Follow the steps to complete the application process

1. Use the 'Get Form' button to download the form and access it in the appropriate online editor.
2. Begin by filling out the provider information section. Enter the provider's name (last, first, and middle initial), followed by the provider number. Check if the provider has an active IHSS/WPCS exemption in place on another case.
3. Proceed to the WPCS participant information section. Provide the participant's name, date of birth or age, and their Client Index Number (CIN). Specify the waiver care agency associated with the participant.
4. Indicate the number of exemptions previously granted for this case. Specify the number of IHSS only providers and their authorized hours, as well as the number of WPCS only providers and their authorized hours.
5. Complete the section detailing the total number of IHSS/WPCS providers and the overall total number of providers involved in the care process.
6. Ensure to work closely with the Waiver Agency Care Management Team to gather the necessary documentation that supports the request for an overtime exemption.
7. Answer all the questions regarding exemption requirements for both waiver participants enrolled on or before January 31, 2016, and those enrolled after this date. Provide details as needed.
8. Carefully review all filled sections for completeness and accuracy before proceeding to the certification section. Ensure all signatures are provided where necessary.
9. Once the form is fully completed, you may choose to save changes, download the form for your records, print it out, or securely share it with your Waiver Agency.

Start your application process for the CA DHCS 2279 form online today!