Form 4122 PDF Details

Are you familiar with the form 4122? If not, you should be. This important document can help you save money on your taxes. Here's a brief overview of what the form is and how it can benefit you. The form 4122 is used to claim certain tax credits that are available to taxpayers. These credits can include the earned income credit, the child tax credit, and the American Opportunity Tax Credit. If you qualify for any of these credits, using the form 4122 to claim them can save you money on your taxes. So if you're looking for ways to reduce your tax bill this year, be sure to check out the form 4122. You may be surprised at just how much money you can save!

Form NameForm 4122
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namestexas department of aging and disabilty services form 4122 april 2014 e, department of aging form 4122, form 4120 dads, form 4122 april 2014 e

Form Preview Example

Texas Department of Aging

Form 4122

and Disability Services

February 2012

Home and Community-based Services

Foster/Companion Service Delivery Log

Individual Name (First, Last)


Local Case No./CARE ID

Week Of

At the end of the day, mark (initial or check) all items that you completed with the individual. If there were any incidents, concerns or special events, document on the bottom of the form.









Activities of Daily Living



Personal Hygiene


Meal Planning

Meal Preparation



Develop and Improve Independent Living Skills

Community Integration

Develop Socially Valued Behaviors

Use of Natural Supports

Participation in Leisure Activities

IP Skill Development

Assisting With

Ambulation and Mobility

Administration of Medication

Reinforcing Specialized Therapies


Supervising Safety and Security

Monitoring Health

Monitoring Personal Hygiene

Not in Home (comments required)

Temporary Discharge

Active on Leave

Foster/Companion Initials




Foster/Companion Printed Name

Foster/Companion Staff Signature

Staff ID No.

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It will be an easy task to complete the pdf using this detailed guide! Here is what you should do:

1. It is critical to complete the department of aging form 4122 accurately, thus take care when filling out the sections comprising these blanks:

Filling out section 1 in form 4122 april 2014 e

2. Once your current task is complete, take the next step – fill out all of these fields - Assisting With, Ambulation and Mobility, Administration of Medication, Reinforcing Specialized Therapies, Transportation, Supervising Safety and Security, Monitoring Health, Monitoring Personal Hygiene, Not in Home comments required, Temporary Discharge, Active on Leave, FosterCompanion Initials, Date, Initials, and Comments with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Completing part 2 of form 4122 april 2014 e

3. Your next part is easy - complete every one of the form fields in FosterCompanion Printed Name, FosterCompanion Staff Signature, and Staff ID No to finish this segment.

Filling in section 3 in form 4122 april 2014 e

Those who use this PDF often get some things incorrect when completing FosterCompanion Printed Name in this area. Be sure you re-examine what you type in right here.

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