Supported Employment/Employment Assistance Service Delivery Log. Form 4117-2025

See details

4.2 out of 5

42 votes

The document is a service delivery log (Form 4117) for Home and Community-based Services in Texas, specifically focusing on Supported Employment and Employment Assistance. It includes sections for recording individual client information, service dates, times, locations, types of assistance provided, staff initials, and comments regarding special events or occurrences.

Here's how it works

01. Edit your service delivery form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Supported Employment/Employment Assistance Service Delivery Log. Form 4117 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering the individual's name in the 'Individual Name' field, ensuring you include both first and last names.
Next, input the 'Date of Service' using the mm/dd/yy format for clarity.
Fill in the 'Local Case No./CARE ID' to identify the case associated with this service log.
Record the 'Begin Time' and 'End Time' for each service session, selecting a.m. or p.m. as appropriate.
Calculate and enter the 'Total Time' spent on services provided during that session.
In the 'Location' section, specify where the assistance was provided.
Mark all relevant areas of assistance by checking or initialing next to options like Employment Skills Training or Support and Intervention.
Use the 'Comments' section to note any special events or occurrences during service delivery.
Finally, ensure all staff initials and signatures are completed at the bottom of the form for verification.

Start filling out your Supported Employment/Employment Assistance Service Delivery Log today for free using our platform!

See more Supported Employment/Employment Assistance Service Delivery Log. Form 4117 versions

We've got more versions of the Supported Employment/Employment Assistance Service Delivery Log. Form 4117 form. Select the right Supported Employment/Employment Assistance Service Delivery Log. Form 4117 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (67 Votes)
2012	4.2 Satisfied (42 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What do I need to sign my Supported Employment/Employment Assistance Service Delivery Log. Form 4117 electronically?

Electronic document signing demands a software solution that works in compliance with data security and eSignature standards. DocHub is an excellent tool for that, because it fulfills all the above mentioned requirements. Whatever method you prefer to sign your Supported Employment/Employment Assistance Service Delivery Log. Form 4117 in DocHub, your eSignature will be legally binding and court-admissible.

How do you get Supported Employment/Employment Assistance Service Delivery Log. Form 4117 for my state?

If you are searching for a state-specific Supported Employment/Employment Assistance Service Delivery Log. Form 4117 sample, you can find it in our DocHub Forms & Templates catalog. Use the search field, enter your form’s name, and search through the results for your state. You may also filter out irrelevant results while exploring our catalog by groups.