Utah

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

*UT DSPD NEW ENROLLMENT PACKET COMPLETE (Fillable) 2678 Form F8821 Form Fingerprint Reimbursement Form Form SS-4 Sample Forms for Employers - UT DSPD UT All Change in CT ER Info REV March 2022 UT All ER Secondary Auth Rep Form March 2022 UT DSPD Acumen Authorization Form Rev March 2022 UT DSPD EVV FOB ORDER FORM REV JUNE 2022 UT DSPD Employer Agreement March 2022 UT DSPD Pay Schedule July 2022 to June 2023 UT DSPD Show Me the Money - how much can I pay 1-1-23 to 6-30-23 UT DSPD Timesheet Instructions UT DSPD Timesheet UT Employee Termination Form

Direct Care Employee Forms

DHS Code of Conduct - Required for all Employees EVV Live-In Caregiver Attestation FLSA-Employee Live-In Exemption Form Form 2-9C (ABI) Form 2-9C (CSW) Form 2-9C (PD) Form 2-9EA (ABI) Form 2-9EA (CSW) Form 2-9EA (PD) Form W-4 I-9 Form Sample Forms for Employees - UT DSPD UT DSPD Background Screening Application UT DSPD Background Screening Authorization form - REQUIRED FOR YOUTH UNDER 18 UT DSPD Background Screening Instructions UT DSPD Employee Rate Sheet UT DSPD Fingerprint Locations UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 8821 Form SS-4 UT Client & Employer Change Information Form UT EPAS Employer Agreement UT EPAS Rate Form UT EPAS Timesheet Instructions UT EPAS Timesheet UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

2678 Form Acumen Authorization Form Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT NCW Employer Agreement

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT NCW Employee Rate Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 Payment Schedule for the Salt Lake County Aging Waiver Program Payment Schedule for the Salt Lake County Alternatives Program (TAP) UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT SLC Aging Acumen Authorization Form

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2021 - June 2022 Payment Schedule UT SLC Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form

Participant Employer Forms

Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form UT Employee Termination Form UT July 2022 - June 2023 Payment Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans Timesheet

Direct Care Employee Forms

Form W-4 I-9 Form UT Employee Change Information Form UT Employee Information Form UT Pay Selection and Direct Deposit Form