» Instructions and Frequently Asked Questions » Participant-Hired Worker Start- Up Checklist » Participant-Hired Worker Start-Up Information Form » F-01201: IRIS Participant-Hired Worker Set-up » F-01201A: IRIS Participant-Hired Worker Relationship...Participant-Hired Worker Paperwork • June 8th, 2023
F-00180B: Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation - F-82064: Background Information DisclosureParticipant-Hired Worker Paperwork • April 17th, 2015
INSTRUCTIONSNote: Participant-Hired Worker may be abbreviated as PHW throughout this form. Personal Allowances Worksheet: A-HThis worksheet is used to assist in determining the number of elections for this form. Employee’s Withholding Allowance Certificate: This is the portion that will need to be turned in. Some PHWs may separate the form here to keep the worksheet (top) for their records. Box 1: The legal first name, middle initial, and last name of the PHW – as well as his/her home address, city, state, and ZIP code. Box 2: The PHW’s Social Security number. Box 3: Check the box that best describes the PHW’s marital status. Box 4: Check if the PHW’s last name is different than what is shown on his/her Social Security card. Box 5: Enter the number of allowances the PHW is claiming. This is typically the same number as is found on Line H of the Personal Allowances Worksheet but may differ. Box 6: Enter any additional amount the Participant-Hired Worker Box 7: Enter “Exempt” if ## #
