| Brokers - Resources specifically for Support Brokers |
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| 1. |
2011 Disbursement Schedule - Voucher Deadlines and Disbursement Dates for 2011
click
to download |
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| 2. |
2012 IFP/VOUCHER COMBO - 2012 IFP/VOUCHER COMBO
click
to download |
|
| 3. |
2012 SDS DISBURSEMENT SCHEDULE - 2012 SDS DISBURSEMENT SCHEDULE
click
to download |
|
| 4. |
A - 2011 IFP/Voucher Combo - This fill-in-the-blank Excel file creates the 2011 IFP and vouchers all from one file. Download and save to your computer for each consumer to save time when updating documents. This version includes the contracted services update for 2011, as well as the addition of several AFH providers.
(12-14-2010)
If you need to complete an IFP/Voucher combo for 2010, please contact FA for the proper file.
Please note: For 2011 if a consumer uses Sound Response you will have to select TWO contracted services - one is for Sound Response on the Waisman side and one is for Responsive Solutions that provides the staffing.
click
to download |
|
| 5. |
Contracted Services Update - 2011 - This file contains the updated contracted services for 2011, as well as the addition of several AFH providers. This file should be used to update your existing IFP/Voucher Combo files for each consumer. After updating the contracted services page in your existing IFP/Voucher Combo please double-check to make sure that all the services come across to the IFP correctly in case a service name has changed from previous versions.
For 2011 if a consumer uses Sound Response you will have to select TWO contracted services - one is for Sound Response on the Waisman side and one is for Responsive Solutions that provides the staffing.
(12-14-2010)
click
to download |
|
| 6. |
EER-VOUCHER COMBO - Combo form to be used for Execptional Expense Requests.
click
to download |
|
| 7. |
Provider Update 10-27-2010 - This file contains the updated provider list as of 10/27/2010, which includes the address change for SWO, and should be used to update your IFP/Voucher Combo files for each consumer as necessary.
click
to download |
|
| 8. |
Quarterly Report Explanation - Guardians - Explanation of the quarterly financial statements that are mailed to the guardians.
click
to download |
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| 9. |
Reports Explained - Explanation of Reports
click
to download |
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| 10. |
Required Paperwork for Support Brokers - Explanation of required paperwork
click
to download |
|
| Rep Payee Documents |
|
| 1. |
Brochure - Rep Payee Brochure
click
to download |
|
| 2. |
Client Budget Summary - Budget form
click
to download |
|
| 3. |
Client Data Change Form - To be used for any client changes and emailed to FA Rep.
click
to download |
|
| 4. |
Client Intake Form - To be used for new rep payee clients
click
to download |
|
| 5. |
Client Intake Form Instructions - Instructions for filling out the Intake Form.
click
to download |
|
| 6. |
Client Personal Spending Log - To be used for personal spending & petty cash
click
to download |
|
| 7. |
Client Personal Spending Log Instructions - Instructions on how to fill out the personal spending log
click
to download |
|
| 8. |
Rep Payee Responsibilities - Chart of responsibilities
click
to download |
|
| 9. |
Transition Checklist - Checklist of Agency tasks for transition
click
to download |
|
| 10. |
Transition FAQs - Frequently asked questions for rep payee transition process
click
to download |
|
| 11. |
Transition Timeline - Timeline overview for rep payee transition
click
to download |
|
| Vouchers - Voucher forms and descriptions |
|
| 1. |
2012 IFP/VOUCHER COMBO - 2012 IFP/VOUCHER COMBO
click
to download |
|
| 2. |
2012 SDS DISBURSEMENT SCHEDULE - 2012 SDS DISBURSEMENT SCHEDULE
click
to download |
|
| 3. |
A - 2011 IFP/Voucher Combo - This fill-in-the-blank Excel file creates the 2011 IFP and vouchers all from one file. Download and save to your computer for each consumer to save time when updating documents. This version includes the contracted services update for 2011, as well as the addition of several AFH providers.
(12-14-2010)
If you need to complete an IFP/Voucher combo for 2010, please contact FA for the proper file.
