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Form preview Palco timesheet 408272834 form Www. palcofirst. com Arkansas SDSB Biweekly Timesheet Make plenty of copies of this timesheet. This is the only timesheet that will be accepted. If you make a mistake mark a single line through the mistake initial beside it and make the correction nearby. Employer Signature Date Worker Signature Timesheets are due by NOON 12 pm on the THURSDAY after the last day worked. Email To timesheets palcofirst. com Or Fax To 501-821-0045 Or Mail To Palco P. O. Box 242930 Little Rock AR 72223 For assistance please call toll free 1-866-710-0456 or local 501 604-9936 or TDD/TTY Relay Service 711. On days that the worker does not work you may leave it blank or put a 0 or X in the box. Checklist Date time in/out of hours worked each day/week Timesheet submitted after hours worked Blue or black ink Did NOT use white-out Employer worker both signed Employer Case ID Worker Service Period // through // Month TUE Homemaker Service Hours Week 1 WED THU FRI SAT SUN MON Day Year Time In am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm Time Out of hours Week Total Week 1 Total Hours Biweekly Total Homemaker Service Hours Your signature confirms that these hours were actually worked. If you sign this timesheet and the hours were not actually worked your timesheet will be sent to the Office of Medicaid Inspector General and Department of Labor for further review. Employer Signature Date Worker Signature Timesheets are due by NOON 12 pm on the THURSDAY after the last day worked. Email To timesheets palcofirst. Com Or Fax To 501-821-0045 Or Mail To Palco P. O. Box 242930 Little Rock AR 72223 For assistance please call toll free 1-866-710-0456 or local 501 604-9936 or TDD/TTY Relay Service 711. Allow up to 2 business days after payday for your financial institution to receive your funds from the Federal Reserve. Allow up to 2 business days after payday for your financial institution to receive your funds from the Federal Reserve.
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