Payment & Ongoing Forms
EPAS
Participant Forms
DSPD
Participant Forms
- Full Employer Packet >
- Set-Up Form >
- IRS Form SS4 >
- IRS Form 2678 >
- IRS Form 8821 >
- Domestic Employment Status Report >
- How Much Can I Pay? >
- Working Agreement >
- Rate Form >
Worker Forms
Self-Administered Respite (SAR)
Worker Forms
Autism
- Worker Packet >
- Employee Set-Up Form >
- I9 >
- W4 >
- Relationship Form >
- Live-In Exemption Form >
- Direct Deposit Agreement Form >
- Background Screening Application (Adult) >
- Youth Background Screening Application (Minor) >
- Employment Agreement (2-9EA) >
- Employer Service Agreement (2-9SA) >
- Application for Certification (2-9C) >
Worker Forms
Acquired Brain Injury (ABI)
- Worker Packet
- Employee Set-Up Form >
- I9 >
- W4 >
- Relationship Form >
- Live-In Exemption Form >
- Direct Deposit Agreement Form >
- Employment Agreement (2-9EA) >
- Employer Service Agreement (2-9SA) >
- Application for Certification (2-9C) >
- Background Screening Application (Adult) >
- Youth Background Screening Application (Minor) >
Worker Forms
Community Supports Waiver (CSW)
- Worker Packet >
- Employee Set-Up Form >
- I9 >
- W4 >
- Relationship Form >
- Live-In Exemption Form >
- Direct Deposit Agreement Form >
- Employment Agreement (2-9EA) >
- Employer Service Agreement (2-9SA) >
- Application for Certification (2-9C) >
- Background Screening Application (Adult) >
- Youth Background Screening Application (Minor) >
Worker Forms
Physical Disabilities Wavier (PDW)
- Worker Packet >
- Employee Set-Up Form >
- I9 >
- W4 >
- Relationship Form >
- Live-In Exemption Form >
- Direct Deposit Agreement Form >
- Employment Agreement (2-9EA) >
- Employer Service Agreement (2-9SA) >
- Application for Certification (2-9C) >
- Background Screening Application (Adult) >
- Youth Background Screening Application (Minor) >
Worker Forms
Limited Supports Waiver (LSW)
New Choices Waiver (NCW)
Participant Forms
- Participant Packet (Full) >
- Employee Set-Up Form >
- IRS Form SS4 >
- IRS Form 2678 >
- IRS Form 8821 >
- Domestic Employment Status Report >
- Working Agreement >
- Rate Form >
Technology Dependent Waiver (TDW)
Participant Forms
Medically Complex Children’s Waiver (MCCW)
Participant Forms
- Participant Packet (Full) >
- IRS Form SS4 >
- IRS Form 2678 >
- IRS Form 8821 >
- Domestic Employment Status Report >
- Working Agreement >
- Rate Form >
Aging Waiver
Participant Forms
- Participant Packet (Full) >
- IRS Form SS4 >
- IRS Form 2678 >
- IRS Form 8821 >
- Domestic Employment Status Report >
- Working Agreement >
- Rate Form >
Contact Information
Phone: (801) 317-1900
Toll Free: (855) 355-5363
Fax: (855) 500-4521
Email: utah@premier-fms.com
alee@premier-fms.com
Mail: 2150 S 1300 E Suite 500
Salt Lake City, UT 84106
