AGREEMENT FOR IN-HOME AIDE SERVICES:In-Home Aide Services Agreement • July 14th, 2010
This Agreement establishes a working understanding between the In-Home Aide Services recipient/ family, In-Home Aide, and the N.C. Division of Services for the Blind regarding the service(s) to be provided. The Aide is employed by the DSB consumer and the Division acts as the agent for the consumer in filing Social Security taxes (FICA). A form 2678 Employer Appointment of Agent must be completed by each recipient of In-Home Level I and filed with the Chief of Independent Living Services. Changes in this Agreement may be requested by either of the signers. For significant changes, the Agreement must be rewritten. For minor changes, notations will be made on this document and signers will initial and date them on page 4. If no changes need to be made when annual redetermination is made, write date of redetermination and "no change" on previous year's agreement.
