North Carolina Independent Living Program Forms

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. 

New Items for 2021

• 2021 Payment Schedule for North Carolina Independent Living Program

Consumer

• 2020 Consumer Packet
  • 2020 Consumer Sample Packet
• 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)
  • Instructions and Sample iLIFE Consent for the Release of Confidential Information
• Consumer Status Change Form (fillable)
  • Sample Consumer Status Change Form
• 2020 Payment Schedule for North Carolina Independent Living Program
• 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
• Grievance Form for North Carolina Independent Living Program

Attendant

• 2021 Attendant Packet
  • ​2021 Attendant Sample Packet
• 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
• Attendant Timesheet
  • Sample Attendant Timesheet
• Attendant Start Date Letter (Attendant Copy)
• Grievance Form for North Carolina Independent Living Program

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