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DR 296A - California Department of Rehabilitation - rehab cahwnet 2026
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- Click ‘Get Form’ to open the DR 296A in the editor.
- Begin by entering the 'Service Month/Year' in the designated field, indicating when you provided services.
- Fill in your 'Provider Name' and the 'Consumer Name' as per the details on the DR 297B form.
- Input the 'Counselor Name' who referred you to the consumer, also found on the DR 297B form.
- Specify the 'Authorized Dates of Service', which should reflect your approved service timeframe from the DR 297B.
- Record each date you provided services, along with corresponding times and hours worked using quarter increments.
- Describe the services rendered in detail, ensuring clarity for reimbursement purposes.
- If applicable, enter transportation costs including total miles and any other expenses like tolls or parking.
- Finally, sign your name in blue or black ink before saving and submitting your completed form.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2013 | 4.8 Satisfied (270 Votes) |
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CALIFORNIA. California Dept of Rehab. Deaf and HH Services. 2000 Evergreen Street. Sacramento, California 95815. Voice: 916-263-8938. TTY: 916-263-7481. Fax:
The federal Voting Accessibility for the Elderly and Handicapped Act requires polling place access for senior voters and voters with disabilities. California