Families First Coronavirus Response Act (FFCRA) Information

The Families First Coronavirus Response Act, or FFCRA, provides paid sick time and paid Family Medical Leave Act (FMLA) time to those affected by the novel coronavirus disease, COVID-19. iLIFE recently sent out a packet with information to all employers containing information about the FFCRA. To view those materials and additional resources, click here. 

Important Note:

ALL APPROPRIATE FORMS MUST BE SIGNED.

Employer Start-Up Forms:

• Handbook
• Employer Checklist
• IRS Form 2678
• IRS Form SS-4
• IRS Form 8821
• Information for the Fiscal Intermediary
• Employer Status Change Form
• Consent for Release of Confidential Information
• Employer Information Form
• 2021 Employer Start-up Packet (blank) (sample)
• ​Information for Guardians and Power of Attorney
• If the client/employer has a guardian or power of attorney, the following forms are required:
  • Guardianship or Power of Attorney Documents
  • Form F-00036
    • Form F-00036 is required if the client/employer has a power of attorney

__________________________________________________________________________________________________________________________________________________

Employee Start-Up Forms

• New Employee Set-Up Form
• New Employee Set-Up Form - Inclusa & My Choice Wisconsin
• Employee Checklist - My Choice Wisconsin
• Relationship Disclosure Form
• Employer and Employee Agreement
  • Employer and Employee Agreement - for Children's Waiver Programs ONLY
• Employee Status Change Form
• Form I-9
• W-4
• Copy of Social Security card
• Background Check Information and Release
• Background Information Disclosure - English
  • Background Information Disclosure - Hmong
  • Background Information Disclosure - Spanish
• Direct Deposit Authorization Form (optional form)

• 2021 Fiscal Agent Employee Start-up Packets
  • Inclusa (blank) (sample)
  • Children's Waiver Programs (blank) (sample)
    • Portage County also requires: Participant Specific Training Certification
    • Washingon County also requires: Participant Specific Training Certification Form 
  • My Choice Wisconsin (blank) (sample)

Employee Payment Forms

• Fiscal Agent Mileage Log
• Fiscal In/Out Timesheet (blank) (fillable) (sample) (sample for Inclusa)
• Children's Waiver Programs In/Out Timesheet (blank) (fillable) (sample)
• Payment schedules by program:
  • Dodge Self and Washington County
  • Care Wisconsin, Dodge County, Green County Health Department, Portage HHS, Trempealeau HHS, The Human Service Center
  • Western Wisconsin Cares
  • Waukesha County
• 2021 Fiscal Agent Payroll Payment Schedule
• 2020 Fiscal Agent Payroll Payment Schedule

__________________________________________________________________________________________________________________________________________________

Vendor Start-Up Forms

• Vendor Start-up Packet
• Vendor Checklist
• W-9 (sample)
• Authorization for Fiscal Agent Vendors
• Provider Agreement
• Direct Deposit Authorization with voided check
• Credentialing Requirements List
• Adult Family Home Information
• Vendor Application Sample - Agency
• Vendor Application Sample - Individual

Vendor Payment Forms

• Vendor Payroll Schedule
• Vendor Invoice (sample)

Case Manager Start-Up Forms

• Case Manager Checklist
• Fiscal Agent Authorization Form
• Employer Status Change Form
• Case Manager Start-up Packet

__________________________________________________________________________________________________________________________________________________

Adobe Acrobat version 8 or higher may be necessary to view some of these forms. 
Download Acrobat Reader

iLIFE Financial Management Services
6100 North Baker Road
Glendale, WI 53209