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To designate a respite worker, both parties must complete and sign/initial the areas indicated on the Parent/Guardian Waiver. The person being designated must complete the W-4. A copy of a signed Social Security card or other documentation matching the person’s name to the Social Security number should be included. The original forms must be received by Respite, Inc. before a worker can be paid, however, services can be provided during the interim. In order to match the forms with the correct person it is best to submit the original forms with the person’s first timesheet. A direct deposit form can be found on the “Workers” page.
Click on the following underlined titles to open and print forms:
Parent/Guardian Waiver – Designate a Respite Worker
Fill in blanks as indicated.
W-4 (Federal Withholdings)
A copy of documentation matching the respite worker’s name with Social Security number should be included.
Padre/Custodio renuncia a favor del trabajador/a designado de respiro
Complete los espacios en blanco
Una copia de un documento con el nombre y el numero de seguro social del trabajador/a debe ser incluido.
Fillable Form I-9 Once open, Click on Form I-9 (PDF, 535 KB) near the top of the webpage.