Form Sr 2b Phv - Sw Paid Hours Verification Worksheet
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
SW PAID HOURS VERIFICATION WORKSHEET
MONTH:
GROUP HOME:
SR 2B
REPORTED TIME CARD
VERIFIED TIME CARD
REPORTED PAID
VERIFIED PAID
AUDITED
SOCIAL WORKERS
HOURS
HOURS
HOURS
HOURS
HOURS
GROSS
AUDITED
TOTAL
DIFF.FROM
COMMENTS *
REPORTED
WAGES
HOURLY
HOURS
NAME
REPORTED
1st
1st
2nd
2nd
1st
2nd
1st
2nd
PAID
RATE
ALLOWED
SR 2B
Period
Period
Period
Period
Period
Period
Period
Period
TOTAL
*LEGEND
1.
Per Payroll Hours
2.
Per time card hours
3.
Did not meet CCL requirements
4.
Per SW billings
5.
No allocation between functions
6.
No payment for services
Page____ of ____
SR 2B PHV (6/03)
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