Indiana Consumers Directed Attendant Care Program  

Procedures & Information

Federal Form 2678 NEW Federal Form W-4 2023 NEW Federal SS-4 Form NEW Federal USCIS Form I-9 2023 NEW Health and Wellness_IN FSSA Consumer Referral Form – PPL24 NEW Health and Wellness_IN FSSA Consumer and Employee Relationship Form NEW Health and Wellness_IN FSSA Direct Deposit Update NEW Health and Wellness_IN FSSA Employee Checklist NEW Health and Wellness_IN FSSA Employee Enrollment NEW Health and Wellness_IN FSSA Employee Training Checklist NEW Health and Wellness_IN FSSA Employee Welcome Letter NEW Health and Wellness_IN FSSA Employer Welcome Letter + FAQs – PPL24 NEW Health and Wellness_IN FSSA Employer of Record Cover Page – PPL24 NEW Health and Wellness_IN FSSA Employment Agreement NEW Health and Wellness_IN FSSA FLSA Live-in Exemption NEW Health and Wellness_IN FSSA Information Authority Form – PPL24 NEW Health and Wellness_IN FSSA Referral Form Cover Page – PPL24 NEW Health and Wellness_IN FSSA Separation of Employment Form NEW Health and Wellness_IN FSSA Tax Exemptions NEW Health and Wellness__IN FSSA Employer Agreement – PPL24 NEW IN POA-1 Form 49357 (7-23) NEW IN SF 2837 NEW IN WH-4 (8-23) NEW Pathways_Consumer Referral Form – PPL24 NEW Pathways_IN FSSA Consumer and Employee Relationship Form NEW Pathways_IN FSSA Direct Deposit Update NEW Pathways_IN FSSA Employee Checklist NEW Pathways_IN FSSA Employee Enrollment NEW Pathways_IN FSSA Employee Training Checklist NEW Pathways_IN FSSA Employee Welcome Letter NEW Pathways_IN FSSA Employer Agreement – PPL24 NEW Pathways_IN FSSA Employer Welcome Letter + FAQs – PPL24 NEW Pathways_IN FSSA Employer of Record Cover Page – PPL24 NEW Pathways_IN FSSA Employment Agreement NEW Pathways_IN FSSA FLSA Live-in Exemption NEW Pathways_IN FSSA Information Authority Form – PPL24 NEW Pathways_IN FSSA Referral Form Cover Page – PPL24 NEW Pathways_IN FSSA Separation of Employment Form NEW Pathways_IN FSSA Tax Exemptions NEW

Payroll Documents

Blank Timesheet IN FSSA Pay Schedule 2025 NEW IRS Form W-4 IRS Form W-4 (Spanish)

Referral & Enrollment Process

Consumer Directed Attendant Care Overview IN FSSA Direct Deposit Form IN FSSA Employee Welcome Packet IN FSSA Pay Schedule 2024 IN FSSA Quick Hits Guide IN FSSA Referral Form IN FSSA Separation Of Employment Form IN What To Expect Enrollment Timeline New Employee Enrollment Path Participant Enrollment Path USCIS Form I-9 USCIS Form I-9 Instructions USCIS Form I-9 Instructions, Spanish (FOR REFERENCE ONLY) USCIS Form I-9, Spanish (FOR REFERENCE ONLY)