Fiscal Intermediary PDF File Access


The Fiscal Intermediary Program makes frequently used forms available from this location.

The forms are provided as PDF (portable document format). This will allow viewing and printing of forms from your computer. You can learn more and download the free Acrobat Reader* distributed by Adobe Systems. If you do not have Reader installed on your computer, click on the button below to open a link to the Adobe website. Follow the instructions for downloading the free Acrobat Reader*.

 

 

 

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BLANK PDF FORMS PDF SAMPLE FILES
   

  NEW!     FILL-IN TIMESHEET    NEW!

 

   

 

 

CONSUMER AGREEMENT

 

FORM SS-4

SAMPLE FORM SS-4

FORM TA-1

SAMPLE FORM TA-1

FORM 8821

SAMPLE FORM 8821

FORM 8655

SAMPLE FORM 8655

CONSENT PAYROLL AGENT FORM 2678

SAMPLE FORM 2678

CONSENT HEALTH INFORMATION

 

CHANGE & REQUEST FORM  
FORM W-4 SAMPLE FORM W-4
FORM W-5: Earned Income Credit  
EMPLOYMENT ELIGIBILITY VERIF.I-9 SAMPLE FORM I-9
DIRECT DEPOSIT APPLICATION  
DEBIT CARD APPLICATION  
PCA SIGNATURE FORM  
PAYROLL PROCESSING AGENT CONSENT
 
LETTERS & MEMOS
 

EMPLOYMENT PACKAGE LETTER

DEBIT CARD MEMO

POLICY & PROCEDURE: GRIEVANCES

FORM 0590-A: FILING UNEMPLOYMENT

PRIVACY NOTICE PCA SCHEDULE 1
WHO MAY NOT BE A PCA PCA SCHEDULE 2
TIMESHEET INSTRUCTIONS I-9 MEMO
NOTICE 797: EARNED INCOME CREDIT  
   
PCA SCHEDULE 1 (2008)  
PCA SCHEDULE 2 (2008)