Stavros Center for Independent Living

Stavros Fiscal Forms Page


FISCAL FORMS
[ Activity Timesheets ] [ Direct Deposit Form ]
[ Type-able Timesheet ]
[ Timesheet Instructions ] [ Week 1 Schedule ]
[ I9/W4 forms ] [ Week 2 Schedule ]
[ W5 forms ] [ Reinstatement of PCA ]
[ PCA Signature forms ] [ Change Request Forms ]

[ New Hire Forms ]

[ CDC Program Forms ]
[ Termination Forms ] [ PCA Union Registration Form ]

SCO FORMS
[ CCA ]
[ Evercare Timesheets ]
[ SWH ]

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

 

Activity Timesheets


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 Active Timesheet

 

Type-able Timesheet

The Type-able 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 consumer/surrogate and the PCA to be accepted.)

Get the Type-able timesheet here! (Please right click the link and choose Save target as to download it on your computer.)

Important things to know about using the Type-able timesheet:

To move between fields on the timesheet use the tab key or click the field with the mouse.

To fill-in 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 daily and weekly hours will not be calculated on the form for you. You must still enter this information 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

 

I9/W4, PCA Signature Forms, and New Hire Forms


When you hire new PCA's, you need to file government I9 and W4 forms along with a PCA Signature form before their checks can be processed.

If you need to get copies of I9, W4, or PCA Signature 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 W4 form

Click here to download the Spanish W4 form

Click here to download the English I9 form (This form is not available in Spanish format)

Click here to download the PCA Signature form

Click here to download the English New Hire Form

Click here to download the Spanish New Hire Form

 

W5 Forms

If any of your PCAs want to file for earned income credit, she/he will need to fill out a W5 form.

If you need to get copies of the W5 form, please click on the link below to get it from the official goverment site. Please note that all of these documents are in PDF format and Spanish format does not exist.

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.

Click here to download the English Termination Form

Click here to download the Spanish Termination Form

 

Direct Deposit 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

Week 1 Schedule

Please use this schedule only 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 only if your employer number falls between 5000 thru 9999 and N001 thru Z999 . It is very important that you select the proper schedule based on your employer number!

Reinstatement of PCA

Please use this form to reinstate a previously hired PCA.

 

Change of Information Request Form

Please use the Change Request Form to update any informationwe 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 use this form if you wish to join the PCA Union (1199 SEIU). Please note if you are a PCA for only SCO CONSUMERS you cannot join the union at this time.

Click here to download the Union Registration Form

Any questions about joining the union please check their website located here or call them at (877) 409-7227

CDC Program Forms (Consumer Directed Care)

Please use this form for the Consumer Directed Care Program.

 

SCO FORMS - USE ONLY IF YOU ARE PART OF SCO (Senior Care Option)

CCA

Evercare Timesheets

SWH

Click here to download the SWH Form