Form Il488 2261 PDF Details

The IL488 2261 form, integral to the operations of the State of Illinois Department of Human Services - Division of Rehabilitation Services, serves as a crucial document for individual providers within the Home Services Program. It meticulously tracks the time spent by providers traveling from one customer to another, thereby ensuring that compensation for travel time is accurately recorded and fairly compensated. The form requires detailed information, such as the provider's name, Santrax ID, customer details, travel time, and total minutes spent in transit. Furthermore, its design facilitates a straightforward process for logging visits on specific dates, positioning itself as an essential tool for both administrative efficiency and accountability. The certification section at the bottom underscores the serious commitment to honesty, emphasizing the legal implications of falsifying information. Not just a simple ledger, the IL488 2261 embodies a binding agreement between individual providers and the state's commitment to uphold the principles of integrity and justice within the framework of its Home Services Program. Its existence reflects an organized attempt to manage and compensate for the often overlooked aspect of travel time, highlighting the broader efforts to deliver equitable working conditions for those providing critical services across communities.

QuestionAnswer
Form NameForm Il488 2261
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesRehabilitation, Certification, certify, dhs timesheet

Form Preview Example

State of Illinois

Department of Human Services - Division of Rehabilitation Services

Home Services Program Travel Time Sheet

Individual Provider Name:

 

 

 

 

 

 

 

Santrax ID:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM CUSTOMER

 

 

TO CUSTOMER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

Name (Last, First)

 

Case #

Time (AM/PM)

Name (Last, First)

 

 

Case #

 

Time (AM/PM) Travel (minutes)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Travel (minutes):

INDIVIDUAL PROVIDER CERTIFICATION

I certify that the above information is true and in accordance with the Home Services Program Travel Agreement. I understand that falsification of any information submitted on this form could lead to criminal prosecution.

Individual Provider Signature:

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IL488-2261 (N-12-14) Home Services Program Travel Time Sheet Printed by the Authority of the State of Illinois -0- copies

 

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Part # 1 of filling in Santrax

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Stage no. 2 of filling in Santrax

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