We'll help take the sting out of the paperwork.
Forms
Whether you're a Consumer-employer or an Attendant (employee), you'll find all of the forms you need below. If you have any questions, please don't hesitate to contact us.
Consumer Packet (Employer)
These forms will help Consumers get started employing and managing an Attendant for in-home personal care.
- Attendant Pay Schedule 2012, 1st Quarter, Philadelphia
- Attendant Pay Schedule 2012, 1st Quarter, Allentown
- Consumer Demographics
- Consumer signature sample page
- Agreement between Consumer and Resources for Living Independently
- Roles and responsibilities of RLI and reporting agent
- Form SS-4: Application for employer identification number
- Form 2678: Employer/Payer appointment of agent
- Form 8821: Tax information authorization
- PA Form UC-884: Pennsylvania Unemployment Compensation Power of Attorney
- Form PA-100: PA enterprise registration form
- New Hire Reporting Information
- Worker's Compensation Information
- Consumer-Attendant Employer-Employee Agreement
- Representative Designation Form
Attendant Packet (Employee)
These forms will help Attendants ensure that their pay is received in a timely manner.
- Download Full Attendant Packet
- Attendant Pay Schedule 2012, 1st Quarter, Philadelphia
- Attendant Pay Schedule 2012, 1st Quarter, Allentown
- Act 28 of 1995 Summary
- Agreement Between Consumer and Attendant
- Application for Employment as a Personal Assistant - CSPPPD
- Att Medicaid Provider Agreement
- Attendant - FEA agreement
- Health Benefit Information
- Attendant Non PA Resident Tax Form
- Certification of Consumer-Attendant Relationship
- Child Abuse Clearance - Letter to Applicant
- Child Abuse Clearance Form
- Criminal Record Check Form
- Criminal Record Check Policy for Consumer Employers - ACP ONLY
- Direct Care Worker Agreement - partially completed
- Direct Deposit form
- Direct Deposit letter
- Employment Clearance Disclosure Statement - CSPPPD
- Exposure To Blood booklet
- H1 N1 Virus Notice Philly - 2009
- HealthMark Letter - 2010
- Hepatitis B Form - ACP
- I-9
- LIBC-510 (2009)
- New Hire Reporting Information
- Notice 797
- Timesheet Q and A (October 2010 Edition)
- Universal Precautions Consent - ACP
- Universal Precautions Consent - CSPPPD
- W-4 (2010)
