FEA Forms

A Division of the

Northeast Pennsylvania

Center for Independent Living (TM)

ACES$, Proprietary (TM)

PARTICIPANT/PERSONAL SUPPORT WORKER

ENROLLMENT FORMS

NAVIGATION MENU

PARTICIPANT/PERSONAL SUPPORT WORKER

To download forms, right-click the form you want and select Save Target As. You can also left-click the form to open it first, then save or print it

If anyone needs loose copies, they can contact us at enrollment@acessfea.org

ILLINOIS

PARTICIPANT FORMS

Definitions of Commonly Used Terms Illinois

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ACES$ Contacts

Instructions for Participant-Employer Packet

Participant Link

Illinois Participant Employer Appointment of Agent

Illinois Service Agreement Participant and Employer

SS-4 Application for Employer Identification Number

Employer Identification Number Authorization Form

IRS Form 2678 Employer Appointment of Agent Form

IRS Form 8821 Tax Information Authorization

Participant Grievance Policy/Procedure

Illinois Payroll Schedule

Consent for Release of Professional Information Form

Employer Worker's Compensation Acknowledgement Form

LE-10 Power of Attorney

UC ISSUE Checklist

Packet Checklist

ILLINOIS

PERSONAL SUPPORT WORKER FORMS

Definitions of Commonly Used Terms Illinois

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Application Illinois

Federal W4 2009

Federal W4 2010

Federal W5

Illinois W4

Employment Eligibility

Background Check Form

Acknowledgement of Employer Illinois

Participant and PSW Agreement

PSW Certification of Relationship

Illinois New Hire

Illinois Compiled Statutes Abuse and Neglect

Child Abuse and Neglect Tracking System-CANTS CFS689

Illinois Pay Schedule Final

Illinois Direct Deposit Agreement

Illinois W5NR

Notice 797

Illinois Personal Support Worker Instructions

Waiver Program Provider Agreement Part 1 of 2

Waiver Program Provider Agreement Part 2 of 2

HFS 2243-Provider Enrollment Application Illinois Medical Assistance

HFS 1413a-Waiver Program Provider Agreement For Participantion In Illinois Medical Assistance

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A Division of the N. E. PA Center for Independent Living (TM)

ACES$, Proprietary (TM)