Client NameCDS Program NameEmployer Bonus RequestforAttendantNameAttendant Check the appropriate request below check one onlyBudgeted Bonus Please Note If there are insufficient funds in my Bonus Acco ID: 866934
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1 ConsumerDirected ServicesBonus Request C
ConsumerDirected ServicesBonus Request C lient Name : CDS Program Name: Employer Bonus RequestforAttendantNameAttendant: Check the appropriate request below (check one only): Budgeted Bonus: __________________Please Note: If there are insufficient funds in my Bonus Account, please advise me of the availablebalance. My budget fiscal year ends within 30 days. When all timesheets have been received, please analyze my remaining expenses to deter C riteria for Bonus Approval: The CDS Departmentmust receive this request at least 21 days prior to the desired bonus payday.Request isconsistent with your Individual Program Plan BudgetSufficient funds remain within your budget.Sufficient hours have been worked to earn bonus.Bonus is for a currently employed attendant. Please Note!! CDS Department Review Response Date Received:______________________ Date Returned to Employer:_______________________We have reviewed your bonus request and determined the followingYour bonus request is approved for the entire amount and will be paid _______________________We suggest that you revise your bonus request to the amount listed below, which will not require a budget revision. Your fiscal budget ends ________________. We estimate that there will be funds available in the amount listed below. With yourapproval, these funds will be reallocated into your Bonus Account. We are sorry that we were unable to approve your bonus request due to insufficient funds. A quarterly budget report is attached for your review. 4300 Beltway Place, Suite 103, Arlington, TX 76018 For a more timely response, send it by FAX: 817/275, or by EMAIL: cdstimesheets@hratexas.orgIf you need help with completing this form, please call the CDS Department at 8171977