Flexible Support Funding

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Flexible Support Funding (FSF)
Attendance Record
(This Form must accompany the FSF Claim for Payment form)
SERVICE CCB: ___________________________
SERVICE NAME: _________________________________________________________
CHILD/REN'S NAME: _______________________________________________________________
CLAIM PERIOD: __ / __ / 20__ to __ / __ / 20__ FLEXIBLE SUPPORT FUNDED STAFF NAME/S: _________________________________________
Hours
Hours
Hours
FSF Staff
Staff
FSF Staff
Staff
FSF Staff
Staff
Date
Attended
Date
Attended
Date
Attended
Hours
Signature
Hours
Signature
Hours
Signature
By Child
By Child
By Child
I, the undersigned, being the authorised officer, submit this Attendance Record.
I declare that the information provided is correct and that the total hours claimed have been used to provide staffing above the licensing requirements
in the care environment, in accordance with the approved FSF application.
Name (authorised signatory): __________________________________
Signature (authorised signatory): _____________________________________

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