Please note: For 2011 if a consumer uses Sound Response you will have to select TWO contracted services - one is for Sound Response on the Waisman side and one is for Responsive Solutions that provides the staffing.
click
to download |
|
| 4. |
EER-VOUCHER COMBO - Combo form to be used for Execptional Expense Requests.
click
to download |
|
| 5. |
IFP & EER Vouchers Explained - Description and Instructions for IFP and EER Vouchers
click
to download |
|
| 6. |
Provider Update 10-27-2010 - This file contains the updated provider list as of 10/27/2010, which includes the address change for SWO, and should be used to update your IFP/Voucher Combo files for each consumer as necessary.
click
to download |
|
| X - Employer Agent Documents - Documents needed to establish FA as Employer Agent. |
|
| 1. |
2012 Payroll Schedule - Employer Agent Biweekly Payroll - Deadlines for 2012
click
to download |
|
| 2. |
Address Change Form - Use for address changes
click
to download |
|
| 3. |
Background Information Disclosure - Form & Instructions on obtaining Background Information Disclosure information
click
to download |
|
| 4. |
Direct Deposit Form for Employer Agent Employees - Use this form if you would like to have your paychecks deposited directly to your bank account. Please make sure to include a voided check when you send the form to Fiscal Assistance.
click
to download |
|
| 5. |
Employee Forms Instructions - Instructions for filling out Employee Forms.
click
to download |
|
| 6. |
Employee or Independent Contractor? - This form should be used to determine if a person is an employee or an Independent Contractor.
click
to download |
|
| 7. |
Employer Agent Agreement Completion Instructions - Instructions for completing the Employer Agent Agreement
click
to download |
|
| 8. |
EMPLOYER AGENT INTERACTIVE AGREEMENT - A fill-in-the-blank form that does the math FOR you.
click
to download |
|
| 9. |
Form 2678: Employer Appointment of Agent - For Home Care Employers: Employment tax filing.
click
to download |
|
| 10. |
Form 8821: Tax Information Authorization - For Home Care Employers: Information related to employment tax forms.
click
to download |
|
| 11. |
Form I-9 - Immigration and Naturalization - Required form to be filled out by employees and employers.
click
to download |
|
| 12. |
Form SS-4: Application for Employer Identification Number - For Home Care Employers: Obtain a Federal EIN from the IRS.
click
to download |
|
| 13. |
Form W-4 - Federal Withholding Tax - Required form to be filled out by all employees.
click
to download |
|
| 14. |
Form WT-4 Wisconsin Withholding Tax - Employee Wisconsin Withholding Tax form to be completed if your Wisconsin withholding is different from your Federal withholding.
click
to download |
|
| 15. |
Getting Started in the Employer Agent Program - Information on what is needed to get started using FA as an Employer Agent.
click
to download |
|
| 16. |
Intake Data Form - Employer Agent - Please complete each field in this form for new employers, new employees, as well as for changes that need to be made to existing employer and employee information. Include the form with the new employer and new employee packets that are sent to FA.
click
to download |
|
| 17. |
Medicaid Program Provider Agreement - For waiver service provider agencies or individuals - self-directed supports.
click
to download |
|
| 18. |
MINORS REQUIRE A WORK PERMIT - If you are under 18 years of age, you will need a work permit.
click
to download |
|
| 19. |
Paperwork Tips - Tips on what is needed to use FA as an Employer Agent
click
to download |
|
| 20. |
Reference Checklist - Checklist to be used when checking employee references.
click
to download |
|
| 21. |
Resignation Notice - Form to be used when an employee resigns.
click
to download |
|
| 22. |
Timesheet - Employer Agent - Bi-Weekly Timesheets to be used by employees under the Employer Agent program.
click
to download |
|
| 23. |
Training Manual for In-Home Care Providers - This manual contains general guidelines and instructions that may be helpful to Consumers for training their new or current employees.
click
to download |
|
| 24. |
Training Verification Form - Employee completes one form for each employer.
click
to download |
|
| 25. |
Travel Reimbursement Form - Form to be used for travel reimbursement.
click
to download |
|
| 26. |
Worker's Comp Insurance Application - Application to be completed to apply for Worker's Compensation Insurance.
click
to download |
|
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