Important Information: Please Read Instructions
A timesheet without all this information cannot be processed. 1. General information: Enter the payroll period dates, names, and other required information on the time ... e. If you have any questions, please call the FI or your case manager for clarification before submitting the time sheet. Example: It is strongly recommended for Consumers ...
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September 9, 2021 «AddressBlock»
tempusunlimited.orgbetween the Massachusetts Executive Office of Health and Human Services and Tempus Unlimited, Inc. Protected Health Information is information that may identify the Consumer and that relates to the consumer’s past, present or future physical or mental health, and may include name, address, phone numbers and other identifying information.
“Old Consumer Number”
tempusunlimited.org600 Technology Center Drive, Stoughton, MA 02072 www.tempusunlimited.org Toll-Free Phone #: 1-877-479-7577 Toll-Free Fax #: 1-800-359-2884
September 9, 2021 «AddressBlock»
tempusunlimited.orgExecutive Office of Health and Human Services . Name of fiscal intermediary (FI) Tempus Unlimited, Inc. All PCAs hired by a PCA consumer must fill out and sign . this form and give it to their employer (the PCA consumer). The PCA’s employer (the PCA consumer) must submit this form to the FI, along with all other paperwork required by
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