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Fiscal Intermediary - Forms

These forms are frequently used in the PCA/FI program. Northeast Arc FI Department reviews all forms posted here to ensure that they are the most up to date version available.

The forms are presented as a PDF (portable document format).  This will allow you to view and print the forms from a computer. 

Blank Forms for Hiring a Personal Care Assistant

For a COMPLETE PCA HIRE PACKAGE   Click here

Formulario de Registracion del Empleado

 

 For individual forms select the form you wish to print below   

ENGLISH FORMS FORMULARIOS EN ESPANOL
FORM I-9 Blank FORMULARIO I-9
FORM I-9 Sample EJEMPLO DE FORMULARIO I-9
FORM W-4 Blank FORMULARIO W-4
FORM W-4 Sample EJEMPLO FORMULARIO W-4
FORM M-4 Blank FORMULARIO M-4
FORM M-4 Sample EJEMPLO FORMULARIO M-4
DIRECT DEPOSIT FORM FORMULARIO DE DEPOSITO DIRECTO
1199SEIU Membership Application 1199SEIU Aplicacion para membresia
FORM 2848 Power of Attorney & Declaration of Representative  
FORM 8821 Tax Information Authorization  

 

Employer / Consumer Forms  

ENGLISH FORMS FORMULARIOS EN ESPANOL
Payroll Calendar 2013 A-L Horario de Nomina 2013 A-L
Payroll Calendar 2013 M-Z Horario de Nomina 2013 M-Z
Time sheet Instructions Instrucciones para hojas de tiempo
Payroll time sheet  
Stop Payment Request Form Solicitud de paro de pago
PCA Registration Form Formulario de Registración del Empleado
PCA Signature Form  
PCA Termination Form Forma de Terminación de empleo
PCA Termination Form Sample Forma de Terminación de empleo Ejemplo
Reporting Problem when faxing a timesheet Reporte de problemas mientras mandan las hojas de tiempo por fax
Change Request and Supply Request form Solicitud de cambios y de formularios en blanco

 

General Employer/ Consumer Information  

ENGLISH FORMS FORMULARIOS EN ESPANOL
Who can be employed as PCA? Quien puede ser un PCA?
Workers Compensation Policy Póliza de Compensación al Trabajador
Northeast Arc Grievance Policy Póliza de quejas y reportes del NEARC
Northeast Arc Notice of Privacy Practices Póliza de Practicas de privacidad del NEARC
Department of Industrial Accidents Notice to Employees Notificación a empleados Departamento de Accidentes Industriales
How to file for Unemployment benefits? Como aplicar para beneficios de desempleo?
FI Customer service contact list Lista de contactos del Servicio al Cliente de FI
2013 Holiday list 2013 Lista de dias de fiestas

                                

 

 

 


 

 

 

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Main Number: 978-762-4878 - TTY 978-762-4873
The Northeast Arc is a non-profit, 501(c)3, disability service organization. Copyright 2009-2012. Northeast Arc. All rights reserved.