Kentucky Cabinet for Health and Family Services COVID- 2026

1. Click ‘Get Form’ to open the Kentucky Cabinet for Health and Family Services COVID- form in the editor.
2. Begin by entering the Participant Name and ID # at the top of the form. This information is crucial for identifying the individual receiving services.
3. Fill in the Pay Period, Employee Name, and Employee ID #. Ensure accuracy as this will affect payroll processing.
4. For each service provided, input the Date Service Provided (MM/DD/YY), Time IN (AM/PM), and Time OUT (AM/PM). Repeat this for all services rendered during the pay period.
5. Calculate and enter SubTotals for Week 1 and Week 2, followed by Total Hours worked. This section is essential for accurate billing.
6. Complete the GROSS TOTAL AMOUNT FOR PAY PERIOD section by calculating based on hours worked and rate. Ensure all calculations are double-checked.
7. Finally, gather signatures from both the employee and participant/representative/employer to certify that all information is true and correct before submitting.

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