EXAMPLE for Voluntary Agency Workers Completing the Time Study Activity Report 5-11-07

Following is a description of a worker’s schedule for a 3-day period, and an example of the codes that would be
reported by the worker on the Time Study Activity Report.

Day 1

Time Description of Activity Activity

Code
9:00 -9:30 Prepare documents and notes for permanency/extension of placement 38
hearing
9:30-11:00 Travel to and from court to participate in permanency/extension of 38
placement hearing
11:00-11:15 Update case records regarding results of permanency hearing 37
11:15-11:30 Return telephone call to foster parent regarding failure foster parent to 41
receive clothing allowance
11:30-12:00 Meet with supervisor regarding proposed modification of case plan 37
12:00-12:30 Lunch 63
12:30-12:45 Return phone call to local district worker regarding placement of a child at 39
the agency
12:45-1:00 Phone call to set a meeting with prospective foster parents regarding the 39
need to place a child in their foster home
1:00-2:30 Travel to foster home to conduct counseling session with child and foster 42N
parents to remedy behavior management problems
2:30-5:30 Travel to another home to conduct a home study for the purpose of placing 54
a child for adoption

Day 2

Time Description of Activity Activity

Code
9:00-9:30 Case recording regarding the needs of foster child and family 37

9:30-10:00 Make all arrangements for mental health services for family 42C
10:00-11:00 Transport family to mental health services clinic 42C
11:00-11:45 Attend mental health session with family 42C
11:45-12:00 Transport family home from clinic 42C
12:00-12:30 Lunch 63
12:30-1:00 Prepare for meeting for service plan review 37
1:00-3:00 Meet with family, foster parents, and foster child to review service plan and 37
make needed changes
3:00-3:15 Provide referral to drug treatment program for father 44C
3:15-3:30 Write revised service plan 37

3:30-5:00 Authorized Leave for remainder of day 62

Day 3

Time Description of Activity Activity Code

9:00-5:00 Not scheduled to work, as this is not normally a Leave the 15 minute intervals blank –
work day and check the box that says “Check if
not a work day”

On the following page is an example of a completed Time Study Report using the activities specified in the above
diary. The top portion of the form has basic identifying information, which is completed for a fictitious worker whose
name is George Bradley. The record for each day in the is completed as follows:

Day 1: The actual starting time of 9:00am is specified, and the actual date for Day 1 is entered. After that, each of
the codes for the time periods described above are specified in the appropriate boxes. In this example, a total of 34
boxes are specified because the worker’s schedule involved 8 1/2 hours of activities, even though the worker’s regular
workday would normally be 9:00 to 5:00. Thus, if you work 8 hours, you would complete 32 boxes (8 times 4 = 32); if
you work 9 hours, you would complete 36 boxes (9 times 4 = 36); etc. The actual ending time of 5:30pm is specified.
The Total Boxes Completed is marked as 34.

Day 2: The starting time of 9:00am is specified, as this was the actual starting time for this worker on Day 2. The
actual date for Day 2 is entered. In this example, a total of 32 boxes are specified, as applicable to the type of activity.
The actual ending time of 5:00pm is specified. The Total Boxes Completed is marked as 32.

Day 3: There is no starting time or ending time specified, as the worker was not on duty that day. The actual date for
Day 3 is entered, and the box is checked for “Check if not a work day.”
 EXAMPLE - Completing the Time Study Activity Report

Time Study Activity Report: p. 1 Agency Name: XYZ Association

Name: George Bradley

Signature: s/s George Bradley

Title: Case Manager ACTIVITY CODES

37 Case Planning
Phone: 212-438-5724 38 Participation in Judicial Proceedings for Case Plan
39 Placement of Child or Youth

Work Address: 40 N. Pearl St., Albany, NY 40 Working with Investigative Agencies not for Case Plan
41 Case Supervision / Monitoring
Regular Length of Day (from/to): 9:00am to 5:00pm 42C Direct Provision of Services to Individuals (Clinical)
42N Direct Provision of Services to Individuals (Non-Clinical)
Do you have an assigned caseload? Yes X No 44C Referral for Services (Clinical)
44N Referral for Services (Non-Clinical)
If not, which best describes your assignment? 48C Provision of Group Services (Clinical)
Home Approval Other: ______________ 48N Provision of Group Services (Non-Clinical)
49 Fair Hearings and Appeals
In which type of program do you work? 51 Special Initiative Pre/Post Discharge Not Funded as Foster Care
53 Recruitment / Licensing Foster Homes
Instit. / Group Residence X Foster Home 54 Homefinding for Adoption
INDIRECT ACTIVITY/ADMINISTRATION
Group Home / ABH Adoption 60 Training
61 Meeting
Case, irrespective of child’s level of care/facility placement 62 Authorized Leave
63 Lunch Break
64 Misc / Other
65 Non-Case-Specific Facility or Program-Related Activities

Starting Time: 9:00am Total Boxes mo. day year

Ending Time: 5:30pm Completed 34 Day 1 6 13 06 Check if not a work day
9am 9:15 9:30 9:45 10am 10:15 10:30 10:45 11am 11:15 11:30 11:45 12pm 12:15 12:30 12:45 1pm 1:15 1:30 1:45 2pm 2:15 2:30 2:45
9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00

