Form SR2A PHV-CTF-NURSE "Ctf Nurse Paid Hours Verification Worksheet" - California

What Is Form SR2A PHV-CTF-NURSE?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2003;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SR2A PHV-CTF-NURSE by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CTF NURSE PAID HOURS VERIFICATION WORKSHEET
MONTH:
GROUP HOME:
SR 2A
VERIFIED TIME
REPORTED PAID
VERIFIED PAID
REPORTED TIME
TOTAL
AUDITED
CCS/FIRST LINE
HOURS
CARD HOURS
HOURS
HOURS
GROSS
AUDITED
CARD HOURS
HOURS
DIFF.FROM
COMMENTS *
SUPERVISOR NAME
REPORTED
WAGES
HOURLY
ALLOWED
REPORTED
1st
1st
2nd
2nd
1st
2nd
1st
2nd
PAID
RATE
SR 2A
Period
Period
Period
Period
Period
Period
Period
Period
TOTAL
*LEGEND
1.
Per Payroll Hours
2.
Per time card hours
3.
54-hour limitation
4.
Did not meet CCL requirements
5.
Minimum wage requirement
6.
No allocation between functions
Page____ of ____
SR 2A PHV-CTF-NURSE (1/03)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CTF NURSE PAID HOURS VERIFICATION WORKSHEET
MONTH:
GROUP HOME:
SR 2A
VERIFIED TIME
REPORTED PAID
VERIFIED PAID
REPORTED TIME
TOTAL
AUDITED
CCS/FIRST LINE
HOURS
CARD HOURS
HOURS
HOURS
GROSS
AUDITED
CARD HOURS
HOURS
DIFF.FROM
COMMENTS *
SUPERVISOR NAME
REPORTED
WAGES
HOURLY
ALLOWED
REPORTED
1st
1st
2nd
2nd
1st
2nd
1st
2nd
PAID
RATE
SR 2A
Period
Period
Period
Period
Period
Period
Period
Period
TOTAL
*LEGEND
1.
Per Payroll Hours
2.
Per time card hours
3.
54-hour limitation
4.
Did not meet CCL requirements
5.
Minimum wage requirement
6.
No allocation between functions
Page____ of ____
SR 2A PHV-CTF-NURSE (1/03)