Stavros Fiscal Forms Page
[ Activity Timesheets (FI, SCO, CDC, & VIP) ] [ New Hire Packet ] [ Sick Time Activity Timesheets & Instructions ] [ Form W-4 ] Federal Withholding [ Fillable Timesheet (FI, SCO, CDC, & VIP) ] [ Form M-4 ] State Withholding [ Timesheet Instructions ] [ Form I-9 ] [ Week 1 Schedule ] [ PCA Signature forms ] [ Week 2 Schedule ] [ New Hire Forms ] [ Change Request Forms ] [ PCA Union Registration Form ] [ Filing for Unemployment benefits ] [ Direct Deposit Form ] [ Reporting Workers Compensation Claims ] [ PaychekPlus Mastercard Debit Card Forms ] [ Emergency Notification Contact Forms ] [ Reinstatement of PCA ] [ Stavros Web Portal User Agreement ] [ Termination Forms ] [ PCA Union Information & On-Line Sign Up ]
[ Consumer Welcome Letter ] [ Stavros CIL Notice of Privacy Practices ] [ Employer Packet ] [ Union Deduction Schedule ] [ Consumer Information Form ] [ IRS Form 8821 ] [ Consumer Agreement ] [ IRS Form SS-4 ] [ Consent To Use Payroll Procsessing Agent ] [ IRS Form 2678 ] [ Department of Industrial Accidents Notice To Employees ] [ Mass DOR Form M-2848 ] [ Stavros CIL Grievance Procedure ]
NOTE: In order to print out any of these forms, you are required to have Adobe Acrobat Reader installed on your computer. If you do not have it on your computer, please visit this site to download and install it. Click here to download Adobe Acrobat Reader
Timesheets are available to you only in English at this time. If you have any questions about how to fill them out, please see the timesheet instructions in the section below available in English and Spanish. Please DO NOT put any sick time on these timesheets. Please use the Sick Time Activity Timesheets for any earned sick time taken by a PCA.
Sick Time Activity timesheets are to only be used for earned sick time taken by a PCA. Please see the Consumer Memo and PCA Memo sent by MassHealth for rules and regulations regarding sick time. Additonal information regarding earned sick time can be found at mass.gov/ago/earnedsicktime. Please see the Sick Time Activity Timesheet instruction below on how to properly fill out the timesheet.
The Fillable Timesheet allows you the ability to create your PCAs timesheet on your computer using Adobe Acrobat. Simply, input the data that you would normally enter by hand, print, and sign the timesheet. (NOTE: The timesheet must STILL be signed/signature stamped by the consumer/surrogate and the PCA to be accepted.)
Get the Fillable Timesheet here! (Please right click the link and choose Save target as to download it on your computer.)
Important things to know about the Fillable Timesheet:
To move between fields on the timesheet use the Tab key or click the field with the mouse.
To fill-in the AM/PM dots either use the space bar or click on the appropriate dot with your mouse. This is also the same way to fill in the boxes for change of information.
Data cannot be saved on the timesheet.
The total day and weekly hours will not be calculated on the form for you. You must still enter this information just as you have done with the regular timesheet.
If you have questions about filling out your timesheets, please read our helpful instructions below. If you would like a copy of these instructions for your own records, please click on the following link to download a PDF copy of these instructions.
The Stavros Web Portal allows consmers and PCAs to complete their activity timesheets on-line. Please complete the Stavros Portal User Agreement to sign up for this option.
Please use this schedule if your employer number falls between 1000 thru 4999 and A001 thru M999 . It is very important that you select the proper schedule based on your employer number!
Please use this schedule if your employer number falls between 5000 thru 9999 and N001 thur Z999. It is very important that you select the proper schedule based on your employer number!
When you hire new PCA's, you need to file government I-9 and W-4 forms along with a PCA Signature form and New Hire form before their checks can be processed. Consumers also must provide their PCAs with copies of the Union Applications. A complete new hire packet with all the forms necessary to complete the set up process can be found below.
