Employer of Record Forms:

All forms listed below are required in order to participate in the Employee of Record program:

Background Check Release Form (PDF)

Child Waiver Employment Agreement (PDF)

CLS/EOR Time Sheet (PDF)

DHS Clearance Form (to be filled out by employees who provide services for consumers under the age of 18 only) (PDF)

Direct Deposit (PDF)

Employer of Record Agreement (PDF)

Employer of Record Fax Cover Sheet (PDF)

Fiscal Intermediary authorized signatures (PDF)

Form W-4 (PDF)

Michigan W-4 (PDF)

MORC Community Living Supports Log (PDF)

W-9 (PDF)

W-9 Instructions (PDF)

Additional Forms:

2011-2012 Payroll Pay Period Schedule (PDF)

Child Waiver Program Voucher (PDF)

Mileage Log (PDF)

Respite Only Forms:

All forms listed below are required in order to participate in the Respite Only program:

Affidavit (PDF)

Background Check Release Form (PDF)

DHS Clearance Form (to be filled out by employees who provide services for consumers under the age of 18 only) (PDF)

Direct Deposit (PDF)

Respite Invoice (PDF)

Respite Provider Agreement (PDF)

W-9 (PDF)