Forms
Enrollment Packets
Enrollment Resources
- Attendant Welcome Packet (PDF - 208 KB)
- Attendant Welcome Packet - Spanish (PDF - 425 KB)
- Attendant Enrollment Packet Instructions (PDF - 761 KB)
- Attendant Enrollment Packet Instructions - Spanish (PDF - 761 KB)
- Employer Welcome Packet (PDF - 207 KB)
- Employer Welcome Packet - Spanish (PDF - 422 KB)
- Employer Enrollment Packet Instructions (PDF - 610 KB)
- Employer Enrollment Packet Instructions - Spanish (PDF - 615 KB)
Form Samples
Timesheet and Payroll Related Forms
- Timesheet (PDF - 450 KB)
- Timesheet Instructions (PDF - 246 KB)
- Timesheet Instructions - Spanish (PDF - 246 KB)
- 2019 Payroll Schedule (PDF - 119 KB)
- 2019 Payroll Schedule - Spanish (PDF - 271 KB)
- Federal W-4 (PDF - 57 KB)
- Virginia VA-4 (PDF - 79 KB)
- Difficulty of Care Exemption - Compliance with IRS Notice 2014-7 (PDF - 101 KB)
- Difficulty of Care Exemption - Compliance with IRS Notice 2014-7 - Spanish (PDF - 103 KB)
- Live-In Exemption Form (PDF - 134 KB)
- Live-In Exemption Form - Spanish (PDF - 136 KB)
- Companionship Services Exemption Form (PDF - 137 KB)
- Companionship Services Exemption Form - Spanish (PDF - 138 KB)
- Authorized Representative Agreement and Signatory Authority (PDF - 1.15 MB)
- Authorized Representative Agreement and Signatory Authority - Spanish (PDF - 1.13 MB)
- Pay Selection Form (PDF - 164 KB)
- Pay Selection Form - Spanish (PDF - 150 KB)
Service Facilitator
Other
- Acceptance of Responsibility for Hiring Attendant with Criminal Conviction (PDF - 93 KB)
- Acceptance of Responsibility for Hiring Attendant with Criminal Conviction - Spanish (PDF - 94 KB)
- Attendant Contact Information Change Form (PDF - 1.09 MB)
- Attendant Contact Information Change Form - Spanish (PDF - 1.08 MB)
- Consumer Contact Information Change Form (PDF - 1.10 MB)
- Consumer Contact Information Change Form - Spanish (PDF - 1.08 MB)
- Employer of Record Contact Information Change Form (PDF - 1.08 MB)
- Employer of Record Contact Information Change Form - Spanish (PDF - 1.09 MB)
- Feedback Form (PDF - 1.09 MB)
- Feedback Form - Spanish (PDF - 1.10 MB)
- I-9 Instructions (PDF - 565 KB)
- Notice of Discontinued Employment (PDF - 1.08 MB)
- Notice of Discontinued Employment - Spanish (PDF - 1.09 MB)
- Pay Card Instructions (PDF - 259 KB)
- Pay Card Instructions - Spanish (PDF - 280 KB)
- Secure Email Instructions (PDF - 595 KB)
Transition Packets
- Attendant Transition Packet (PDF - 1.70 MB)
- Attendant Transition Packet - Spanish (PDF - 1.33 MB)
- Attendant Transition Packet Form Samples (PDF - 777 KB)
- Employer Transition Packet (PDF - 3.73 MB)
- Employer Transition Packet - Spanish (PDF - 3.57 MB)
- Employer Transition Packet Form Samples (PDF - 1.05 MB)