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Requires completion of all fields, time recorded to the nearest quarter hour using black ink, and signatures performed in black ink aligned with hours worked. Includes submission timing expectations within 30 days of service provision and outlines additional documentation to demonstrate services delivered. 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All times must be documented to the nearest quarter of an hour in black ink or typed. All signatures must be signed following the hours worked, using black ink and signatures may not be reproduced. No pencil please.  \nThe department of labor requires employers to have employees paid in accordance with the payment schedule. The program requires employees’ time sheets to be submitted within 30 days of the last date service is provided.  \n*Additional documentation required to demonstrate services provided ([hhs.iowa.gov/Providers/tools-trainings](hhs.iowa.gov/Providers/tools-trainings)and-services/CBT-for-LTSS/Archive)  \n\n| Date MM/DD/YY | Start Time AM/PM | End Time AM/PM | Total Hours Worked | Service |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nBy my signature below, I certify and attest that the services that are being submitted for payment have been delivered and received in accordance with the Member’s budget. I declare that I am eligible to receive payment through a Medicaid Program and do not appear on any Federal or State Exclusion Lists, and I do not have a criminal history that would exclude me from payment. I understand that payment of this claim maybe from the use of Federal and State funds, and that I may be prosecuted under applicable Federal or State laws, for any false claims, statements or documents or concealment of material fact. Misuse of funds may result in me being fined or penalized including but not limited to the repayment of this claim, collection costs, and legal fees. I understand that any costs incurred due to the submission of a false claim is my legal responsibility. In addition, if I am paid in error, I understand it is my responsibility to repay the funds paid tome in error. I also authorize Veridian to withdraw/withhold any overpaid funds from future payroll. Medicaid fraud is considered a crime and will be investigated and is punishable by law.  \n\n| Employee Signature: | Date: |\n| --- | --- |\n| Employer Signature: | Date: |","cbCaithMcp0qyMNB","https://ap.wps.com/l/cbCaithMcp0qyMNB","pdf",128159,"English","# Timesheet Information\n## Provider, Employee, and Required Rules\n## Time Entry Table\n# Attestation and Signatures\n## Employee Certification\n## Employer Certification","[{\"question\":\"What information must be completed on the semi-monthly timesheet?\",\"answer\":\"All fields on the timesheet must be completed, or the time sheet will be returned. Time entries and the service associated with the work must be documented.\"},{\"question\":\"How should the work times and signatures be recorded?\",\"answer\":\"All times must be documented to the nearest quarter of an hour in black ink or typed. Signatures must be signed following the hours worked, using black ink; pencil is not allowed and signatures may not be reproduced.\"},{\"question\":\"When must timesheets be submitted and what extra documentation may be required?\",\"answer\":\"Timesheets must be submitted within 30 days of the last date service is provided. Additional documentation may be required to demonstrate services provided, referencing the provided documentation resource.\"}]","Consumer Choices Option Semi-Monthly Time Sheet | PDF",1790076322]