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
• Employer Start-up Packet
  • ​Employer Start-up Sample Packet
• ​Information for Guardians and Power of Attorney - New in 2018!
• 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

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Employee Start-Up Forms

• Employee Checklist
• New Employee Set-Up Form
• Relationship Disclosure Form
• Employer and Employee Agreement
  • ​Employer and Employee Agreement - Children's Waiver ONLY - New in 2019!
• 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)
• Fiscal Agent Employee Start-up Packet
  • ​Fiscal Agent Employee Start-up Sample Packet
• Fiscal Agent Employee Start-up Packet for Inclusa
  • ​Fiscal Agent Employee Start-up Sample Packet for Inclusa
• ​Fiscal Agent Employee Start-up Packet for Children's Waiver Programs
  • ​Fiscal Agent Employee Start-up Sample Packet for Children's Waiver Programs - New for 2019!
• Fiscal Agent Employee Start-up Packet for My Choice Family Care - New for 2019!
  • Fiscal Agent Employee Start-up Sample Packet for My Choice Family Care - New for 2019!

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
• 2018 Fiscal Agent Payroll Payment Schedule
• 2019 Fiscal Agent Payroll Payment Schedule

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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

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