Get Independent Provider Packet

The Independent Provider Packet is a vital document for securing home care services through the CalPERS Long-Term Care Program. This guide provides clear, step-by-step instructions on how to fill out the packet accurately and effectively, ensuring a smooth application process for users of all experience levels.

Follow the steps to complete your Independent Provider Packet online.

1. Press the ‘Get Form’ button to obtain the Independent Provider Packet and open it in your preferred online editor.
2. Begin with the 'Independent Provider Personal and Professional History' section. Fill in the claimant's name and coverage ID number appropriately, ensuring that all details regarding the independent provider, such as name, address, phone number, and email are accurately listed.
3. Complete the section regarding the independent provider’s relationship to the claimant, answering yes or no to the questions regarding living arrangements and existing legal statuses.
4. Provide thorough details about the independent provider's training, education, and skills. This includes any relevant licenses or certifications, including the expiration date of coverage.
5. In the schedule section, indicate the days and hours per week the independent provider will be working. Clearly list the hourly rate that will be paid.
6. Check off whether you intend to withhold any state or federal taxes from the payments, and ensure that all information reflects the financial arrangements appropriately.
7. Sign the completed form at the bottom, ensuring both the claimant and independent provider have signed and dated it, confirming the information provided is accurate.
8. After completing all necessary sections, make sure to save your changes, then download, print, or share the completed packet as required.

Start completing your Independent Provider Packet online today to ensure timely and efficient care.