IHSS SPECIAL TRANSACTION TIME SHEET RECIPIENT NUMBER PROVIDER NUMBER

INTENDENCIA MUNICIPAL DE MONTEVIDEO UNIDAD ESPECIAL
MAESTRÍA EN DERECHO EMPRESARIAL (MADE) Y ESPECIALIZACIÓN
16 OBSERVATIONS ON ESTATE PLANNING (WITH SPECIAL

17 ADPIC LICENCIAS OBLIGATORIAS ESPECIALES PARA LA
2 REUNIÓN ESPECIALIZADA DEL CIDI OEASER WII4
2 SESIÓN ESPECIAL DE LA COMISIÓN DE

IHSS SPECIAL TRANSACTION TIME SHEET


RECIPIENT NUMBER: PROVIDER NUMBER:


Last Name


First

Ml

Last Name


First

MI











Address

Address

City

State

Zip

City


State

Zip









You are authorized: Hours for this SPEC transaction for the Month of:



DAY

1

2

3

4

5

6

7

8

HOURS/MINS















 

 

DAY

9

10

11

12

13

14

15

 

HOURS/MINS

 

 

 

 

 

 

 

 

 

 

 

 

 

 


WE AFFIRM THAT THIS TIMESHEET IS A TRUE AND CORRECT STATEMENT OF TIME WORKED THE IHSS PROGRAM AND THE SHARE OF COST LIABILITY ________

FOR THE PERIOD HAS BEEN MET (SIGN ONLY AFTER WORK HAS BEEN COMPLETED).


AFIRMAMOS QUE ESTE 1-IORARJO ES CUENTA CORRECTA DE 1-IORAS TRABAJADAS BAJO EL PROGRAMA DE II-ISS Y QUE LA PARTE DEL COSTO QUE PAGAMOS

NOSOTROS POR ESTE PERIODO Y A ESTA PAGADA (FIRME SOLAMENTE CUANDO EL TRABAJO ESTE COMPLETADO) IHSS SPECIAL TRANSACTION TIME SHEET RECIPIENT NUMBER PROVIDER NUMBER RECIPIENT SIGNATURE: DATE: PROVIDER SIGNATURE: DATE:


X X______________________________________

_________________________________________________________________________________________________________________


IHSS SPECIAL TRANSACTION TIME SHEET


RECIPIENT NUMBER: PROVIDER NUMBER:


Last Name


First

Ml

Last Name


First

MI











Address

Address

City

State

Zip

City


State

Zip









You are authorized: Hours for this SPEC transaction for the Month of:



DAY

16

17

18

19

20

21

22

23

HOURS/MINS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAY

24

25

26

27

28

29

30

31

HOURS/MINS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


WE AFFIRM THAT THIS TIMESHEET IS A TRUE AND CORRECT STATEMENT OF TIME WORKED THE IHSS PROGRAM AND THE SHARE OF COST LIABILITY ________

FOR THE PERIOD HAS BEEN MET (SIGN ONLY AFTER WORK HAS BEEN COMPLETED).


AFIRMAMOS QUE ESTE 1-IORARJO ES CUENTA CORRECTA DE 1-IORAS TRABAJADAS BAJO EL PROGRAMA DE II-ISS Y QUE LA PARTE DEL COSTO QUE PAGAMOS

NOSOTROS POR ESTE PERIODO Y A ESTA PAGADA (FIRME SOLAMENTE CUANDO EL TRABAJO ESTE COMPLETADO) IHSS SPECIAL TRANSACTION TIME SHEET RECIPIENT NUMBER PROVIDER NUMBER RECIPIENT SIGNATURE: DATE: PROVIDER SIGNATURE: DATE:


X X ____________________________________


3 ECAC25(SP)WP2 TWENTYFIFTH PLENARY SESSION (SPECIAL) OF
3 ORGANIZACIÓN METEOROLÓGICA MUNDIAL ORGANISMO ESPECIALIZADO DE
CLI SPECIAL DIRECTIVES PRINT CLI VERSION


Tags: number, recipient, special, sheet, provider, transaction