TIME SHEET Pay Period End Date Client's Name Service Code Start Time Finish Time Total Hours CN Actions +- +- +- +- +- Service Codes (Write the Service Code, not the initials.) 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 TR –T7777 – Training REG –T8888 – Regular/OFFICE HANDY –T9999 – Handy Man/Lawns I affirm that the above is a true and correct record of the hours (services rendered) worked by me on behalf of Bright Horizon Homes LLC. Attach Signature
