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North Carolina
North Carolina CAP Program
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Acumen consistently exceeds 95% Customer Service Ratings across all of the programs we serve throughout the United States.
To contact Acumen Fiscal Agent, please call
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A. Innovations Waiver Forms
Participant Employer Forms
Authorization to Obtain PHI Information Form
Form 2678
Form 8821
Form SS-4
Form W-9
Innovations Acumen Authorization Form
Innovations Employer Agreement
MCO Referral Form
NC MCO Employee Background Checks Approval Process & Procedures
NC MCO MVR Check Payment Request Form
NC Budget Estimator Planning Tool
NC Client Termination Form
NC Client and Employer Change Information Form
NC Dept of Commerce POA
NC Dept of Revenue POA
NC Employee Termination Form
NC Innovations Employer Packet
NC Innovations Overtime Request Form
NC Innovations Pay Schedule July 2023 to June 2024
NC Show Me the Money
NC Trillium Bi-Weekly Pay Schedule 7-2023 to 6-2024
NC Vendor EFT Form
Overtime Estimator Tool
Withdrawal to Obtain PHI Information Form
NC Bonus and Reimbursement Request Guide
Direct Care Employee Forms
Employee Background Checks Process & Form
EVV Live-In Caregiver Attestation
Form I-9
Form NC-4
Form W-4
HR Profile Background Check
NC Background Check Forms
NC Innovations Employee Agreement
NC Innovations Employee Change Information Form
NC Innovations Employee Packet
NC Innovations Employee Rate Form
NC Innovations Pay Selection and Direct Deposit Form
NC-4EZ Withholding Form
DCI Portal
B. Alliance Forms
Withdrawal to Obtain PHI Information Form
NC Budget Estimator Planning Tool
NC Alliance Employee Packet
HR Profile Background Check
Form W-4
Authorization to Obtain PHI Information Form
Alliance Paying for Supports Packet
Alliance Max Bill Pay Rate
Alliance Employer Packet
Alliance Accrued Funds Payment Request Form
NC Online Purchase Request Form
NC Vendor Payment Form
DCI Portal
C. Partners Forms
Withdrawal to Obtain PHI Information Form
Partners Request for Employee Bonus and Reimbursement
Partners Paying Supports Packet
Partners Employer Packet
Partners Background Check Payment Request Form
HR Profile Background Check
NC Partners Max Bill Pay Rates
NC Partners BHM Employee packet
NC Budget Estimator Planning Tool
Form W-4
Authorization to Obtain PHI Information Form
NC Online Purchase Request Form
NC Vendor Payment Form
DCI Portal
D. Sandhills Forms
Withdrawal to Obtain PHI Information Form
Sandhills Max Pay Rates Form
Sandhills Employer Packet
HR Profile Background Check
NC Sandhills Paying Supports Packet
NC Sandhills Employee Packet
NC Sandhills Budget Surplus Payment Req Form
NC Budget Estimator Planning Tool
Form W-4
Authorization to Obtain PHI Information Form
NC Vendor Payment Form
NC Online Purchase Request Form
DCI Portal
E. Trillium Forms
Trillium Employer Packet
Withdrawal to Obtain PHI Information Form
Trillium Reserve Payment Request Form
Trillium Max Pay Rates
Trillium Health Resources Introduction Webinar
HR Profile Background Check
NC Trillium Paying Supports packet 6
NC Trillium Employee Packet
NC Budget Estimator Planning Tool
Form W-4
Authorization to Obtain PHI Information Form
NC Vendor Payment Form
NC Online Purchase Request Form
DCI Portal
F. Vaya Forms
Withdrawal to Obtain PHI Information Form
Vaya Employer Packet
HR Profile Background Check
NC Vaya Paying Supports Packet
NC Vaya Max Bill Pay Rates
NC Vaya Hep B Form
NC Vaya Fund Balance Payment Req Form REV 12
NC Vaya Employee Packet
NC Budget Estimator Planning Tool
Form W-4
Authorization to Obtain PHI Information Form
NC Vendor Payment Form
NC Online Purchase Request Form
DCI Portal
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