ENTER DATE FOR WEEK OF: RED CDPAS WEEKLY TIME SHEET #2 *This Time Sheet should ONLY be used if the Consumer’s = i caer: ‘MLTC Contract Authorization is Sunday thru Saturday Sunday: to Saturday | ___ PRINT CONSUMER’S NAME. oH | PRINT PERSONAL ASSISTANTS NAME Dt | PRINT Name of Consumer's MLTC Contract c aa FILL IN BELOW FOR ACTUAL HOURS WORKED Day Date ‘Time-In ‘Time-Out Hours Personal Assistant’s Consumer's Signature ~~" AuorPM | CheckaMer?n | Worked Signature (Must sgn every day PA has workes) SUN am OAM opm orm MON oam am orm opm TOES Dam OAM orm apm WED OAM OAM : orm orm ae THUR OAM am — Qe | orm ERI DAM OAM | Bie orm ___om| Hi SAT Qam gam \ Ee orm ____pem i TOTAL WEEKLY HOURS WORKED |__| *No Overtime permitted without special authorization, PERSONAL ASSISTANT ACKNOWLEDGEMENT By signing tis time sheet, T am attesting tothe truth atid accuracy thatthe hous above are the actual hours worked and have beh, propdlycestied oye the ‘Consumer/Designated Representative, LIVE-IN: If] am working on a Live-in case, I am attesting that I received $ hours of uninternipted sleep'and 3 hours of meal times. In the event I am-unable to receive required time off, I have been instructed to immediately call the Recco office, Please Note: Te deadline for submitting timesheets is Tuesday by 2pm. Any timesheets received later will be paid the following week. REMEMBER: A new timesheet must be started every SUNDAY. Please mail the Time Sheet for the previous week to: Receo Home Care Service, Inc., PO Box 100, Massapequa, NY 11758. WHITE & YELLOW: SEND TO OFFICE PINK: CONSUMER'S. COPY BLUE: ASSISTANTS COPY