Attendant Data

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Message Board: This is where messages will be posted and updated.

Do You Need A Ride?

Ride Services Now Offered: Call 618-818-2108

Rides Must be Scheduled at least 72 hours (3 days) before hand.

If scheduled within 72 hours (3 days) there will be additional fees.

WARNING: DO NOT SUBMIT YOUR TIMESHEET EARLIER THAN YOUR 'END TIME'. YOU WILL NOT BE PAID FOR YOUR ENTIRE SHIFT.

Pay Stubs

Everyone is now able to view pay stubs, documents, and tax forms inside of the "my documents" area via the Employee App.

Notice: When you submit this form, it will automatically take you to the app.

Pay-Dates

Pay Dates are listed on the app in the "My Documents" area. We do not authorize direct deposits before those dates, so if you receive your pay earlier than the date listed, it is due to your financial institution.

W-2

W-2 forms will be mailed at years end. Please make sure your Tax Information is up to date. You can update your Forms on the app in the "My Documents" area.
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Employee ID Number* This field is required.NOTICE: Your Employee ID Number is your FCSR number.
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Employees First Name and Last Name* This field is required.
Employee's First Name
Employee's Last Name
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Email
example@example.com
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Client Name:* This field is required.
First Name
Last Name
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Client Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Deprecated Date of Service* This field is required.
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Date of Service* This field is required.
Date
Month
Day
Year
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Current Date
Date
Month
Day
Year
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Start Time and End Time* This field is required.
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Hour
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Minutes
AM
AM
PM
until
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Hour
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45
Minutes
AM
AM
PM
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Start Time* This field is required.
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Hour
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Minutes
AM
AM
PM
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Current Time
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Hour
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Minutes
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PM
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End Time* This field is required.
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Hour
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Minutes
AM
AM
PM
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Total Hours TodayNot Valid For Over Night Shifts
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Detected Location
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Total Number of Hours Worked Today* This field is required.Use decimals (example. 1.5, 2,3.25)
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Activities Performed* This field is required.(select all that apply)
Dressing/Grooming
Bathing
Ostomy Hygiene
Catheter Hygiene
Bowel and Bladder Routine
Assist with Toileting
Assistive Transfer Device
Passive Range of Motion
Mobility & Transfer
Medications
Turning and Postioning
Treatments
Clean and Maintain Equipment
Clean Bath
Make Bed
Change Linens
Clean Floor
Tidy and Dust
Laundry
Trash
Essential Correspondence
Meal Prep and Eating
Wash Dishes
Clean Kitchen
Essential Transportation (non medical)
Shopping and Errands
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Flag Submission for InvalidationSets a flag to invalidate and/or cancel the submission's corresponding entry in Sandata. This action cannot be reversed once executed.
YESNO
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Disable Re-submissionPrevents respondents from editing an invalidated submission. This field is set as part of an automated process (triggered by flagging the submission for invalidation) and should NOT be set manually.
YESNO
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Show Change Reason FieldShows Change Reason field. This field is set as part of an automated process (triggered by respondents editing the submission) and should NOT be set manually.
YESNO
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Change Reason
Member No Show
Member Unavailable
Member Refused Verification
Member Refused Service
Member Incapable, Designee Unavailable
Caregiver Failed to Call In - Verified Services Were Delivered
Caregiver Failed to Call Out - Verified Services Were Delivered
Caregiver Failed to Call In and Out - Verified Services Were Delivered
Caregiver Called Using an Alternate Phone
Caregiver Change
Mobile App Issue/Inoperable
Telephony Issue/Inoperable
FVV Issue/Inoperable
Service Outside the Home
Unsafe Environment
Does Not Contain Task Information
Other
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Attendant Signature * This field is required.
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Client Signature * This field is required.
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Additional Notes
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Please be sure not to submit this form until AFTER the end of your shift.* This field is required.For example, say your shift ends at 6:30 PM but you actually clocked out at 6:27 PM. Doing this will VOID your entire shift, and you will NOT be paid.
YES, I Waited until AFTER the shift to submit the timesheetNO, I understand I voided my ENTIRE SHIFT, and I WILL NOT be paid.
Should be Empty:

Pay Stubs

Pay-Dates

W-2