Effective immediately, PCAs hired after January 1, 2014 who are brand new to the MassHealth PCA program, must complete the PCA New Hire Orientation requirement within 6 months from their date of hire. New PCAs who fail to complete the Orientation within the six months - an after-tax payroll deduction equal to two dollars ($2.00) per hour will apply, until such time as they complete the Orientation program.
If the New PCA completes the Orientation within 2 months of their 6 month anniversary date, the payroll deductions will cease and all accumulated deductions will be returned. If the New PCA completes the Orientation after 8 months of the date of hire and submits the correct paperwork, the payroll deductions will cease but they will forfeit all accumulated deductions.
Orientations may be given by the consumer or the PCA can attend an orientation session with the Homecare Training Benefit (HTB). A consumer who wishes to do the orientation must submit a completed Consumer Option Form to Stavros Fiscal. The materials for the orientation will then be mailed to them from HTB. The Consumer Option Form will be included with the notification sent once an orientation eligible PCA is hired. If this form is needed, please contact Stavros Fiscal. Consumers may review the orientation material here prior to choosing the consumer taught option. Please note the on-line materials are for review only and cannot be used to give the orientation.
PCAs who will attend an orientation session with the HTB will need to call (877) 409-8283 to schedule a time.
If you feel you have an orientation notification in error, please contact us at Stavros Fiscal (800) 442-1185 or by email.
Click here to download the complete New Hire Packet
Individual copies of the forms found in the New Hire Packet can be found below. Please click on the links below to get the Form W-4 and Form I-9 from the official government sites. M4 forms, PCA union applications, and New Hire forms are also available below. Please note that all of these documents are in PDF format.
Click here to download the Spanish Form W-4 - The 2015 Spanish Form W4 is not currently available. You may use the 2014 Spanish Form W4 provided you are not claiming "Exempt". Individuals wishing to claim "Exempt" will need to use the 2015 English Form W4.
Click here to download the application for the PCA Union SEIU 1199 - Must be provided to PCA upon hiring. The PCA then has the option to join the Union and send the form to the Union.
If you wish to have your PCA sign up to have her/his paycheck direct deposited to her/his checking or savings account, please click on the link below to download the Direct Deposit form which must be filled out completely and mailed to the Stavros FI Office, along with a deposit form or a voided check.
Stavros FI also offers a debit card through Comerica Bank, the PaychekPlus! Select MasterCard. Please be sure to download and review all the forms. Please only return the debit card enrollment form to Stavros.You need to file a termination form for the PCA who no longer works for you. Please send this form to the FI office.
Please click on the link below to print a termination form.
Please use this form to reinstate a previously hired PCA..
Please use the Change Request Form to update any information we have on file for the consumer and /or PCAs. Please do not forget to check the change box on the timesheet.
To sign up for the Union on-line, please go to this website: pcasignup.org
Any questions about joining the Union please see thier website or call them at (877) 409-1199
The Massachusetts Department of Workforce Development provides an on-line Resource Center where unemployed persons can find contact information to different agencies designed to assist them. Please go to the Resource Center website prior to consulting unemployment briefing material found below. Click here to visit the Resource Center website.
Please use the information found in the form below to file for unemployment benefits from the Massachusetts Division of Unemployment Assitance (DUA).
If you have any additional questions about filing an unemployment claim please visit the DUA website
Please follow the procedures found in the form below to file a Workers Compensation claim with Altantic Charter Insurance if you are injured while working. All claims should be reported within 24 hours to Atlantic Charter Insurance.
Please fill out this form and send it back to us so we have your updated contact information
For a brief explaination of the forms found in this section please read the Consumer Welcome Letter. The letter is available in both English and Spanish . If you have any further questions about these forms, please ask your Skills Trainer. They will be happy to assist you.
If you wish to download the complete Employer Packet please click here. For individual forms, please see below.