Get Tx Form 4117 2012

Filling out the TX Form 4117 online is a straightforward process that ensures accurate tracking of services provided through home and community-based services. This guide will help you navigate through each section of the form effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the individual’s name in the designated 'Individual Name' section, where you will need to provide both the first and last name.
3. Next, input the 'Date of Service' in the format mm/dd/yy to document when the service was provided.
4. In the 'Local Case No./CARE ID' field, enter the unique identification number associated with the individual’s case.
5. Input the 'Begin Time' and 'End Time' of the service in the corresponding sections, being sure to select a.m. or p.m. as appropriate.
6. Calculate the 'Total Time' spent providing the service and fill this in.
7. Next, indicate your role in the individual's employment support services by marking (initialing or checking) all applicable areas of assistance that you provided, such as Employment Skills Training or Monitoring for Desired Behaviors.
8. In the 'Comments' section, provide any relevant details regarding special events or occurrences during the service.
9. Finally, sign off with your initials and staff ID along with the 'Employee Signature' to validate the information recorded.
10. Review the completed form for accuracy before proceeding to save changes, download, print, or share your form as needed.

Start filling out your TX Form 4117 online today for seamless service tracking!