Form Sr 2-54 - 54 Hour Limit Worksheet

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
54 HOUR LIMIT WORKSHEET
PROGRAM NAME:
AUDIT PERIOD:
EMPLOYEE NAME:
MONTH/YEAR:
WORK WEEK:
TOTAL
TOTAL
TOTAL
WEEK
WEEK
HOURS
HOURS
HOURS
START
END
WORKED
ALLOWED
DISALLOWED
TOTALS
COMMENTS: (Comments must be completed for any hours disallowed)
SR 2-54 (12/02)

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