Independence Timesheet Form PDF Details

In managing the provision of care, the Independence Timesheet form acts as a crucial document, outlining the hours worked by direct service workers for their clients. This form ensures that the care provided is accurately recorded and compensated, catering to services like Personal Care, Adult Companion Care, Attendant Care, Homemaker Service, and Intermittent & Skilled Nursing. It captures essential details, including the member's name, employee's name, service period, specific service codes, and the hours worked for each service provided. Notably, the form has sections for the signature of both the participant or their representative and the direct service worker, underscoring the mutual agreement on the services delivered and the hours claimed. Moreover, it emphasizes the rule that direct service workers are not supposed to exceed 40 hours of work per week, promoting fair labor practices while safeguarding the well-being of both the caregiver and the recipient. By submitting this timesheet to GT Independence, as instructed, parties ensure that the caregiving process remains transparent, accountable, and within the stipulated guidelines, facilitating a smooth operational flow that benefits all involved.

QuestionAnswer
Form NameIndependence Timesheet Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesgt independence timesheet, gt independence 2021 pay schedule, gt independence timesheets, gt payroll calendar 2021

Form Preview Example

Please note that direct service workers are NOT allowed to work more than
Signature of Participant/Representative
Signature of Direct Service Worker

 

 

 

 

 

GT Independence

 

Agency Code:______________________________

 

Self Directed Timesheet

 

Member Name:_____________________________________

 

 

Fax to GT Independence:

 

 

 

(PRINT)

 

855-329-8648

 

Employee Name:____________________________________

 

 

 

 

 

 

(PRINT)

 

 

 

 

 

Period Begin:_____________ Period End:______________

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

Service Code 1

 

 

 

Service Code 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mo/Day

 

In (am/pm) Out (am/pm)

Total Hrs

 

 

In (am/pm) Out (am/pm)

Total Hrs

Service Codes:

T1019 - Personal Care

S5135 - Adult Companion Care

S5125 - Attendant Care

S5130 - Homemaker Service

S9124 - Intermittent & Skilled Nursing

Service Code 3

In (am/pm) Out (am/pm)

Total Hrs

Totals:

This timesheet shows the correct service and the correct number of hours that I have provided care to the participant during this time period. Date:

This timesheet shows the correct service and the correct number of hours that my direct service worker has provided care to me during this time period. Date:

40 hours per week.

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So as to complete this document, make sure that you enter the required information in every field:

1. First, when filling out the gt independence service codes, begin with the part that includes the subsequent fields:

Filling out section 1 in independence self timesheet online

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this field, next field, and other fields of independence self timesheet online

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Please note that direct service, Signature of, and Totals inside independence self timesheet online

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