Individual Provider Enrollment Forms
If you have selected an individual provider who will be assisting you with your needs and they need to be enrolled in the payroll system, please download, print and return an Individual Provider Enrollment Packet.
A completed enrollment packet is required to enroll the provider as an authorized service provider in the payroll system. Time cards will not be issued until a completed packet is received by your social worker.
Please make sure that you contact your social worker to report any changes in your provider status within 10 days.
The packet is currently being revised please check back at a later date.