Fiscal Agent Handbook and Forms
| Handbook
| Case Mgr. Start Up |
Employer Start Up |
| Employee Start Up | Employee
Payment |
Important note:
ALL APPROPRIATE FORMS MUST BE SIGNED.
Case Manager Start-Up
Forms:
• Case
Manager Checklist
• Authorization
for single employee
• Authorization
for multiple employees
• Termination
report for Employer
• Termination
report for Employee
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Employer Start-Up
Forms:
• Employer
Checklist
• IRS
Form 2678 with copy of Guardianship or POA papers
• Worker’s
Compensation (optional form)
• Fiscal
Intermediary
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Employee Start-Up
Forms:
• Employee
Checklist
• Employee
New Hire/Status Change, signed by Employer
• I-9
Eligibility, signed by Employer
• W-4
• Copy of Social Security card
• Background
Check Information and Release
• Background
Information Disclosure
• Direct
Deposit with voided check (optional form)
• Employer
& Employee Agreement, signed by Employer (optional form)
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Employee Payment Forms:
• Employee
Time Report, signed by Employer and Employee
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