FLSA Forms 

Starting February 1, 2016 IHSS  providers will be paid overtime at a rate of one and a half times their regular hourly pay rate for  hours worked over 40 in a workweek, not to exceed 66 hours.

The following documents were sent to recipients and providers explaining the new rules.

1.    Consumer’s-(Recipient’s)

TEMP 3002 – Recipient Important Information

SOC 2271A – Recipient Notice of Maximum Weekly Hours – Informs recipient of his/hers   weekly maximum hours.

SOC 2256 – Recipient and Provider Workweek Agreement – To be completed by recipients to agree on a workweek assignment. (3 pages) To be mailed to the IHSS office.


2.     Provider’s

TEMP 3001 – Provider Important Information

  SOC 846 – Provider Enrollment Agreement –  Provider Agreement includes Overtime and Maximum hours policy   * DUE BY APRIL 29, 2017 to the Consumer’s IHSS office

In the case where the provider has not yet been assigned to a Recipient case, the return address will be the DOJ County address.

SOC 2271 – Provider Notification of Recipient Authorized  Hours and Services and Maximum Weekly Hours

SOC 2255 – Provider Workweek and Travel Time Agreement (if applicable) 

This is completed by Providers serving multiple  IHSS Recipients. Return to recipient IHSS office (7 PAGES)






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