1. Employers/Individuals and Personal Support Workers (PSWs) Transition to Oregon’s new Financial Management Agent Services (FMAS) Filling out necessary paperwork
December 2016

2. What is changing and when?
Oregon Developmental Disability Services (ODDS) is transitioning the Financial Management Agent Services (FMAS) for individuals who hire their own employees (PSWs).
TNT  PPL
Employers: Everyone who currently employs PSWs (or wants to continue having the option to hire PSWs in the future) will need to complete PPL enrollment to transfer to the new system to continue paying their support providers.
PSWs: Will need to complete PPL enrollment to transfer to the new system in order to be paid for the hours that they work.
All necessary paperwork must be fully processed by PPL no later than December 15th to ensure payment without interruption.
Information Session for CDDPs and Brokerages

3. When will PPL begin issuing paychecks?
The first pay period in December is the last time paychecks will be generated from TNT.
Last TNT payroll expected to be deposited/mailed by: 12/31/ (for payroll period Dec 1-15, 2016)
PPL will begin issuing paychecks the second pay period in December.
First PPL payroll to be deposited/mailed: 1/18/ (for payroll period Dec 16-31, 2016)
You will be able to access PPL’s full payment schedule for 2017 at:
Information Session for CDDPs and Brokerages

4. List of forms being sent to new Employers and PSWs
Note: PSW forms require signatures from both the Employer and PSW.
Employers
Signatures
IRS SS-4 Application for Employer Identification Number
**for new Employers only. TNT Transition Employers don’t need this form.
Employer only
2. IRS Form 2678 Employer/Payer of Agent
3. OR Form Tax Information Authorization & POA Rep
4. Responsible Party Form (optional)
Employees (PSWs)
1. Provider Information and Attestation Form
BOTH
2. I-9 Employment Eligibility Verification
3. W-4
Employees (PSWs) only
CME Webinar for enrolling new Employers and PSWs

5. EMPLOYERS: Confirm information in Enrollment Packets
If any information is incorrect:
Employers will need to contact PPL’s customer service to receive a new Enrollment Packet.
Toll-free number – English
Toll-free number – Spanish
Toll-free number – Russian
TTY free number
Information Session for CDDPs and Brokerages

6. EMPLOYERS: Required form
IRS Form 22-4 Application for Employer Identification Number
# of pages: 1
Who needs to sign?: Employer only
What am I signing?: This form is an Application to the IRS for receiving an Employer Identification number.
Where do I sign? PPL put the Employers information into this form. Employers only need to sign and date where highlighted in yellow.
CME Webinar for enrolling new Employers and PSWs

7. EMPLOYERS: Required form
IRS Form 2678 Employer/Payer Appointment of Agent
# of pages: 1
Who needs to sign?: Employer only
What am I signing?: This form tells the IRS that the Employer is giving PPL permission to complete tax processes on their behalf for this program. This form only allows us to withhold taxes from the PSW’s paychecks and deposit those taxes with the IRS. It does not allow PPL access to any personal income tax information.
Where do I sign? PPL will put the Employers information into this form. They only need to sign and date where highlighted in yellow.
Information Session for CDDPs and Brokerages

8. EMPLOYERS: Required forms
OR Form Tax Information Authorization & Power of Attorney Representation
# of pages: 1
Who needs to sign?: Employer only
What am I signing?: This state form will authorize PPL to perform withholding and other tax preparations/ filing functions on behalf of the Employer at the state level.
Where do I sign? PPL will put the Employer’s information into this form. They only need to sign and date where highlighted in yellow.
Information Session for CDDPs and Brokerages

9. EMPLOYERS: Optional form
Responsible Party Form
# of pages: 1
Who needs to sign?: Employer and responsible party
What am I signing?: This form gives PPL permission to speak to someone other than the Employer. An employer may want a friend or family member to be able to contact PPL with questions or to update the employer’s information. Without this form on file, PPL may only give case-specific information to the Employer themselves.
Where do I sign? The responsible party and employer sign and date the fields highlighted to the right:
Information Session for CDDPs and Brokerages

10. PSW: Required form Provider Information and Attestation Form
This is a 7 page form which needs to be returned.
PPL uses this form to enroll someone in their system. It also tells PPL:
How the PSW wants to be paid (Direct Deposit Form)
The relationship between the Employer and PSW for tax purposes; and
Communicates responsibilities of a PSW in this program.
On this page, select your Gender and Relationship to Member.
Example: if you are a parent, and you are providing care/service to your child (individual/employer), you would select “Parent / Step Parent box.
Both the PSW and Employer must sign this form (page 7)
Information Session for CDDPs and Brokerages

