Inclusa Forms

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Document NameSummaryTags
2022 Fiscal Agent Payroll Payment Schedule2022 Fiscal Agent Payroll Payment Schedule. This schedule details the dates of each pay period. Employer
2022 Employer Start-up Packet (blank) (sample)2022 Employer Start-up Packet. This packet includes all the forms that the Employer will need and/or have to complete for employment. Employer
Employer ChecklistEmployer Checklist. This form is to list all the forms that the Employer must have completed. Employer
Fiscal Agent Authorization FormFiscal Agent Authorization Form. This form is required by the Employer/Client and Gurdian/POA. Employer
IRS Form 2678IRS Form 2678. Allows us to file returns and make deposits and/or payments of employment on behalf of the participant employer. Employer
IRS Form SS-4IRS Form SS-4. This form is used to apply for an EIN on behalf of the participant employer. Employer
IRS Form 8821Form 8821. This form authorizes information exchanges between FEA and IRS. Employer
Information for the Fiscal IntermediaryInformation for 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 FormEmployer 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 InformationConsent for the Release of Confidential Information. This form is to consent to iLIFE releasing confidential information to the employer (pay rates, hours, budget details, etc.)Employer
Employer Information FormEmployer Information Form. This form is to list the contact information and other details of the Employer and Client. Employer
Information for Guardians and Power of AttorneyInformation 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-00036Form 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 - Inclusa & My Choice Wisconsin. Both the Employer and the Client must fill out the information for employment.Employee
Inclusa (blank) (sample)Inclusa Packet. This packet includes all the forms that must be completed for employment. Employee
Fiscal In/Out Timesheet (blank) (fillable) (sample)iLIFE Fiscal Agent Employee Timesheet. This form is used to detail the dates and times worked, and other details. Employee
Fiscal Agent Mileage LogFiscal Agent Mileage Log. This form is used to detail transportation services. Employee
Relationship Disclosure FormRelationship Disclosure Form. This form is to identify if the Employer and Client have a legal relationship with each other. Employee
Employer and Employee AgreementEmployer and Employee Agreement. Employee
Employee Status Change FormEmployee Status Change Form. This is for the Employee only. Use this form to indicate a changed status. Employee
Form I-9Form I-9. This form is used to verify the identity and employment authorization of individuals hired in the United States. Employee
W-4Form W-4. This form determines how much is withheld from an employee's paycheck for federal income tax. Employee
Background Check Information and ReleaseBackground Check Information and Release. This form has individuals list all the previous places they have lived, any names they used to go by, and other background information. Employee
Background Information Disclosure - EnglishBackground Disclosure Form. This form is used to verify the identity of the employee for employment. Employee
Background Information Disclosure - HmongBackground Disclosure Form. This form is used to verify the identity of the employee for employment. Employee
Background Information Disclosure - SpanishBackground Disclosure Form. This form is used to verify the identity of the employee for employment. Employee
Direct Deposit Authorization FormDirect Deposit Authorization. This form is to list direct deposit information for payment. Employee
Vendor Start-up PacketVendor Start-up Packet. This packet includes all the forms the vendor may need to complete to be an approved service provider. Vendor
Vendor ChecklistVendor Checklist. This form details what forms a vendor must complete for the application process. Vendor
W-9 (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 VendorsAuthorization for Fiscal Agent Vendors. This form is to authorize Client/Employer and Provider/Employee information. Vendor
Provider AgreementProvider Agreement. This form is used for the Provider to agree to provide/arrange for training. Vendor
Direct Deposit Authorization with voided checkDirect 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 ListCredentialing Requirements List. This list has all of the occupations or fields that must send a copy for their license and/or certificate in order to receive payment. Vendor
Adult Family Home InformationAdult Family Home Information. This form is required for Adult Family Home providers. Vendor
Vendor Application Sample - AgencyVendor Application Sample for Agency. This is a sample of what the Vendor Applicaiton will look like once it is completed. Vendor
Vendor Application Sample - IndividualVendor Application Sample for the Individual. This is a sample of what the Vendor Application will look like once it is completed. Vendor
Vendor Payroll ScheduleVendor Payroll Schedule. This is the schedule of when Vendors will receive payments. Vendor
Vendor Invoice (sample)Sample of Vendor Invoice. This is a sample of what the Vendor Invoice will look like once completed. Vendor
Case Manager ChecklistCase Manager Checklist. This checklist shows the forms that must be completed by the Case Manager. Case Manager
Case Manager Start-up PacketCase Manager Start-up Packet. This packet must be completed by the Case Manager. Case Manager