2025 CDC+ Duplicate W-2 and 1099 Request Form - Official Application

Sep 19, 2026

Upload by Cart

This document serves as the official request form for the Agency for Persons with Disabilities (APD) Consumer-Directed Care Plus (CDC+) program. It facilitates the replacement of lost or missing IRS Form W-2 or 1099-MISC documents for employees and contractors. The form requires essential identifying details including consumer and provider names, identification numbers, and contact information. Users must specify the reason for the request, provide current mailing address updates, and include a formal certification statement under penalty of perjury. Processing instructions specify that documents are provided via mail only, strictly prohibiting fax or email transmission of sensitive tax documents, and emphasize that incomplete forms will lead to delays. The template ensures secure record management and regulatory compliance for financial document issuance within the state-funded CDC+ program framework.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Personal Information

Reason for Request

Certification Statement

FAQs

How can I receive my requested W-2 or 1099 forms?

Please note that CDC+ cannot fax or email your W2s and/or 1099s; they will be mailed to the address provided on the form.

What information is required to process the request?

You must provide the Consumer Name and Number, Provider Name and Number, Provider contact phone, the specific reason for the request, and a completed address section.

What must be submitted if the address is incorrect?

If the provider is a current provider and you are requesting a change of address, a new 2026 W-4 or W-9 form must be included with this request.

Sep 19, 2026

Upload by Cart