Dd form 3054-2026

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4.9 out of 5

45 votes

The document is a service delivery record form from the Texas Department of Aging and Disability Services, specifically for Primary Home Care. It includes sections for recording employee details, individual client information, assigned tasks (such as bathing, meal preparation, and grooming), scheduled hours, and a record of time worked. The form emphasizes the importance of accurate billing to prevent fraud and requires signatures from both the employee and timekeeper to certify the accuracy of recorded hours and tasks.

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Click ‘Get Form’ to open the dd form 3054 in the editor.
Begin by entering the Month and Year of Service at the top of the form. This sets the context for your service delivery record.
Fill in the Contract Number, Employee Name/No., and Individual Name along with their ID No. These details are crucial for identifying the service provider and recipient.
In the Task(s) Assigned section, check all applicable tasks such as Bathing, Meal Preparation, or Cleaning. If there are additional tasks, specify them in the 'Other' field.
Record Scheduled or Authorized Hours for each day of the week. Input 'In' and 'Out' times accurately to ensure proper billing.
Complete the Record of Time section by detailing Time in and Time out for each day of the month. Ensure that totals are calculated correctly.
Finally, both Employee and Timekeeper must sign to certify that hours worked and tasks completed are accurate before submitting.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (58 Votes)
2012	4.9 Satisfied (45 Votes)
2009	4.2 Satisfied (47 Votes)

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