Attn: KS WORK United Public Partnerships, LLC Toll Free Numbers Instructions for Kansas WORK Phone: Paper Timesheet Fax: PPL Paper Timesheett

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Attn: KS WORK United Public Partnerships, LLC 1 Cabot Road, Suite 102 Medford, MA 02155 Toll Free Numbers Phone: 1-877-908-1747 Paper Timesheet Fax: 1-855-617-9658 Instructions for Kansas WORK PPL Paper Timesheet Whether you have used other paper timesheets or not, you may be wondering, How in the world am I supposed to fill out this timesheet? This worksheet should provide you with clear instructions for doing so. First, just a little overview of the payroll process: PPL processes payroll on a twice monthly pay schedule. Payments for all properly completed timesheets that are submitted on time and are within available authorizations are disbursed according to the program payment schedule. PPL accepts timesheets by fax, by mail, or online. There are many benefits to submitting timesheets online through PPL s Web Portal including immediate confirmation of whether there are any issues with the timesheet. If you would like to learn about online timesheet submission through the PPL Web Portal, please contact PPL customer service at 877-908-1747. Instructions for Mail or Fax: Timesheets are read by a machine (like the ones that read standardized tests) so it is important that you fill out the timesheets clearly and completely. Black ink is best. There are 18 required fields. They are shown below and described on the next page. 1 4 2 3 6 7 5 8 9 12 10 11 13 14 15 16 18 17

Instructions for Kansas WORK PPL Paper Timesheet Page 2 Required Fields All of these fields MUST be completed for the timesheet to be paid. This list corresponds to the picture on the previous page. 1. Provider s Name. Enter the name of the Personal Assistant (PA) providing services (last name first). 2. Provider ID. This is the ID given to the PA by PPL. It begins with the letter E followed by 6 numbers. For example, E000321. The E has already been filled in for you. 3. Participant s Name. Enter the name of the person receiving services (last name first). 4. Participant ID. This is the ID given to the participant by PPL. It begins with the letter C followed by 6 numbers. For example, C000123. The C has already been filled in for you. 5. Service Type. There are four possible services PAs can be paid for through the WORK program. Fill in the circle for the service type worked during this pay period. IMPORTANT!! If the PA works more than one service per pay period, more than one timesheet will need to be submitted. Only one service code may be entered on one timesheet. For example, if a PA works 5 hours of Activities of Daily Living and 2 of Employment Related Support, they will need to submit one timesheet for the 5 hours of Daily Activities and one timesheet for 2 hours of Employment Related services. Here is a key for the four possible services: Service Name Activities of Daily Living Instrumental Activities of Daily Living Employment Related Support Sick or Vacation Leave Listed on the Paper Timesheet as Daily Living Activities Instrumental Activities Employment Related Sick or Vacation Leave 6. Year. Fill in the boxes with the last two digits of the year in which you are working. Example: for 2013, enter 13 (the first two digits of the year have been completed for you). 7. Month. Fill in the two digits of the month in which you are working. Example: for June, enter 06 8. Pay Period. This is the period of time that will be covered on a single paycheck. Fill in the circle for either the 1 st pay period (1 st - 15 th ) or the 2 nd pay period (16 th - end) of the month. Please note: you must fill in the circle completely. An x or a check mark will not be accepted. 9. Day of Month. You must fill in the day of the month according to the pay period. If it is for the first pay period simply fill in numbers 1 through 15. If the timesheet is for the 2 nd pay period fill in numbers 16-31 for months with 31 days or through the 28 th or 30 th depending on the number of days in the month.

Instructions for Kansas WORK PPL Paper Timesheet Page 3 10. Time IN (HH:MM). Enter the time of day the Personal Assistant begins working a shift. Please make sure to include whether the services began in the AM or PM. 11. Time OUT (HH:MM). Enter the time of day the Personal Assistant ends working a shift. Please make sure to include whether the services end in the AM or PM. 12. Additional Time IN and Time OUT: If a Personal Assistant works more than one shift a day, enter the addition Times IN and Times out in these extra boxes. These boxes are only required if the provider works more than one shift in one day. For example: If Sally works from 9 AM to 12:30 PM and then begins work again at night from 4PM to 6PM her timesheet would look like this for this day worked: 13. Sub Total of Hours per Day(HH:MM). Add up the daily totals of hours/minutes worked and enter total time worked (see total hours column above for Sally). 14. Sub Total of Hours per Timesheet (HH:MM). Add up the total time worked on this timesheet and enter in this box. Check your math: the timesheet reader will check the total entered in this box against the sum of your daily hours for that service. 15. Date of Provider Signature. Enter the date the Personal Assistant signed the timesheet. This date must be on or after the final date billed on the timesheet. 16. Provider Signature. This is the signature of the Personal Assistant. 17. Date of Employer Signature. Enter the date that the participant/employer or Authorized Representative signed the timesheet. This date must be on or after the final date billed on the timesheet. 18. Employer Signature. This is the participant/employer or Authorized Representative s signature. Important Tips for Completing Timesheets Fill in the timesheet clearly. Remember, it is being read by a machine. If your timesheet cannot be read properly, your payment may be delayed. Fill in all the required fields. You will not be paid unless all of the required fields are filled in. Do not use lightly colored ink. The machine has trouble reading light colors. Black ink is best. Do not cross out information. The machine will not read it. Use a new timesheet. Employees must record exact time worked on timesheets. Employees should not round any time on their timesheets. PPL automatically rounds payments for each shift of each service provided to the nearest 15-minute increment. If a shift is longer than 15 minutes, PPL pays for all full 15-minute periods and then rounds any remainder minutes.

o Any shifts that are 7 minutes or less will round down to zero minutes. The PA will not be paid for this shift o Any shifts that are 8 minutes or more will round up to 15 minutes. The PA will be paid for a full 15 minute shift Personal assistants may not work more than 40 hours in a work-week for a participant/employer. A work-week runs Monday through the following Sunday, and may overlap more than one timesheet/pay period. If more than 40 hours are submitted for a work-week, only 40 will be paid and the rest will be denied. Note for Participants/Employers: Use separate timesheets for different Personal Assistants (PAs). If you work with more than one PA, make sure you use separate timesheets for each PA. Note for Personal Assistants: Use separate timesheets for different participant/employers. If you work for more than one participant/employer, make sure you use separate timesheets for each.

Instructions for Kansas WORK PPL Paper Timesheet Page 4 Obtaining Copies of Timesheets You can make photocopies of the paper timesheet we ve given you. However, please make sure they are clear copies, are full-size and not tilted, or our machine will not be able to read them properly. OR You can download and print-out additional copies of the timesheet by going to www.publicpartnerships.com. Click on Program Login in the upper-right hand corner of the screen, choose Kansas, and click on UnitedHealth Care link. Username: To submit your timesheet, you may fax or mail them to PPL. Do not e-mail your timesheet. Fax Paper Timesheets to: Mail Paper Timesheets to: 1-855-617-9658 OR Attn: KS WORK United Public Partnerships, LLC 1 Cabot Road, Suite 102 Medford, MA 02155 PPL Web Portal Timesheet Submission Option: If you would like to submit your timesheet online through the PPL Web Portal, please go to www.publicpartnerships.com and login using the username and password above to access instructions, or contact PPL customer service at 1-877-908-1747. We encourage you to use this as the preferred method of submitting timesheets.