North Carolina Forms

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Document NameSummaryTags
2022 Payment Schedule for North Carolina Independent Living ProgramNorth Carolina Payroll Payment Schedule. This iLIFE document details the pay period start dates, end dates, due dates, and check dateAttendant
2022 Attendant Packet (Sample)This packet includes all of the forms an Attendant may need to complete to be a service provider with iLIFE. Attendant
Attendant Information Form (fillable) (Sample)The Attendant Information Form is used to verify the Attendant's and Consumer's information.Attendant
Form W-4 (Sample)This is an sample form of the W-4. Form W-4 is used to withhold the correct amount of Federal income tax from your pay. Attendant
Form NC-4 EZ (fillable) (Sample)Attendant
Copies of Social Security Card and Form I-9 DocumentsCopies of Social Security Card and Form 1-9 Documents. These forms are used to verify the identitiy of the Attendant. This form lists tips to ensure the forms are accepted. Attendant
Form I-9 (Sample)This is a sample form of the I-9. Form I-9 is used to document verification of the identity and employment authorization of the Attendant. Attendant
Employer and Attendant Agreement (fillable)Employer and Attendant Agreement. This form is to verify that the Consumer and the Attendant agree on employment guidelines. Attendant
Background Check Disclosure and Release (fillable)This is the Background Check Disclosure and Release form. This form is used to verify identity of Attendant for employment. Attendant
Relationship Disclosure (fillable) (Sample)Relationship Disclosure Form. This form is to idenfity if the Attendant and the Consumer have a legal relationship with each other. Attendant
iLIFE and Attendant Employment AgreementiLIFE and Attendant Employee Agreement. This form is to verify that iLIFE and the Attendant agree on employment guidelines. Attendant
Direct Deposit Authorization (fillable) (Sample)Direct Deposit Authorization. This form is to list direct deposit information for payment. Attendant
Attendant Status Change Form (fillable) (Sample)Attendant Status Change Form. This form is used to indicate if an Attendant's work status was changed. Attendant
Attendant Timesheet (Sample)Attendant Timesheet. This form is used to indicate what days and times the Attendant worked. Attendant
Attendant Start Date Letter (Attendant Copy)Attendant Start Date letter. This letter informs the Attendant that the application process for employment is complete. It lists the date that they can begin work. Attendant
Grievance Form. This form is used for any ILDVR iLIFE program consumers and/or Attendants to file any formal grievances regarding any experience that they may have had in the ILDVF program. Attendant
NC IL Local Office FAQ
2022 Consumer Packet (Sample)Consumer Sample Form Packet. This packet includes all of the documents that need to be completed for employment at iLIFE. Consumer
Consumer Information Form (fillable) (Sample)Sample of the Consumer Information Form. This form to verify consumer information. Consumer
Form 2678 (Sample)Form 2678. This form is to request approval to have an agent file returns and make deposits or payments of employment or other withholding taxes.Consumer
Form SS-4 (Sample)Form SS-4. This form is used to apply for an Employer Identification Number. Consumer
Form 8821 (Sample)Form 8821. This form authorizes the IRS to disclose your confidential tax information to your employer. Consumer
Form NCUI 604 – Employer Status Report (Sample)Consumer
Form GEN-58 (Sample)Form GEN-58. This form is used to appoint someone else to handle tax affairs before the Department of Revenue. Consumer
iLIFE and ILDVR Consumer Agreement (fillable)iLIFE and ILDVR Consumer Agreement. This form is to acknowledge and agree to the rules of working with iLIFE.Consumer
iLIFE Consent for the Release of Confidential Information (fillable)iLIFE Consent for the Release of Confidential Information. Consumer
Consumer Status Change Form (fillable) (Sample)This form is for changing the status of a Consumer.Consumer
Change of Policy - Attendant Start Date Notification LetterChange of Policy Letter. This letter is to inform the Attendant of any changes to the North Carolina policy. Consumer
Attendant Start Date Letter (Consumer Copy)Attendant Start Date Letter. This letter informs the Attendant that the application for employment is complete. It lists the date that they can begin work. Consumer
Consumer Employer HandbookConsumer Employe Handbook. This form lists tips on how to be a successful employer for your Attendants. Consumer
OSHA Standard Precautions for your AttendantOSHA Standard Precautions for Your Attendant. This form has guidelines on preventing the spread of blood borne diseases and infections. Consumer
Standard Precautions for Bloodborne TransmissionStandard Precautions for Blood-borne Transmission. This form has guidelines on practicing basic infection control against blood-borne diseases. Consumer
Grievance Form for North Carolina Independent Living ProgramGrievance Form. This form is used for any ILDVR iLIFE program consumers and/or Attendants to file any formal grievances regarding any experience that they may have had in the ILDVR program. Consumer
Case Manager Contact Form (fillable)Case Manager Contact Form. This form is to list the contact information for the Case Manager. Case Manager