Delaware
Employer Resources
Notice of HIPAA Privacy Practices
These forms are designed to support you as an employer and consumer of services.
Federal
- Form I-9
-
This form is used to document that an employee is eligible to work in the United States.
> Download - Form W-4
-
Form W-4 indicates the amount of income tax allowance that an attendant chooses.
> Download - Form W-9
-
To be kept on file for attendants exempt from FICA taxes.
> Download
JEVS Resource Coordination
- Agreement between Consumer and Attendant
-
This is signed by both the attendant and consumer at the beginning of employment to indicate a formal employer/employee agreement.
> Download - Authorization for Release of Worker's Compensation Information
-
This form allows the insurance carrier to share limited information about the policy with JEVS staff.
> Download - Representative Form
-
This form allows the consumer to elect a designee to complete program paperwork.
> Download - Criminal Record Check Election
-
Consumer uses this form to request either a statewide or a countywide criminal background check on an attendant.
> Download - Waiver of Background Checks
-
Signed by a consumer who wishes to hire an attendant prior to receiving results of the criminal record and Adult Abuse Registry checks.
> Download - Grievance Form
-
To report a concern or a complaint about JEVS' services to our administrative staff.
> Download - Job Posting
-
To inform JEVS' coordination staff of the consumer's need for an attendant.
> Download - Declaration of Intent to Employ
-
This form indicates whether or not a consumer wishes to continue to employ an attendant based on the results of the criminal background check.
> Download - Guidelines for Hiring a Personal Attendant
-
Tips to help a consumer/employer hire the right employee.
> Download - Notice of Discontinued Employment
-
The consumer or attendant complete this form when the employment agreement between the two is broken.
> Download - PAS Attendant Application
-
Submit before hiring a new attendant.
> Download - Personal Attendant Application Checklist
-
Used to check that all forms in the attendant application have been completed.
> Download - Tip List for Consumers
-
A list of practical suggestions to promote professionalism in the consumer-attendant employment relationship.
> Download
JEVS Payroll
- Annual Payroll Summary Template
-
Used to document hours worked by all attendants for the year and their gross and net wages for the year.
> Download - Timesheet
-
Sent to JEVS Payroll Department to report the attendant's biweekly earnings.
> Download Front > Download Back - Payroll Schedule
-
Shows the deadlines for submission of timesheets and for payment of attendant for each payroll period.
> Download - Schedule for SUTA Calculations
-
Shows which hours worked during a quarter are used in the calculation of quarterly unemployment taxes (SUTA).
> Download - Quarterly Payroll Summary Template
-
Used to document hours worked by all attendants for the quarter and their gross and net wages for the quarter.
> Download
State Forms
- Adult Abuse Registry Authorization
-
Allows JEVS or a consumer to obtain this background check on the attendant completing it.
> Download - Application for State Tax ID Number
-
For consumers who need an unemployment tax account number with the Department of Labor.
> Download - Forms for Payment of State Unemployment Tax
-
Used to report and pay state unemployment taxes.
> Download