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Get Tx Dads 1745 2014-2024

Name Pay Period Employer Name Service Type Service Provider Name PAS Service Date Time In (AM or PM) Time Out (AM or PM) Time In (AM or PM) Time Out (AM or PM) SHL Total Hours Respite Community Support Place of Service Residential Habilitation Other Written Narrative Continue narrative on next page, if needed. Total Hours The employer cannot submit a time sheet to the Financial Management Services Agency (FMSA) for time worked by the employee while the individual was in the hospi.

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