North Carolina CAP Program

Authorization to Obtain Disclose PHI Form Personal Representative Form Participant Employer Packet Employee Rate Form Participant Deductible Payment Agreement Employee Wage and Hours Agreement Form Employee Termination Form GEN-58 GEN-58 Guide Nurse Employee Attestation Form NC Dep. of Commerce POA NC Dept. of Commerce POA SAMPLE

Form W-4 Form NC-4EZ Form I-9 Form NC-4 Employee Packet Attestation to the Employee Live-in Exemption Form EVV Live-In Caregiver Attestation Form Direct Deposit Cancellation Form Direct Deposit Authorization Form

NC CAP Pay Schedule July 2025 – June 2026

What is Medicaid Fraud Signs of Abuse, Neglect & Exploitation Employer Resource Guide Employee Safety Training NC CAP Case Worker Monthly Deductible Attestation FAQ’s for NC CAP Commonly Used Acronyms and Terms for NC CAP CAP Max Pay Rates

CAP Participant Referral Form – FMS Transfer CAP Participant Referral Form – New to Self-Direction CAP Budget Request Form Case Worker DCI Access Request CAP Participant Referral Form – Employer Switch Case Worker Monthly Deductible Attestation