North Carolina Independent Living Program Forms

New Items for 2018

• 2019 Payment Schedule for North Carolina Independent Living Program - New for 2019!

Consumer

• 2018 Consumer Packet - New for 2018!
  • 2018 Consumer Sample Packet - New for 2018!
• Consumer Information Form (fillable)
  • Sample Consumer Information Form
• Form 2678
  • Sample Form 2678
• Form SS-4
  • Sample Form SS-4
• Form 8821
  • ​Sample Form 8821
• Form NCUI 604 – Employer Status Report
  • Sample Form NCUI 604 – Employer Status Report
• Form GEN-58
  • Sample Form GEN-58
• iLIFE and ILDVR Consumer Agreement (fillable)
• iLIFE Consent for the Release of Confidential Information  (fillable)  (optional)
  • Sample iLIFE Consent for the Release of Confidential Information
• Consumer Status Change Form (fillable)
  • Sample Consumer Status Change Form
• 2018 Payment Schedule for North Carolina Independent Living Program - New for 2018!
• Attendant Timesheet
  • Sample Attendant Timesheet
• Change of Policy - Attendant Start Date Notification Letter
• Attendant Start Date Letter (Consumer Copy)
   
• Case Manager Contact Form (fillable)
• Consumer Employer Handbook
• OSHA Standard Precautions for your Attendant
• Standard Precautions for Bloodborne Transmission

Attendant

• 2018 Attendant Packet - New for 2018!
  • ​2018 Attendant Sample Packet - New for 2018!
• Attendant Information Form (fillable)
  • Sample Attendant Information Form
• Form W-4
  • Sample Form W-4
• Form NC-4 EZ (fillable)
  • Sample Form NC-4 EZ
• Copies of Social Security Card and Form I-9 Documents
• Form I-9
  • Sample Form I-9
• Employer and Attendant Agreement (fillable)
• Background Check Disclosure and Release (fillable)
  • Sample Background Check Disclosure and Release
• Relationship Disclosure (fillable)
  • Sample Relationship Disclosure
• iLIFE and Attendant Employment Agreement
• Direct Deposit Authorization (fillable)
  • Sample Direct Deposit Authorization
• Attendant Status Change Form (fillable)
  • Sample Attendant Status Change Form
• 2018 Payment Schedule for North Carolina Independent Living Program - New for 2018!
• Attendant Timesheet
  • Sample Attendant Timesheet
• Attendant Start Date Letter (Attendant Copy)

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