DSPD - CSW, PDW, ABI, and LSW Forms

 

 

Employee Forms

  1. New Employee Packet

  2. Employee Packet Checklist

  3. Enrollment Form Instructions for Employees

  4. New Employee Change Notice

  5. Form W-4

  6. Employment Tax Information Questionnaire

  7. Live and Work With the Person You Serve Exemption

  8. Direct Deposit

  9. I-9 Form

  10. Overtime Agreement

  11. Attestation to the Employee Live-In Exemption

  12. Background Check Authorization

  13. Background Screening Application

  14. Youth Background Screening Application

  15. Disclosure & Acknowledge/Fingerprint Reimbursement

  16. Notice 797

  17. Timesheet

  18. Mileage Form

  19. Live and Work With the Person You Serve Exemption Cancellation Form (not required)

Community Supports Waiver (CSW)

  1. 2-9C (CSW)

  2. 2-9EA (CSW)

  3. 2-9SA (CSW)

Physical Disabilities Waiver (PDW)

  1. 2-9C (PDW)

  2. 2-9EA (PDW)

  3. 2-9SA (PDW)

Acquired Brain Injury Waiver (ABI)

  1. 2-9C (ABI)

  2. 2-9EA (ABI)

  3. 2-9SA (ABI)

LIMITED SUPPORTS WAIVER (LSW)

  1. 2-9C (LSW)

  2. 2-9EA (LSW)

  3. 2-9SA (LSW)

Additional PD Information

  1. Code of Conduct

  2. CPR First Aid

  3. Department of Human Services Policies and Procedures

  4. Provider Agreement

  5. R539-5 Self-Administered Services

Employer Forms

  1. Employer Enrollment Packet

  2. Employer Enrollment Cover Sheet

  3. Welcome Letter

  4. Packet Instructions

  5. SS-4 Application for Employer Identification Number

  6. 2678 Assignment of Tax Agent

  7. 8821 Tax Information Authorization

  8. Domestic Employment Status Report

  9. Work Agreement

  10. E-Verify Instructions

  11. Online Expense Summary Enrollment

  12. Consent for the Release of Information

  13. EVV Data Information Form

  14. Employment Application

  15. Child Labor Laws

  16. Payroll Schedule

  17. Timesheet

  18. How Much Can I Pay (LSW) Form

  19. How Much Can I Pay (DSPD) Form

EVV Online Form

  1. EVV Data Information Online Form

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