IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM - PROVIDER WORKWEEK & TRAVEL TIME AGREEMENT - Form

Sep 19, 2026

IN-Home Supportive Services (IHSS) Provider Workweek & Travel Time Agreement sets limits and responsibilities for IHSS providers who serve multiple recipients. It defines the workweek from Sunday midnight through Saturday 11:59 p.m., states that the 66-hour weekly maximum does not include allowable travel time, and outlines how recipient monthly authorized hours constrain provider overtime. The form instructs providers to list recipients, case numbers, start dates, addresses, and daily/weekly service hours, and explains violation consequences from notice and training through suspension and termination.

LanguageEnglish

CategoryForms

FormatPDF

Pages7

Reading Time3 min

AccessFree to download

PROVIDER REQUIREMENTS

Workweek definition and hour limits

Recipient authorization and approved adjustments

Provider responsibilities to stay within limits

INSTRUCTIONS FOR COMPLETING THE CHART

Recipient and case information

Schedule planning columns A–F

Weekly total hours requirement

VIOLATIONS AND CONSEQUENCES

First through fourth violations

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 12300.4) 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 a. m. (midnight) and ends at 11:59 p. m. 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. You will get a notice telling you how many authorized service hours each of your recipients gets weekly and monthly. You may never work more than a recipient’s monthly authorized hours for that recipient. However, you may work more than a recipient’s weekly authorized hours in certain circumstances. A recipient may adjust his or her weekly authorized hours, but he/she must get approval from the county if the adjustment will result in either a provider working more overtime hours in the month than the provider would normally work or working over 40 hours in any workweek for him/her (when, he/she is authorized to receive 40 hours or less in services in a workweek) .
• It is your responsibility as a provider to:
• Make sure that the total combined hours you work providing authorized services for all the recipients you work for in one workweek do not total more than the 66 hours in a workweek.
• Make sure that the hours you work providing services to any one of your recipients are not more than that recipient’s weekly authorized hours, unless the hours are correctly adjusted. | | | | | SOC 2255 (3/19) Page 1 of 7 | PROVIDER NUMBER
• Make sure that if one of your recipients adjusts their weekly authorized hours to have you work more than the usual authorized amount, that you work less hours in a previous or later week to make sure you are not working more than his/her authorized monthly hours or working more overtime in the month than you normally would.
• If you submit a timesheet in which you violate the workweek schedule in any of the following ways, you will receive a violation:
• You work more than 40 hours in a workweek without county approval for a recipient if he/she is authorized 40 hours or less in a workweek;
• You work more hours for a recipient than he/she is authorized in a workweek, without county approval and it causes you to work more overtime hours in the month than you normally would;
• You work for multiple recipients and work more than the 66 hours in a workweek; You claim more than seven hours of travel time (see Part B of this agreement) .
• If you violate the workweek schedule in any of the ways described above, you will receive the following: | | | | --- | --- | --- | | First Violation | • | You and your recipient(s) will get a notice of the violation with appeal rights information. | | Second Violation | •
• | Your recipient(s) and you will get a notice of the violation, and you will have a choice to complete a one-time training about the workweek and travel time limits. If you choose to complete the training, you will avoid a second violation.
If you choose not to complete the training within 14 calendar days from the date of the notice, you will be sent a notice of your second violation with the appeal rights information. | | Third Violation | •
• | You and your recipient(s) will get a notice of th

FAQs

What is the maximum weekly workweek hour limit for IHSS providers serving multiple recipients?

Providers serving multiple recipients are limited to providing 66 hours per workweek. The limit excludes travel time as described in Part B of the agreement.

Does the workweek include travel time?

No. The maximum weekly workweek does not include travel time as described in Part B. The workweek runs from Sunday 12:00 a.m. (midnight) to 11:59 p.m. the following Saturday.

What happens if a provider violates the workweek schedule or travel time limits?

Violations trigger escalating consequences: a notice with appeal rights for the first violation; a second violation notice and an option for one-time training to avoid it; a three-month suspension for the third violation; and termination for one year for the fourth violation.

Sep 19, 2026

Upload by Aria Callaghan