Oregon

Participant Employer Forms

Form 2678 Form SS-4 Form W-9 OR Client & Employer Change Information Form OR DOR Tax Information Authorization Form OR Employee Termination Form OR ICP Acumen Authorization Form OR ICP Cash Benefit Auto Withdrawal Form OR ICP Cash Benefit Payment Agreement OR ICP Employer Agreement Form OR ICP Request for Vendor Reimbursement Form OR Individual & Employer Business Information OR SUTA POA -FORM 2553 Rev 03 OR Tax Authorization Rep Form Oregon Combined Payroll Tax Business Change in Status Form Employer’s Previous Business Information Form

Direct Care Employee Forms

Form I-9 Form OR-W-4 Form OR-W-4 Spanish Form W-4 OR Employee Change Information Form OR ICP Employee Agreement Form OR ICP Application for Tax Exemptions OR Pay Selection & Direct Deposit Form OR ICP EVV Only Report Schedule July 2025 to June 2026 OR ICP Payroll Schedule July 2025 to June 2026 OR Mobile App Voice Attestation