[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-638753-105":59,"doc-detail-638753-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","employee-packet-clts-checklist-for-home-care-employees","Employee Packet - CLTS Checklist for Home Care Employees","","Checklist for Home Care Employees from Fiscal Assistance, Inc. outlines required onboarding forms, signatures, and return deadlines before a start date is confirmed. It covers employment eligibility verification (including guidance to complete Section 1 and employer completion of Section 2 with supporting document requirements), tax withholding (W-4), Medicaid provider agreement, CLTS training verification, and direct deposit authorization. The packet also explains self-directed services roles and how Fiscal Assistance serves as the fiscal/employer agent supporting paperwork, background checks, timesheet review, payroll processing, and year-end W-2 issuance.",{"@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/employee-packet-clts-checklist-for-home-care-employees/638753/",{"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/employee-packet-clts-checklist-for-home-care-employees/638753.png","ImageObject",300,407,{"name":92,"@type":93},"Nguyễn Văn Học","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What must new home care employees do before a start date can be established?","Question",{"text":112,"@type":113},"All new employees must fill out each required form, sign and date them, and return every form to Fiscal Assistance, Inc. before a start date can be established. Confirmation of the start date must be received before work begins.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What documents are required for the Form I-9 in Section 2?",{"text":117,"@type":113},"In Section 2, the employer must examine one original document from List A OR one original document from List B AND one original document from List C. The employer must record the title, number, and expiration date of the documents and then sign, certify address, and date the form.",{"name":119,"@type":110,"acceptedAnswer":120},"How does Fiscal Assistance support participants and employees in self-directed services?",{"text":121,"@type":113},"Fiscal Assistance serves as the fiscal/employer agent by assisting with initial employer/employee paperwork, performing background checks, receiving and ensuring timesheet compliance, paying only authorized hours, processing payroll with tax withholding and deductions, and issuing W-2 forms at year-end.","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},638753,1792735453,{"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":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1374402739827,"https://ap-avatar.wpscdn.com/avatar/14000c97e7351f1a627?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787885694763230660","Fiscal Assistance, Inc.  \n4646 S. Biltmore Lane  \nMadison, WI 53718 Phone (608) 846-7058  \nFax: (608) 842-0115  \nChecklist for Home Care Employees  \nAll new employees must fill out each form, sign, date, and return all forms to FA, Inc. before a start date can be established.  \n** Please wait for confirmation of your start date before you begin working **  \n􀂉 Employee Acknowledgment Form  \n􀂉 Relationship Disclosure Form  \n􀂉 Background Information Disclosure  \n􀂉 Form I-9, Employment Eligibility Verification  \n**Refer to instructions and Sample I-9**  \n􀁸 Section 1-Employee must fill in and complete Section 1. Sign and date.  \n􀁸 Section 2-Employer (Person you will be working for must complete and SIGN)  \no must examine one original document from List A OR examine one original document from List B AND examine one original document from List C.  \no must record the title, number, and expiration date of the original documents in the spaces under List A OR List B AND List C in Section 2.  \no must sign, then enter his/her address, and date the form in the Certification fields in Section 2.  \n􀂉 W-4 Form-Federal Tax Withholding  \n􀂉 Medicaid Provider Agreement  \n􀂉 CLTS Training Verification Form (Employer and Employee MUST both sign)  \n􀂉 Direct Deposit Authorization (Direct Deposit of Wages)  \nA copy of a voided check or an account verification letter from your bank must accompany this form.  \nIf you have questions, please contact:  \n\n| Renae Huffman | Scarlett Russell | Theresa Chard |\n| --- | --- | --- |\n| Enrollment and Outreach Director | Enrollment and Outreach Coordinator | Enrollment and Outreach Coordinator |\n| Phone: 608.846.7058 ext. 24 | Phone: 608.846.7058 ext. 12 | Phone: 608.846.7058 |\n| [RenaeH@fiscalassistance.org](RenaeH@fiscalassistance.org) | [ScarlettR@fiscalassistance.org](ScarlettR@fiscalassistance.org) | [TheresaC@fiscalassistance.org](TheresaC@fiscalassistance.org) |\n\nReturn Packet to: Fiscal Assistance, Inc.  \n4646 S. Biltmore Lane  \nMadison, WI 53718  \nPhone: 608.846.7058 or 1-855-201-4230 (toll free)  \nFax: 608.842.0115 or 1-844-727-7533 (toll free)  \nEmail: [Enrollment@fiscalassistance.org](Enrollment@fiscalassistance.org)  \nRev. 08/2019  \nFor your information  \nNew Employee Information  \nWelcome to Self-Directed Services!  \nA participant (employer) has selected you as a potential employee. As an employee, you will provide in-home care services to your employer. The employer or his/her representative will direct the work you do, including hiring, firing, scheduling, training, supervising and managing your employment.  \nFiscal Assistance, Inc., (FA), will serve as a Fiscal/Employer Agent on behalf of the participant/employer.  \nOverview of Self-Directed Services  \nIn this employment model, employers select, hire, train, schedule, supervise and manage their own employees. The employer may elect to have a representative, a trusted friend or family member, who will help them manage their services. The employee is always an employee of either the employer or his/her representative.  \nThe employer appoints a Fiscal/Employer Agent to help with some of the administrative employer responsibilities.  \nFiscal Assistance, Inc., (FA), is the Fiscal/Employer Agent.  \nFA supports the employer or representative by doing the following:  \n􀁸 Assisting with completing initial employer/employee paperwork  \n􀁸 Performing background checks on potential employees  \n􀁸 Receiving timesheets  \n􀁸 Ensuring completed timesheets meet all requirements of the program  \n􀁸 Paying only those hours that are authorized in the participant’s budget  \n􀁸 Paying employees, including withholding taxes and processing any other deductions  \n􀁸 Issuing Forms W-2 at year-end  \nGetting Started  \nBefore you can serve as an employee, you must be approved to provide services. To be approved, you must do the following:  \n􀁸 Correctly complete and return ALL of new employee application forms. See the Checklist for Home Care Providers  \n􀁸 Pass a criminal background che","cbCaioZjnfsBxjoW","https://ap.wps.com/l/cbCaioZjnfsBxjoW","pdf",1402767,27,"English","# Checklist for Home Care Employees\n## Getting Started\n## For your information: New Employee Information\n## Program Integrity and Fraud Prevention","[{\"question\":\"What must new home care employees do before a start date can be established?\",\"answer\":\"All new employees must fill out each required form, sign and date them, and return every form to Fiscal Assistance, Inc. before a start date can be established. Confirmation of the start date must be received before work begins.\"},{\"question\":\"What documents are required for the Form I-9 in Section 2?\",\"answer\":\"In Section 2, the employer must examine one original document from List A OR one original document from List B AND one original document from List C. The employer must record the title, number, and expiration date of the documents and then sign, certify address, and date the form.\"},{\"question\":\"How does Fiscal Assistance support participants and employees in self-directed services?\",\"answer\":\"Fiscal Assistance serves as the fiscal/employer agent by assisting with initial employer/employee paperwork, performing background checks, receiving and ensuring timesheet compliance, paying only authorized hours, processing payroll with tax withholding and deductions, and issuing W-2 forms at year-end.\"}]","Employee Packet - CLTS Checklist for Home Care Employees | PDF",1792699087,68]