Children’s Long-Term Support Forms
Know the exact form you are looking for? Type in the form name in the search bar or click on buttons on the left to see forms sorted by role and type.
| Document Name | Summary | Tags |
|---|---|---|
| 2024 Fiscal Agent Payroll Payment Schedule | 2024 Fiscal Agent Payroll Payment Schedule. This schedule details the dates of each pay period. | Employer |
| 2025 Fiscal Agent Payroll Payment Schedule | 2025 Fiscal Agent Payroll Payment Schedule. This schedule details the dates of each pay period. | Employer |
| 2024 Employer Start-up Packet (blank) (sample) | 2024 Employer Start-up Packet. This packet has all the forms that the Employer must complete for employee employment. | Employer |
| Employer Checklist | Employer Checklist. This checklist shows all the forms that an Employer must complete. | Employer |
| Fiscal Agent Authorization Form | Fiscal Agent Authorization Form. This form is required by the Employer/Client and Guardian/POA. | Employer |
| IRS Form 2678 | IRS Form 2678. This form allows the FEA to file returns, make deposits, and/or payments of employment on behalf of the participant employer. | Employer |
| IRS Form SS-4 | IRS Form SS-4. This form is used to apply for an EIN on behalf of the participant employer. | Employer |
| IRS Form 8821 | IRS Form 8821. This form authorizes information exchanges between the FEA and IRS. | Employer |
| Information for the Fiscal Intermediary | Information for the Fiscal Intermediary. This form is used for determining if Employers/Clients have participated in the program, and if so, if they had a fiscal agent. | Employer |
| Employer Status Change Form | Employer Status Change Form. This form is used to make changes to contact information, termination date, or having check stubs sent to themselves. | Employer |
| Consent for Release of Confidential Information | Consent for Release of Confidential Information. This form is to consent to iLIFE relasing confidential information to the employer (pay rates, hours, budget details, etc.) | Employer |
| Employer Information Form | Fiscal Agent Employer/Client Information Form. This form is used for contact and other information. | Employer |
| Information for Guardians and Power of Attorney | Information for Guardians and Power of Attorney. This form has information for parents/guardians and Power of Attorneys to know before you sign on behalf of the Employer. | Employer |
| Form F-00036 | Form F-00036. This form is only required if the client/employer has a power of attorney. This form allows POAs to plan for future financial decisions. | Employer |
| New Employee Set-Up Form | New Employee Set-Up Form. | Employee |
| Relationship Disclosure Form | Relationship Disclosure Form. This form is to identify if the Employer and Client have a legal relationship with each other. | Employee |
| Employer and Employee Agreement. This form is used for the Employer and Employee to agree to certain terms. | Employee | |
| Employee Status Change Form | Fiscal Agent Employee Status Change Form. This form is used to make changes to contact information, termination date, or having check stubs sent to themselves. | Employee |
| Form I-9 | Form I-9. This form is used to verify the identity and employment authorization of individuals hired in the United States. | Employee |
| W-4 | Form W-4. This form determines how much is withheld from an employee's paycheck for federal income tax. | Employee |
| Direct Deposit Authorization Form | Direct Deposit Authorization Form. This form is to list direct deposit information for payment. | Employee |
| Employee Start-Up Packet for Children's Waiver Programs (blank) (sample) | Children's Waiver Programs. This packet has all the forms that must be completed to participate in Children's Waiver Programs. | Employee |
| Kenosha County Training Verification Form | Training Verification form for Children's Long-Term Support. | Employee |
| Portage County Certification: Participant Specific Training | Participant specific training required for new employees | Employee |
| Fiscal Agent Mileage Log | Fiscal Agent Mileage Log. This form is used to detail transportation services. | Employee |
| Children's Waiver Programs In/Out Timesheet (blank) (fillable) (sample) | Children's Waiver Programs In/Out Timesheet. This Timesheet is used to detail services provided in the Children's Waiver Program. | Employee |
| Vendor Start-up Packet | Vendor Start-up Packet. This packet includes all the forms the vendor may need to complete to be an approved service provider. | Vendor |
| Vendor Checklist | Vendor Checklist. This form details what forms a vendor must complete for the application process. | Vendor |
| W-9Â (sample) | Sample Form W-9. This IRS tax form is a sample to show how it is used. This is used to confirm a vendor's information for tax-filling purposes. | Vendor |
| Authorization for Fiscal Agent Vendors | Authorization for Fiscal Agent Vendors. This form is to authorize Client/Employer and Provider/Employee information. | Vendor |
| Provider Agreement | Provider Agreement. This form is used for the Provider to agree to provide/arrange for training. | Vendor |
| Direct Deposit Authorization with voided check | Direct Deposit Authorization with voided check. This form is used to void a check. Voided Check or letter from the bank must be attached with this form. | Vendor |
| Credentialing Requirements List | Credentialing Requirements List. This lists the occupations or fields that must send a copy for their license and/or certifiicate in order to receive payment. | Vendor |
| Adult Family Home Information | Adult Family Home Information. This form is required for Adult Family Home providers. | Vendor |
| Vendor Application Sample - Agency | Vendor Application Sample for Agency. This is a sample of what the Vendor Application will look like once it is completed. | Vendor |
| Vendor Application Sample - Individual | Vendor Application Sample for Individual. This is a sample of what the Vendor Application will look like once it is completed. | Vendor |
| Vendor Invoice (sample) | Vendor Invoice Sample. This is a sample of what the Vendor Invoice will look like once completed. | Vendor |
| Case Manager Checklist | Case Manager Checklist. This checklist shows the forms that must be completed by the Case Manager. | Case Manager |
| Case Manager Start-up Packet | Case Manager Start-up Packet. This packet must be completed by the Case Manager. | Case Manager |