Minnesota

Participant Employer Forms

Acumen Fiscal Agent FMS Contact Information & Fees Form 2678 Form SS-4 Form SS-8 Form W-9 MN CDCS Acumen Authorization Form MN CDCS Employer Agreement Form MN CDCS How To Read Your Account Statement MN CDCS Roles & Responsibilities MN Client & Employer Change Information Form MN Employee Rate Information Form MN Employee Termination Form MN July 2025 to June 2026 Payment Schedule MN REV 184 I FORM POA MN Request for Vendor Reimbursement Form MN Show Me the Money MN Vendor EFT Form MN Worker’s Comp Waiver

Direct Care Employee Forms

Form I-9 Form W-4 Form W-4MN Form MWR Application for Tax Exempt Form MN Background Study Acceptable Forms of ID MN Background Study Fingerprint & Photo Info MN Background Study Information Form MN Background Study Privacy Notice MN CDCS Employee Agreement Form MN CDCS Roles & Responsibilities MN Department of Labor & Industry Employee Notice MN Employee Change Information Form MN Pay Selection & Direct Deposit Form MN Vaccination Letter MN Vaccine Letter Instructions

Participant Employer Forms

Acumen Fiscal Agent FMS Contact Information & Fees (1) Form 2678 Form SS-4 Form SS-8 Form W-9 MN CSG Acumen Authorization Form MN CSG Employer Agreement Form MN CSG How To Read Your Account Statement MN CSG Roles & Responsibilities MN Client & Employer Change Information Form MN Employee Rate Information Form MN Employee Termination Form MN July 2025 to June 2026 Payment Schedule MN REV 184 I FORM POA MN Request for Vendor Reimbursement Form MN Show Me the Money MN Vendor EFT Form MN Worker’s Comp Waiver

Direct Care Employee Forms

Form I-9 Form W-4 Form W-4MN Form MWR Application for Tax Exempt Form MN CSG Employee Agreement Form MN CSG Roles & Responsibilities MN Department of Labor & Industry Employee Notice MN Employee Change Information Form MN Pay Selection & Direct Deposit Form MN Vaccination Letter MN Vaccine Letter Instructions