Pay Period

Date Client’s Name Service Code Start Time Finish Time Total Hours

I affirm that the above is a true and correct record of the hours worked by me on behalf of Bright Horizon Homes.

Service Codes

DH –T2021 => Day Habilitation
SL – T2017 => Supported Living
IH – T2017U4 => In Home Support
HR – S5150 => Hourly Respite
DR – S5151 => Daily Respite
SE – T2019 => Supported Employment
GH – T2016 => Group Home
REG - R8888 => Regular Hours
OFF - O9999 => Office Hours
TRA - T7777 => Training Hours

Security code