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N*: Hourly wage*: Employer s first and last name*: Pay period from: Date* Start Time* 470-4429 (Rev. 4/08) End Time* Start Time* End Time* Total Hours Worked* Rate of Pay* 1 SERVICE PROVIDED AND NARRATIVE* Services provided must match service on the individual budget. Please identify in the narrative if hours worked are from the emergency back up plan or from savings. (Use more than one line if needed.) Note any progress/changes for consumer. Iowa Department of Human Services *.

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How to use or fill out the Consumer Choice Options online

Filling out the Consumer Choice Options online can seem daunting, but with a clear understanding of each component, the process becomes straightforward. This guide will walk you through the necessary steps to complete the time sheet efficiently and accurately.

Follow the steps to successfully complete the Consumer Choice Options form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the employer or Medicaid number in the specified field. This number is crucial for identifying the funding source for the services provided.
  3. Fill out the employee's name in the designated section. Ensure that you provide the complete name as it appears in official documents.
  4. Input the social security number for the employee. This is a necessary field to verify the individual's identity.
  5. Next, enter the position of the employee. Clearly indicate the role they are performing to prevent any confusion later.
  6. Provide the hourly wage of the employee in the corresponding section. This amount should reflect their agreed pay rate.
  7. Input the employer’s first and last name in the designated space. This information is essential for accountability.
  8. Indicate the pay period by entering the start and end dates. Accurate dates are necessary for processing payment.
  9. Document the start and end times for each service provided. Make sure to enter these times accurately to the nearest quarter hour.
  10. In the total hours worked section, calculate the total hours the employee has worked during the pay period. This should match the documented start and end times.
  11. Provide a narrative of the services rendered. Specify if the hours are from the emergency back-up plan or savings and note any progress or changes regarding the consumer.
  12. Both the employee and employer must sign the form in the designated areas, along with the dates of signing. This step ensures all parties recognize and agree to the information provided.
  13. Finally, review the completed form for accuracy. Once confirmed, you may save changes, download, print, or share the form as necessary.

Start filling out your documents online today to ensure timely processing and payment.

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Contact support

For more information on the Consumer Choices Option (CCO) program, please visit the Veridian CCO website at https://.veridianfiscalsolutions.org/cco or email us at ccoiowa@veridiancu.org. You can also call us at (866) CCO-IOWA or (319) CCO-IOWA.

The Consumer Choices Option (CCO) is an option that is available under the Home- and Community-Based Services (HCBS) waivers that gives you control over a targeted amount of Medicaid dollars so that you can develop a plan to meet your needs by directly hiring employees and/or purchasing other goods and services.

Most Iowa Medicaid members are enrolled in the IA Health Link managed care program. MKSN members receive coverage from the IA Health Link program. This program gives you health coverage through a Managed Care Organization (MCO) that you get to choose.

Members that are eligible for both Medicare and Iowa Medicaid are required to be enrolled with a Medicare Part D plan. Your Medicare Part D plan is now responsible for your prescription drugs.

Members should call Iowa Medicaid Member Services for help at 1-800-338-8366 or locally in the Des Moines area at 515-256-4606.

Medicaid is a state-federal funded program that is administered by the Department of Human Services of the State of Iowa.

the range of competing products and services from which a consumer can choose.

Consumer Choices Option (CCO) is an Iowa Medicaid program for Iowans with disabilities and aging Iowans. CCO allows individuals on Home and Community Based Services (HCBS) waivers more flexibility over how their services are provided.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232