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Fiscal Agent Employee Checklist for Children’s Waiver Programs
April 17th, 2017
  • Filed
    April 17th, 2017

# Employee Start-up Forms When Required 1 New Employee Set-up Form For all Employees 2 Relationship Disclosure Form For all Employees 3 IRS Form W-4 (current year) For all Employees 4 IRS Form WT-4 For all Employees 5 Form I-9 Employment Eligibility Verification For all EmployeesNOTE: Section 1 must be filled out by Employee, and Section 2 must be completed and signed by the Employer/Client. 6 Copy of Social Security Card Optional but recommended 7 Wisconsin Medicaid Children’s Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgment of Terms of Participation for Sole Proprietor or Individual Waiver Service Providers(F-02364) For all Employees 8 Background Information Disclosure Form(BID) (F-82064) For all Employees 9 Employer/Client and Employee Agreement For all Employees 10 Direct Deposit Authorization Optional

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