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KAISER HEALTHCARE FORMS
KAISER HEALTHCARE FORMS
Before filling out Packets and forms. it is important to know your role. Click here or scroll to the bottom of the page to review roles to help you determine which forms you need to fill out.
ENROLLMENT PACKETS
Employer of Record (EOR) Enrollment
The Employer Enrollment Packet contains all the required forms to set up an individual as the Employer. This packet is for new employers only. If you are transitioning from ACES$, please call or email CDVA.
No resources available.
Attendant Enrollment
No resources available.
Fiscal Agent Request Form (FARF)
No resources available.
CHANGE OF EMPLOYER OF RECORD
Change of Employer of Record Forms (Consumer and Attendant Remain the Same)
No resources available.
PAYROLL, EXEMPTIONS, AND OTHER FORMS
Payroll Related Forms
No resources available.
Out-of-State Tax Forms
No resources available.
Exemption Forms
No resources available.
Other
No resources available.
WHAT’S MY ROLE?
Before filling out packets and forms, it is important to know your role. Below are definitions to help you determine which forms you need to fill out.
Employer of Record (EOR) – The Employer of Record (EOR) is the person who performs the function of the employer in the consumer-directed model. The EOR may be the individual receiving the services or another person designated by the individual. If you are an Employer of Record, you will fill out the Employer packets and/or forms.
Attendant – The person hired to provide consumer-directed care or supports. This person is sometimes called a Caregiver. If you are an Attendant, you will fill out the Attendant packets and/or forms.
Service Facilitator – A person who helps Participants and their family. If you are the Service Facilitator you will fill out the Fiscal Agent Request Form [FARF].