38 38 38 38 38 38 38 38 37 41 37 37 63 63 39 39 42N 42N 42N 42N 42N 42N 54 54

3pm 3:15 3:30 3:45 4pm 4:15 4:30 4:45 5pm 5:15 5:30 5:45 6pm 6:15 6:30 6:45 7pm 7:15 7:30 7:45 8pm 8:15 8:30 8:45
3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00

54 54 54 54 54 54 54 54 54 54

Starting Time: 9:00am Total Boxes mo. day year

Ending Time: 5:00pm Completed 32 Day 2 6 14 06 Check if not a work day
9am 9:15 9:30 9:45 10am 10:15 10:30 10:45 11am 11:15 11:30 11:45 12pm 12:15 12:30 12:45 1pm 1:15 1:30 1:45 2pm 2:15 2:30 2:45
9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00

37 37 42C 42C 42C 42C 42C 42C 42C 42C 42C 42C 63 63 37 37 37 37 37 37 37 37 37 37

3pm 3:15 3:30 3:45 4pm 4:15 4:30 4:45 5pm 5:15 5:30 5:45 6pm 6:15 6:30 6:45 7pm 7:15 7:30 7:45 8pm 8:15 8:30 8:45
3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00

44C 37 62 62 62 62 62 62
Time Study Activity Report: page 2 Agency Name: XYZ Association
Worker Name: George Bradley

Starting Time: Total Boxes mo. day year

Ending Time: Completed Day 3 6 15 06 Check if not a work day X
9am 9:15 9:30 9:45 10am 10:15 10:3 10:45 11am 11:15 11:3 11:45 12pm 12:15 12:30 12:45 1pm 1:15 1:30 1:45 2pm 2:15 2:30 2:45
0 0
9:15 9:30 9:45 10:00 10:15 10:30 10:4 11:00 11:15 11:30 11:4 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00
5 5

3pm 3:15 3:30 3:45 4pm 4:15 4:30 4:45 5pm 5:15 5:30 5:45 6pm 6:15 6:30 6:45 7pm 7:15 7:30 7:45 8pm 8:15 8:30 8:45
3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00

EXAMPLE - Completing the Time Study Report Summary

Following is an example of a completed Time Study Report Summary. This form is a summary of the codes that were
specified above for each of the three days of the Time Study.

In the column for Day 1, the counts for each of the codes used are specified. Thus, in this example, code 37 was
used three times in Day 1, code 38 was used eight times, and so on. At the bottom of the column is a total of the
counts for Day 1. The total (in this case, 34) should equal the number of hours worked that day times 4.

The process above is repeated in the columns for Day 2 and Day 3. In the Totals column, the counts for each code
are added horizontally. Thus, in this example, code 37 had 3 counts for Day 1, 13 for Day 2, and 0 for Day 3, so the
Totals column has the count of 16 (i.e., 3 plus 13 plus 0 = 16). At the bottom of the Totals column, the counts in the
Totals column are added for a grand total at the bottom.
SPECIFIC ACTIVITIES Day 1 Day 2 Day 3 Totals
37 Case Planning 3 13 16
38 Participation in Judicial Proceedings for Case Plan 8 8
39 Placement of Child or Youth 2 2
40 Working with Investigative Agencies not for Case Plan
41 Case Supervision / Monitoring 1 1
42C Direct Provision of Services to Individuals (Clinical) 6 10 16
42N Direct Provision of Services to Individuals (Non-Clinical)
44C Referral for Services (Clinical) 1 1
44N Referral for Services (Non-Clinical)
48C Provision of Group Services (Clinical)
48N Provision of Group Services (Non-Clinical)
49 Fair Hearings and Appeals
51 Special Initiative Pre/Post Discharge Not Funded as Foster
53 C
Recruitment / Licensing Foster Homes
54 Homefinding for Adoption
60 Training 12 12
61 Meeting
62 Authorized Leave
63 Lunch Break 6 6
64 Misc / Other 2 2 4
65 Non-Case-Specific Facility or Program-Related Activities
Totals 34 32 66
 EXAMPLE – Completing the Agency Wide Summary
(To be Completed in the Finance Office for the Entire Agency)

Following is an example of the Agency Wide Summary that the Finance Office of the Agency would
complete at the conclusion of the Time Study. From the example above, the 3-day results for George
Bradley would be posted to this Summary as illustrated below. The Worker # is simply a consecutive
number assigned to each worker that participated in the Time Study, as a way to keep count of the number
of workers included in the Time Study and listed in this Summary.

The person completing this form would post the results from p.2 of the completed Time Study Activity
Reports for each participating worker. An “X” would only be entered in the field for FC/MA for each
social worker that is allocated to Medicaid as well as to Foster Care programs, in accordance with
the rules established by the Department of Health regarding such expenditure allocations for
treatment-oriented services provided by certified social workers.

Time Study – Agency Wide Summary Agency Name: XYZ Association

Time Study: June 2007

Worker Worker's FC/ 37 38 39 40 41 42C 42N 44C 44N 48C 48N 49 51 53 54 60 61 62 63 64 65
No.
Name MA
1 George 16 8 2 1 16 1 12 6 4
Bradley

Totals 16 8 2 1 16 1 12 6 4