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<br />APPENDIX B <br /> <br />Attendant Care Billing - Sample <br />Agency <br />Address Authorized Official <br />City, State, Zip <br /> <br />Date <br /> <br />Billing Period: <br />Placements Billed: <br /> <br />8410 Sti d <br /> <br />Jen s <br /> Attendant Name !Ootional\ Hours Rate Total <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> <br />Total Hours <br /> <br />Total Stipends $ <br /> <br />8430 Supplies <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />, 8420 Meals/Snacks/Food <br /> <br />8440 Equipment (Attach Documentation) <br /> <br />8460 Other (Attach Documentation) <br /> <br />8470 Att <br /> <br />endant Care Traminq <br />Attendant Traininn Dates Hours Rate Total <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> $ - <br /> <br />Meal <br />Mileag <br />Lad in <br /> <br /> <br />$ <br />$ <br /> <br />Grand Total <br /> <br />$ <br />$ <br />