Stavros Center for Independent Living

Stavros Fiscal Forms Page


FISCAL FORMS

[ Activity Timesheets (FI, SCO, One Care, CDC, VIP & MFP) ] [ PCA Orientation Information ]
[ Sick Time Activity Timesheets & Instructions ] [ New Hire Packet ]
[ Fillable Timesheet (FI, SCO, One Care CDC, & VIP) ] [ Form W-4 ] Federal Withholding
[ Timesheet Instructions ] [ Form M-4 ] State Withholding
[ Week 1 Schedule ] [ Form I-9 & Instructions ]
[ Week 2 Schedule ] [ PCA Signature Forms ]
[ Change Request Forms ] [ New Hire Forms ]
[ Filing for Unemployment benefits ] [ PCA Union Registration Form ] 
[ Reporting Workers Compensation Claims ] [ Direct Deposit Form ]
[ Emergency Notification Contact Forms ] [ 1199SEIU Green Dot Debit Card ]
[ Stavros Web Portal User Agreement ] [ Reinstatement of PCA ]
[ PCA Union Information & On-Line Sign Up ] [ Termination Forms ]

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, One Care, 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. 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.

Click here to download the English Activity Timesheet

Activity Timesheets for Money Follows the Person (MFP)

Money Follows the Person timesheets are available for download below. These timesheets are only to be used by consumers in the MFP program. Consumers in other programs (FI, SCO, CDC, One Care, and VIP) must use the timesheets found above this section.

Click here to download the MFP Activity Timesheet

Sick Time Activity Timesheets

Sick Time Activity timesheets are to only be used for earned sick time taken by a PCA. Please see the Consumer Memo (English) or Consumer Memo (Spanish) and PCA Memo sent by MassHealth for rules and regulations regarding sick time. PCAs can view the sick time they have earned on-line at OnlineEmployer.com/feapca. Instructions for accessing and using the sick time portal are below. 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.

Click here to download the English Sick Time Activity Timesheet

Click here to download the English Sick Time Timesheet Instructions

Click here to download the Sick Time Portal Instructions

Fillable Timesheet for FI, SCO, One Care, 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

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!

PCA Orientation Information

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 will have an after-tax payroll deduction equal to two dollars ($2.00) per hour sanction applied until they complete the Orientation program.

If the 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 Options Form to Stavros Fiscal. A Consumer Options form is required for each PCA going through the with their conusmer. The materials for the orientation will then be mailed to them from HTB. Please allow 4 to 6 weeks for the materials to arrive. The Consumer Options Form will be included with the notification sent once an orientation eligible PCA is hired. If this form is needed, please contact Stavros Fiscal.

The PCA New Hire Orientation is available to be performed online. To complete it online, please go to https://pcaworkforcecouncil.training.ehs.state.ma.us (Please click here for instructions for the online orientation). The consumer and PCA will need to complete and return a Consumer Options form to Stavros Fiscal before accessing the site. A Consumer Options form is required for each PCA going through the orientation online. Usernames are only valid for the PCA assigned to it. They cannot be used to complete the orientation with another PCA. Please allow two weeks from returning the form to Stavros for the set up process to be completed. Stavros will contact the consumer once the online set up is complete. Please contact Stavros Fiscal if you need a Consumer Options form. .

If you are unsure if your PCA needs to complete an orientation, please contact Stavros Fiscal prior to beginning the online orientation. Only eligible PCAs, who have not completed the orientation in the past, can be paid for completing it.

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 received an orientation notification in error, please contact us at Stavros Fiscal (800) 442-1185 or by email.

PCA New Hire Paperwork

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. New hire packets with all the forms necessary to complete the set up process can be found below.

Click here to download the New Hire Packet part 1 (Required Forms)

Click here to download the New Hire Packet part 2 (Optional Forms)

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.

Required New Hire Forms

New Hire Checklist - Please use this convenient checklist to ensure to you complete and submit correctly all required forms in the PCA new hire process. Click on the link to download the New Hire Checklist in English or Spainsh

Click here to download the New Hire Form in English and Spanish

Click here to download the PCA Signature Form

Click here to download the English Form I-9 Paper version (Click here to download instructions on how to complete the Form I-9) If you have any questions, please click the link to refer to the Important I-9 Instructions. The electronic version of the Form I-9 can be downloaded here. This form still must be printed and signed before submission.

Click here to download the English Form W-4

Click here to download the Spanish Form W-4

Click here to download the Direct Deposit Form - As of January 1, 2017 all PCAs will be required to have some form of direct deposit. Please complete this form and submit it to Stavros FI with supporting documentation from the bank or debit card company of your choice. Information on the 1199SEIU Green Dot Debit Card and enrollment forms for the Paycheck Plus! Select MasterCard can be found below if needed.

Union Membership Application - Must be provided to PCA upon hiring. The PCA then has the option to join the Union. The application should be sent to the 1199SEIU.

Click to download the application for the PCA Union 1199SEIU in English

Click to download the application for the PCA Union 1199SEIU in Spanish

Optional Forms

Click here to download the Form M-4

Stavros Portal User Agreement


Direct Deposit Forms, 1199SEIU Green Dot Debit Card, & Paychek Plus! Select MasterCard Forms

PCAs must have their paycheck direct deposited into a bank account or on to a debit card. Please click on the link below to download the Stavros FI Direct Deposit form. The direct deposit forms must be filled out completely and include documentation (for proof of account) from your financial institution. Please remember the consumer and/or surrogate cannot be on the account you wish to have you paycheck direct deposited to. Return completed forms to the Stavros FI office. Information pages on direct deposit can be found here in English and here in Spanish.

Click here to download the Direct Deposit Form

The 1199SEIU sponsors a debit card option through Green Dot. Below is the Green Dot flyer with information about the card and a link to sign up for it.

Click here to download the 1199SEIU Green Dot Debit Card Flyer

Click here to sign up for the 1199SEUI Green Dot Debit Card

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.
***If you choose the PaychekPlus! Select MasterCard, please allow 5-10 business days for your card to arrive. To avoid delays to you payroll, please call Stavros FI customer service at 800-442-1185 to inform us once you have received and activated your card. We will not be able to set up your direct deposit until you inform us your card has been activated.***

Click here to download the PaychekPlus! Enrollment Form

Click here to download the PaychekPlus! ePay Brochure

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.

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 Information & On-Line Sign Up

To sign up for the 1199SEIU 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

Learn more about what trainings and classes are provided by the 1199SEIU to PCAs on the Homecare Training Benefit website. Classes available include First Aid/CPR, Computer Skills, and English for Speakers of Other Languages. For more information on these classes please call (877) 409-8283 ext 8 or email infoMA@1199funds.org.

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)