Forms

Self-direction forms that simplify your journey to independence

In self-direction, both Participants and Direct Care Workers have responsibilities in managing the relationship and making it a positive experience. Our job is to make it simpler and easier for both of you. On this page, you’ll find forms that Participants and Direct Care Workers will need to manage their relationship and comply with requirements and regulations.

Participant Packet - Complete

Enrollment Checklist

Onboarding Form

IRS Form SS4 - Application for Employer Identification Number

Sample SS-4 Completed Form

IRS Form 2678 - Employer/Payer Appointment of Agent

Sample 2678 Completed Form

IRS Signature Requirements

Michigan UIA 1488 - Power of Attorney

Release of Confidential Information Authorization

Authorized Representative Form

Backup Supports

Household Employer Orientation

Referral Form

Ageways Enrollment Packet

Ageways VA Enrollment Packet

CLS Wayne / DWIHN Enrollment Packet

DAAA Enrollment Packet

Molina Enrollment Packet

MORC Enrollment Packet

R2 Enrollment Packet

Region 7 Enrollment Packet

St. Clair Enrollment Packet

TIC Enrollment Packet

TSA Enrollment Packet

Valley Enrollment Packet

Rate Change Form

Live-In Exemption Form

Wisely Paycard Overview

Sample I-9 Completed Form

IRS Signature Requirements

Address Change Request Notification

2025 - 2026 Payroll Schedule

Earned Sick Time Act - Timesheet

Rate Change Form

DWIHN Training Payment Form

Wisely Paycard Overview

PAS Employer Pay Authorization (EPA)

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PAS Attendance Incident Report (AIR)

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PAS Progress/Visit Note (PVN)

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DoscuSign Instructions

If you have questions about the forms on this page or other aspects of self-direction, please contact PAS today.

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