Get Nj Ddd Employee Hourly Wage Change Form Version 2.00

This guide provides clear, step-by-step instructions for completing the NJ DDD Employee Hourly Wage Change Form Version 2.00. By following these instructions, users can efficiently fill out the form online while ensuring accuracy and compliance.

Follow the steps to complete the form online

1. Click the ‘Get Form’ button to access and launch the form in your preferred editing platform.
2. Begin by completing Section I: Individual & Self-Directed Employee (SDE) Information. Input the DDD ID, individual name, and SDE name accurately to ensure proper identification.
3. Proceed to Section II: Support Coordinator (SC) Information. Fill in the last name, first name, phone number, email, agency, and agency email of the support coordinator to facilitate communication.
4. In Section III: Hourly Wage Table, enter the procedure/waiver code for each service applicable. Check all boxes that apply and provide a description for individual supports and expected effective date.
5. Record the current hourly wage and the new hourly wage for each service item listed in the table, ensuring that the new wage is equal to or greater than the minimum wage.
6. Both the self-directed employee (SDE) and the employer of record (EOR) must sign and date the form at the designated signature fields to validate the changes.
7. Once completed, save your changes. You may download, print, or share the form via email to Public Partnerships at njddd@pcgus.com or fax it to 1-844-561-5978.

Complete your NJ DDD Employee Hourly Wage Change Form online today for a seamless experience.