In-Home Supportive Services Provider Information
ƒ Two pay periods per month
o 1
st – 15th
o 16th – end of month
ƒ Timesheets are due on or after the last day worked in the
pay period. Timesheets submitted before the last day
worked will be returned.
ƒ Please see sample timesheet on the next page.
ƒ Rate of pay – $10.40 per hour
ƒ Pay stubs – keep for your records
ƒ Attached timesheet – use for next pay period
ƒ You will receive your paycheck approximately 10 days after
the Payroll department received your timesheet
ƒ Information regarding the issuance of your paycheck will be
available after the 10-day payroll processing period
Payroll Office
ƒ Monday – Friday, 9:00 a.m. – 4:00 p.m.
o 9750 Business Park Drive
ƒ Due to staff availability, walk-ins will be seen from 9:00
a.m. – 4:00 p.m. Monday – Friday and may be subject to a
considerable wait
Phone number
ƒ (916) 874-9805 (Payroll Help Desk)
ƒ To talk with Payroll staff, call between 9:00 a.m. – 4:00
p.m. Monday – Friday
Updating your
ƒ Write name, address, and/or telephone number changes or
corrections on your timesheet, complete an Address Change
Request form at our office, or
ƒ Call the Payroll Help Desk at 874-9805 with any additional
Other services
ƒ Initial and replacement timesheets
ƒ W-4 form
ƒ Wage Verifications
In-Home Supportive Services Payroll Unit
9750 Business Park Drive, Sacramento, CA 95827 (916) 874-9805
SAS160 (Revised 09/10) The timesheet must be completed with the hours you worked and returned to the County IHSS
address listed below.
La hoja de horas trabajadas tiene que ser completada con las horas que usted trabajo y debe ser
regresada a la direccion del condado para IHSS.
IHSS Timesheet
Recipient Number 34-12345678
Roger Recipient
Address Change Yes ( ) Write new address on reverse side
Provider Number 123456
Paul Provider
Address Change Yes ( ) Write new address on reverse side
Total available
hours to be
Day of Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Hours Worked
Fill in hours for each day worked and place total here
Liene las horas para cada dia que trabajo y apunte el
total aqui
Share of Cost Liability $ 0.00 Other Liability Provider Overpayment
“Do not sign unless you have read and understand instructions above.”
“No firme hasta que haya leido y entendido las instrucciones al dorso.”
Recipient Signature Date
Provider Signature Date
Sacramento County DHHS
P.O.Box 269131
Sacramento, CA 95826
After work has been completed, sign, date and mail to this
Una vez que se haya completado el trabajo, fimese y envieses a
esta direccion.
This is to certify that the information contained in this form is true, accurate and complete, and that the provider and recipient have read, understand and agree to be bound by and comply with the
statements, affirmations and conditions contained on the back of this form.
Por medio de la presente certifico que la informacion que contiene esta forma es verdadera, correcta y completa, y que el proveedor y la persona que recibe los beneficios han leido, entienden y estan
de acuerdo en someterse a, y cumplir con las deciaraciones, afirmaciones y condiciones que contiene el dorso de esta forma.
SOC 361 IR (1/98) State of California—Health and Welfare Agency—Department of Social Services
In-Home Supportive Services Payroll Unit
9750 Business Park Drive, Sacramento, CA 95827 (916) 874-9805
SAS160 (Revised 09/10)
Write your daily
hours worked here
The recipient is
responsible for
paying you this
IHSS Payroll
mailing address
Don’t forget
your timesheet
must be signed
and dated.
Please make sure that all information is correct!
Write the number of hours you work each day in the “Hours Worked” boxes.
Minutes worked should be written in decimal form. See chart below:
6 minutes = .1 24 minutes = .4 42 minutes = .7
12 minutes = .2 30 minutes = .5 48 minutes = .8
18 minutes = .3 36 minutes = .6 54 minutes = .9 1 hour = 1.0
Example: If you worked 1 hour and 20 minutes, you should write “1.3”.
If your timesheet is not completed correctly, it will be returned and your check will be delay


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