11. PSW: Required form Form I-9 Employment Eligibility Verification
This is a 2 page form that needs to be returned
The Employment Eligibility Verification Form I-9 is a U.S. Citizenship and Immigration Services form. It is used by an employer to verify an employee's identity and to establish that the worker is eligible to accept employment in the United States.
If your CDDP or Brokerage has a copy of the I-9 on file for existing Employer/PSW relationships these can be sent directly to PPL via fax. If you would like to submit I-9’s on behalf of your PSWs please await further instruction from the state before doing so.
Information Session for CDDPs and Brokerages

12. PSW: Provider Information and Attestation Form
...page 3:
Page 3 (of 7) is to determine if PSW is eligible for the Difficulty of Care tax exclusion. They should check all boxes that applies in Step 2.
CME Webinar for enrolling new Employers and PSWs

13. PSW: Provider Information and Attestation Form
...page 4:
Complete this page to inform PPL whether you would like payment via Direct Deposit (DD), ADP Aline Payroll (debit) card, or paper check. Bank Account Type and Account Inforamtion is required for DD.
CME Webinar for enrolling new Employers and PSWs

14. PSW: Provider Information and Attestation Form
Relationship Questionnaire:
Page 5 (of 7) helps us to determine the PSW’s relationship to the employer so we may properly withhold your taxes and determine if eligible for exemption of FICA/FUTA withholdings.
Check off the Yes/No boxes as appropriate.
NOTE: The relationship questions #2-4 should be based on the Individual the PSW provides services to – (not the “employer if this is different from the Individual).
Information Session for PSWs and Employers

15. PSW: Provider Information and Attestation Form
...page 7:
Page 6 and 7 is the Employment Agreement and must be sign and dated by both the Employer and Personal Support Worker (Provider)
Information Session for PSWs and Employers

16. PSW: Required form
Federal Form W-4 Employees Witholding Allowance Certificate
All PSW’s will need to complete a new W-4 withholding form. For specific advice on how to complete this form PSWs should seek assistance from their tax professional.
Information Session for CDDPs and Brokerages

17. PSW: I-9 Employment Eligibility Verification
# of pages: 2
Who needs to sign?: PSW and Employer
What am I signing?: The Employment Eligibility Verification Form I-9 is a U.S. Citizenship and Immigration Services form. It is used by an employer to verify an employee's identity and to establish that the worker is eligible to accept employment in the United States.
Where do I sign?
PSW must sign and date page 1 where highlighted to the right.
Employer must sign and date on page 2.
Note: PPL cannot pre-populate this form due to DHS guidelines surrounding employer liability.
Information Session for PSWs and Employers

18. PSW: I-9 Employment Eligibility Verification
Section 1 (page 1): 1
Complete the following information:
PSW (Employee) Demographic Information (including SSN)
Checkbox verifying citizenship status
Employee signature 2 3
Information Session for PSWs and Employers

19. PSW: I-9 Employment Eligibility Verification (con’t.)
Section 2 (page 2): 1
Complete the following information:
PSW name
You will be required to provide documentation which verifies your identity. Depending on what type of documentation you provide, you will complete the info. in List A, B, or C.
Please reference page 3 of the I-9 form for more information on authorized forms of ID
PSW’s first date of employment
Employer signature and demographic information
Section 3 at very bottom of I-9 is for rehires only - do not fill out that box/area. 2 3 4
Information Session for PSWs and Employers

20. Where are completed forms sent?
Completed forms can be submitted using one of the following options:
Secure Fill out, sign and scan all required forms into a PDF format. Call PPL customer service to request a secure link be sent to your address. Then attach the PDF to the provided secure link and send to:
Fax: Fill out, sign and scan all required forms and Fax to PPL’s secure fax line:
Mail: Fill out, sign, and send the packet to PPL at:
Public Partnerships – OR FMAS PO Box Phoenix, AZ 85076
PPL will process submitted paperwork within 4 business days of receipt.
Information Session for CDDPs and Brokerages

21. Where can we go to learn more and get help?
PPL will have a dedicated Call Center for OR FMAS program callers beginning October 14th.
Monday-Friday, 8:00 AM to 5:00 PM Pacific Time
(excluding State and Federal holidays)
Toll-free number – English
Toll-free number – Spanish
Toll-free number – Russian
TTY
Fax number (e-fax)
Customer Service address for general questions
Enrollment Paperwork Submission address
Information Session for CDDPs and Brokerages

22. Where can we go to learn more and get help?
PPL has a dedicated OR FMAS website where BetterOnline training materials will be available:
Information Session for CDDPs and Brokerages