Get Ds 1811 - Respite Services Billing Form (spanish) - Dds Ca

The DS 1811 - Respite Services Billing Form is a crucial document for families seeking reimbursement for respite services. This guide provides clear, step-by-step instructions to help you fill out this form online accurately and efficiently.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editing interface.
2. Begin by filling in the consumer's name in the designated fields labeled 'Nombre del consumidor' (first and last name). Ensure the spelling is correct.
3. Next, enter the name of the family member selling the services, filling out their first and last names under 'Nombre del familiar que vende servicios'.
4. Provide the seller's address in the 'Dirección del vendedor' section. Make sure to include street, city, and zip code accurately.
5. Fill in the seller's phone number in the specified field to ensure communication can be established if necessary.
6. Input the Unique Client Identifier (UCI) and the seller's number, which are essential for the processing of the form.
7. Record the details of the service provided, including the dates (in MM/DD format), the address where the respite services were provided (if different), and the name of the worker or agency used for the services.
8. Detail the start and end times of the service as well as the total hours worked and amount charged. Ensure these numbers are complete and accurate.
9. Complete the certification section for the worker who provided the respite services. They must fill in their name, phone number, social security number, and address.
10. If multiple workers were involved, repeat the certification process for each additional worker in the designated area.
11. Before finalizing the form, ensure all information is accurate and complete, then proceed to sign and date the certification sections as required.
12. Lastly, save changes, download, print, or share the completed form as needed, ensuring you maintain a copy for your records.

Take the next step towards completing your documents online with our detailed guidance.