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The form collects attendant and employer details and guides the attendant to complete Part 1 or Part 2, followed by Part 3. Part 1 applies for the federal income exclusion when the attendant provides services in a shared home and meets the private life living criteria. Part 2 removes the exclusion if services in the shared home no longer apply, triggering federal and state tax withholding and earnings reporting.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/difficulty-of-care-federal-income-exclusion-form-attendant-instructions-apply-or-remove/388899/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/difficulty-of-care-federal-income-exclusion-form-attendant-instructions-apply-or-remove/388899.png","ImageObject",300,407,{"name":92,"@type":93},"Emma Wilson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-25",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How does the attendant apply for the Difficulty of Care Federal Income Exclusion?","Question",{"text":112,"@type":113},"Complete Part 1 by checking all boxes that are true for the attendant, including providing services in a shared home and meeting the private life living requirements. If all three boxes are checked, the attendant qualifies.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"When should the attendant remove the exclusion?",{"text":117,"@type":113},"If the attendant no longer provides services to the member in the shared home, complete Part 2 by checking the removal box. This starts federal and state tax withholding and reporting of earnings.",{"name":119,"@type":110,"acceptedAnswer":120},"What is required in Part 3?",{"text":121,"@type":113},"Sign in Part 3 to confirm the form has been read and that the provided information is correct and complete. Include the attendant signature, date, and printed name.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},388899,1790911191,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Difficulty of Care Federal Income Exclusion Form  \nThis form helps a Colorado Consumer-Directed Attendant Support Services (CDASS) attendant determine if they qualify for the Difficulty of Care Federal Income Exclusion. Completing this form will tell Public Partnerships LLC (PPL) whether the attendant qualifies for the exclusion or they request PPL remove it because they no longer qualify. As a Financial Management Services (FMS), PPL will appropriately apply the exclusion on the CDASS employer’s behalf.  \nMember Name (first and last):   PPL ID:   Employer Name (first and last, this is required):    \nInstructions: Attendant, complete Part 1 or Part 2 , then complete Part 3. If your information changes after you submit this form, you must report those changes to PPL by calling 888-752-8250.  \nPart 1-Apply for the Difficulty of Care Federal Income Exclusion  \nCheck all boxes that are true for you, the attendant:☐ I provide services to the member in our shared home.  \n☐ I live and perform the routines of private life, including shared meals and holidays in this home.☐ I do not have a separate home where I live.  \nIf you check all three boxes above, you qualify for the exclusion. If you checked no (0) boxes or only one or two boxes, you do not qualify for the exclusion.  \nPart 2-Remove the Difficulty of Care Federal Income Exclusion  \nIf you no longer provide services to the member in the home you share with that member, check the following box:  \n☐ I no longer qualify for the Difficulty of Care Federal Income Exclusion because I no longer provide services to the member in our shared home.  \nBy checking the box, PPL will begin withholding federal and state taxes and reporting your earnings to federal and state tax agencies.  \nPart 3-Agree and Sign  \nBy signing below, I confirm that I have read this form , and that all the information I have given on this form is correct and complete.  \nAttendant Signature:   Date:   Attendant Printed Name (first and last):   PPL ID:","cbCaisQYqqdgsJFY","https://ap.wps.com/l/cbCaisQYqqdgsJFY","pdf",119728,"English","# Part 1 - Apply for the Difficulty of Care Federal Income Exclusion\n# Part 2 - Remove the Difficulty of Care Federal Income Exclusion\n# Part 3 - Agree and Sign","[{\"question\":\"How does the attendant apply for the Difficulty of Care Federal Income Exclusion?\",\"answer\":\"Complete Part 1 by checking all boxes that are true for the attendant, including providing services in a shared home and meeting the private life living requirements. If all three boxes are checked, the attendant qualifies.\"},{\"question\":\"When should the attendant remove the exclusion?\",\"answer\":\"If the attendant no longer provides services to the member in the shared home, complete Part 2 by checking the removal box. This starts federal and state tax withholding and reporting of earnings.\"},{\"question\":\"What is required in Part 3?\",\"answer\":\"Sign in Part 3 to confirm the form has been read and that the provided information is correct and complete. Include the attendant signature, date, and printed name.\"}]","Difficulty of Care Federal Income Exclusion Form - Attendant Instructions - Apply or Remove | PDF",1790311549]