Record the credential and license number at the time they supervised you. If a supervisor moves, retires, or lets a board approval lapse two years from now, this card is the only place that information still exists.
Hours in the period are counted from your log automatically, so the number on the record and the number in your ledger cannot drift apart.
The packet reports what you entered. It is a summary of your own records, not a board form and not a substitute for one. Check every total against your board's current requirements and their official documentation before you file, and keep your signed originals — this file is your working copy, not your evidence.