DeafBlind Consumer Directed

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Service Initiation Paperwork

• Service Initiation Packet - DBCDS
• Customer Information Page
• Authorization to Release Information
• Disclosure of Employment Responsibilities - Equal Employment Opportunity / Affirmative Action
• Disclosure of Employment Responsibilities - I-9 Compliance
• Notice of Privacy Practices
• Designation of Privacy Official and Contact Information
• PICS Spending Summary Flier
• DeafBlind Overview / Fee Flier
• DeafBlind Grant Agreement

New Employee Hiring Paperwork

• W-4
• Background Study Authorization
• Employment Agreement for Assisting Employee
• Application for Employment
• Child Support Disclosure Form
• Health Information Privacy and Confidentiality (HIPPA) Training Certification - DeafBlind Services
• Form I-9 - Employment Eligibility Verification
• Intervenor for DeafBlind Fact Sheet
• Maltreatment of Minors Training Certification - DeafBlind
• New Employee Checklist - DeafBlind
• Employee Notification of Rights and Responsibilities regarding personnel files
• Program Assistant Fact Sheet (Draft)
• Support Service Provider Fact Sheet
• Vulnerable Adult Training Certification

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