Get Palco Employer Enrollment Packet 2017-2025

Filling out the Palco Employer Enrollment Packet online is a straightforward process that will facilitate your enrollment in the program. This guide provides detailed instructions on each section and field of the form to ensure you complete it accurately and efficiently.

Follow the steps to successfully complete your enrollment packet

1. Click ‘Get Form’ button to access the Palco Employer Enrollment Packet and open it in your preferred online editor.
2. Fill out the Employer Information section at the top of the Participant Referral Form. Include your full name, relationship to the participant, date of birth, social security number, and contact numbers.
3. Complete the Participant Information section by entering the names and social security numbers of all participants requiring services.
4. Proceed with the IRS Form SS-4. On Line 1, enter your full name. On Line 6, provide your county and state of residence. Continue filling out the form as per the instructions related to highlighted sections.
5. Next, move to IRS Form 2678. Print your name on Line 2 and address on Line 4. Ensure to validate that you have signed and dated the bottom of the form.
6. Complete IRS Form 8821 by entering your contact details in Box 1. Ensure to sign and date at the bottom of the page.
7. For the Authorization Agreement, print both your name and the participant's, sign, and date the highlighted area.
8. Fill out the NUCS 4556 Power of Attorney form by completing the top section. Sign and date at the bottom.
9. Review and sign the Employer Service Agreement, which outlines your responsibilities as the employer.
10. Lastly, complete the Privacy Practices Notice, ensuring your name is printed and signed where required.
11. Once all sections are complete, save the document, then download, print, or share the completed forms as necessary. Submit your enrollment packet to Palco via fax, email, or mail.

Begin filling out the Palco Employer Enrollment Packet online today to ensure your timely enrollment in the program.