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Stavros Center for Independent Living

Stavros Fiscal Forms Page


FISCAL FORMS
[ Activity Timesheets (FI, SCO, CDC, & VIP) ] [ 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 ] [ Direct Deposit Form ] 
[ Filing for Unemployment benefits ] [ Termination Forms ] 
[ Reporting Workers Compensation Claims ] [ Reinstatement of PCA ]
[ Emergency Notification Contact Forms ] [ PCA Union Registration Form ]
[ PaychekPlus Mastercard Debit Card Forms ] [ Stavros Web Portal User Agreement ]

CONSUMER FORMS
[ 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
FISCAL FORMS

Activity Timesheets for FI, SCO, CDC, & VIP Progams

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.

Click here to download the English Activity Timesheet

Fillable Timesheet for FI, SCO, CDC, & VIP Programs

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.

Timesheet Instructions

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.

Click here to download English Timesheet Instructions

Click here to download Spanish Timesheet Instructions

Stavros Web Portal User Agreement

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.

Stavros Portal User Agreement

Week 1 Schedule

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!

Week 2 Schedule

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!

W-4, M-4, I-9, PCA Signature Forms, and New Hire Forms

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.

If you need to get copies of I-9, W-4, PCA Signature Forms, or New Hire forms please click on the links below to get them from the official government sites. Please note that all of these documents are in PDF format.

If you have any questions, please click the link to refer to the Important I-9 Instructions.

Click here to download the English Form W-4

Click here to download the Spanish Form W-4

Click here to download the Form M-4

Click here to download the English Form I-9

Click here to download the PCA Signature Form in English and Spanish

Click here to download the English New Hire Form

Click here to download the Spanish New Hire Form

Direct Deposit Forms & Paychek Plus! Select MasterCard Forms

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.

Click here to download the Direct Deposit Form

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.

Click here to download the PaychekPlus! Enrollment Form

Click here to download the PaychekPlus! ePay Broucher

Click here to download the PaychekPlus! ePay Flyer

Click here to download the PaychekPlus! Terms of Use

Termination Forms

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.

Reinstatement of PCA

Please use this form to reinstate a previously hired PCA.

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Change of Information Request Form

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.

PCA Union Registration Form

Please go to this website to sign up for the Union on-line: pcasignup.org

Any questions about joining the Union please see thier website or call them at (877) 409-1199

Filing for Unemployment benefits

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).

Click here to download the procedures for filing an unemployment claim

If you have any additional questions about filing an unemployment claim please visit the DUA website

Reporting Workers Compensation Claims

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.

Click here to download the procedures for filing a Workers Compensation claim

Emergency Notification Contact Forms

Please fill out this form and send it back to us so we have your updated contact information

 

CONSUMER FORMS

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.

Employer Packets

If you wish to download the complete Employer Packet please click here. For individual forms, please see below.

STAVROS & MASSHEALTH FORMS

Click here to download the Consumer Information Form

Click here to download the Consumer Agreement

Click here to download the Consent to Use Payroll Processing Agent

Click here to download the Department of Industrial Accidents Notice to Employees

Click here to download the Stavros Center for Independent Living Grievance Procedures

Click here to download the Stavros Center for Independent Living Notice of Privacy Practices

Click here to download the Stavros Center for Independent Living Notice of Privacy Practices Receipt

Click here to download the Stavros Center for Independent Living Notice of Privacy Practices in Spanish

Click here to download the Stavros Center for Independent Living Notice of Privacy Practices Receipt in Spanish

Click here to download the Union Deduction Schedule

IRS FORMS

Click here to download the Form 8821, Tax Information Authorization

Click here to download the Form SS-4, Application for Employer Indentification Number (EIN)

Click here to download the Form 2678, Employer/Payer Appointment Agent

Click here to download the Form M-2848, Power of Attorney and Declaration of Representative (Massachusetts DOR)