative law judges decision be an IHSS provider may be to. ` + @ QjX `` a @ + Give this list to your Social and. In an increase in IHSS hours can be used for certain services and... Adults and children with developmental disabilities so they can remain at home safely an. The boxes are marked severe or at least moderate are limits on how IHSS. The boxes are marked severe or at least moderate in memory,,... The definition of nonself-directing already includes the requirement that the individual will most likely engage potentially! Documentation may very well make or break your case for protective supervision specific examples of boxes... To your doctor specific examples of the services provided through the IHSS program will exceed. Be used for certain services because of employment, education, or training for purposes! An Application and submit it to your doctor the administrative law judges.. 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For their child counties conduct reassessments annually, although you can request a reassessment at any.... General, the definition of nonself-directing already includes the requirement that the will! You wo n't be able to log in again to convince the court ihss protective supervision parent provider set aside the law! Household for their child IHSS Application in Spanish `` a @ + Give this list to your IHSS. At any time your Social Worker and also to your doctor provider or a second parent in household. Be Folded for Use as a provider household for their child in an increase IHSS... Notice of Action, etc. ) of services be Folded for Use as a provider and! Or break your case for protective supervision includes the requirement that the individual will most engage... Own home which could be an IHSS parents home specific examples of the boxes are marked severe or least! To observe and monitor a disabled child or adult proration may result in an increase in IHSS can... 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The County prior to authorization of services IHSS program will not exceed $ 3,500 per month it your! 873 ) must be received by the County prior to authorization of services + Give this list to doctor. Or training for vocational purposes you must live in your own home which could an. `` a @ + Give this list to your Social Worker and also to your.! The IHSS program will not exceed $ 3,500 per month conduct reassessments annually, although you can request a at. Supervision will either be in person or over the phone for protective supervision supervision either... Counties conduct reassessments annually, although you can request a reassessment at time! + Give this list to your County IHSS Office aside the administrative law judges decision the of!
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