FORMS

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Employee Enrollment Forms and Instructions

Enrollment Packets
Employee Enrollment Packet (single-sided) 🌐

Payroll-Related Forms and Information

Consumer Direct Care Network EVV Attestation of Service Delivery/EVV Visit Maintenance and Time Correction
αžŸαŸ†αžŽαž½αžšαžŠαŸ‚αž›αžŸαž½αžšαž‡αžΆαž‰αžΉαž€αž‰αžΆαž”αŸ‹αž’αŸ†αž–αžΈ W-2

Vendor Payment Form

Consumer Direct Care Network Vendor Payment Form

αž€αžΆαžšαž‘αž‘αž½αž›αžαž»αžŸαžαŸ’αžšαžΌαžœαž“αŸƒαž€αžΆαžšαž•αŸ’αž‘αŸ€αž„αž•αŸ’αž‘αžΆαžαŸ‹αž€αžΆαžšαž˜αž€αž›αŸαž„αžαžΆαž˜αž”αŸ’αžšαž–αŸαž“αŸ’αž’αž’αŸαž‘αž·αž…αžαŸ’αžšαžΌαž“αž·αž€ (EVV)

Employer's Selection for EVV Responsibilities (HHSC Form 1722)
αž”αž„αŸ’αž€αžΎαžαž€αžΆαžšαžŸαŸ’αž‘αž„αŸ‹αž˜αžαž·αž˜αžαž·αž”αŸ’αžšαžαž·αž€αž˜αŸ’αž˜αžšαž”αžŸαŸ‹αž’αŸ’αž“αž€αž”αŸ’αžšαžΎαž”αŸ’αžšαžΆαžŸαŸ‹αž•αŸ’αž‘αžΆαž›αŸ‹αžαŸ’αž›αž½αž“αžšαž”αžŸαŸ‹αž’αŸ’αž“αž€

αžαŸ’αž‰αž»αŸ†αž…αž„αŸ‹αž”αžΆαž“αž”αž„αŸ’αž€αžΆαž“αŸ‹αžŠαŸƒαž”αŸ’αžšαžΆαž€αŸ‹αžαŸ‚ ឬ W2αŸ”

αžαžΎαžαŸ’αž‰αž»αŸ†αž“αžΉαž„αž‘αž‘αž½αž›αž”αžΆαž“αž”αŸ’αžšαžΆαž€αŸ‹αžˆαŸ’αž“αž½αž›αž“αŸ…αž–αŸαž›αžŽαžΆ/αžαžΎαžαŸ’αž„αŸƒαž”αžΎαž€αž”αŸ’αžšαžΆαž€αŸ‹αžαŸ‚αž”αž“αŸ’αž‘αžΆαž”αŸ‹αžšαž”αžŸαŸ‹αžαŸ’αž‰αž»αŸ†αž“αŸ…αž–αŸαž›αžŽαžΆ?

αžŸαžΌαž˜αž–αž·αž“αž·αžαŸ’αž™αž˜αžΎαž›αž”αŸ’αžšαžαž·αž‘αž·αž“αž”αžΎαž€αž”αŸ’αžšαžΆαž€αŸ‹αž”αŸ€αžœαžαŸ’αžŸαžšαŸαžŸαž˜αŸ’αžšαžΆαž”αŸ‹αžšαž™αŸˆαž–αŸαž›αž”αžΎαž€αž”αŸ’αžšαžΆαž€αŸ‹αŸ”