Delaware

Employer Resources

These forms are designed to support you as an employer and consumer of services.

Federal
Homeland Security Form I-9

This form is kept in employer files to document that employee is eligible to work in the U.S. It may be presented during a USCIS audit. It requires copies of the identification specified in the accompanying "List of Acceptable Documents".

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IRS Form Schedule H

Use this form to report annual employment taxes paid by employer (FICA and FUTA). If consumer files an IRS Form 1040 for personal income taxes, the Schedule H must be sent to IRS along with the 1040.

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IRS Form W4

This form must be filled out as part of the attendant application. W4 indicates amount of withholding for income taxes. Attendant must indicate number of allowances as well as marital status and sign. Employer's address to be filled in at bottom of W4.

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W9

This form documents that the employee is tax-exempt and should be kept on file by the consumer/employer in case of an IRS audit.

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JEVS Resource Coordination
Agreement between Consumer & Attendant

This is signed by both the attendant and consumer at the beginning of employment to indicate a formal employer/employee agreement.

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Authorization for Release of WC Information

This form is signed by the consumer and is presented to the consumer's worker's compensation insurance carrier. It allows the carrier to share limited information about the policy with JEVS staff.

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Consumer Representative Form

This form is used to allow an individual to act on a consumer's behalf in the matter of completing PAS program paperwork. Both the consumer and the consumer's elected representative must sign this form.

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Criminal Record Check Election Form

This form documents whether a consumer requests JEVS to obtain a statewide or a countywide criminal background check on the attendant indicated on the form.

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Criminal Record Check Emergency Waiver Form

This form documents that a consumer has chosen to hire an attendant prior to performing and completing the state-mandated criminal record check.

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DE PAS Grievance Form

Either a consumer or an attendant can use this form to report a concern or a complaint about JEVS' services to our administrative staff.

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DE PAS Job Posting

Use this form to inform JEVS' coordination staff of the consumer's need for an attendant. It specifies particular requirements by the consumer that the attendant will need to fill the position.

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Declaration of Intent to Employ

This form indicates whether or not a consumer wishes to employ or to not employ or terminate an attendant based on the results of the criminal background check.

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Guidelines for Hiring a Personal Attendant

Tips to help a consumer/employer hire the right employee.

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Notice of Discontinued Employment

The consumer and/or attendant complete this form when the employment agreement between the two is broken. It documents the reason for the attendant's discharge or resignation.

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PAS Attendant Application

This form must be completed and submitted when hiring of new attendants

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Personal Attendant Application Checklist

This is used to verify that all forms in the attendant application have been completed.

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Tip List for Consumers

This form is a practical list of suggestions to maintain professional boundaries between the consumer/employer and their attendant.

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JEVS Payroll
DE PAS Annual Payroll Summary Template

This form is used to document the attendants who worked in any particular year as well as the total hours those attendants worked. It also documents the gross and net wages earned for each attendant during the year. It is useful in the calculation of end year FICA taxes and in the completion of worker's compensation audits.

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DE PAS Timesheet

This form is signed and verified by both the attendant and consumer and sent to JEVS' Payroll Department to report the attendant's biweekly earnings.

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DE PAS Payroll Schedule

This form shows the deadlines for submission of timesheets and for payment of attendant for each payroll period.

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DE PAS Payroll Schedule for SUTA Calculations

This form is used to determine which hours worked during a quarter are used in the calculation of quarterly unemployment taxes (SUTA).

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DE PAS Quarterly Payroll Summary Template

Use this form to document the attendants who worked in any particular quarter as well as the pay dates and the hours those attendants worked. It should also be used to document the gross and net wages earned for each attendant during the quarter. It is useful in the completion of quarterly unemployment tax (SUTA) calculations and in the completion of worker's compensation audits.

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State Forms
Adult Abuse Registry Authorization Form

This form is signed by the attendant and witnessed by another party. As part of the attendant application, this form allows JEVS or a consumer to obtain this state mandated background check on the attendant completing it.

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DE Department of Labor UC-1

Every consumer/employer needs to fill out this application for a state unemployment tax account number with the Department of Labor.

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DE Department of Labor UC-8, UC-8A and UC payment coupon

These forms should arrive together in a single packet from the Delaware Department of Labor (DOL) on a quarterly basis. They are used to report and deposit state unemployment taxes, which are paid by employers for all covered wages earned by non-exempt employees by the last day of the month following the quarter.

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