Financial duties i understand that dshs is not

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Financial Duties: I understand that DSHS is not responsible for withholding or paying income tax for my IP unless my IP asks them to; DSHS is responsible for the withholding and payment of Social Security and Medicare taxes (FICA); DSHS is responsible for the withholding and payment of federal and state unemployment taxes (FUTA/SUTA) unless the IP is my parent or my child who is between the ages of 18 and 21 years; I must report my Personal Care participation payments to state and federal taxing agencies if I: o Receive my services through Home and Community Services or my local Area Agency on Aging (AAA), and o Employ an IP, and o Pay participation for my Personal Care services. For tax information, contact the Internal Revenue Service at 1-800-829-1040 or the Washington State Department of Employment Security at 1-888-836-1900. Communicating With DSHS: I will contact my Case Manager if I: o Have any concerns about my care plan or about the quality of the care that I am receiving from my IP; o Am not receiving the services for which my IP is billing; o Am not receiving the services authorized in my care plan; o Want to change or add a provider; o Need help hiring/managing my IP; or o Want to assign more hours to my IP than his/her work week limit. I also understand that I have a right to appeal if DSHS denies me my choice of provider. CLIENT / LEGAL REPRESENTATIVE’S SIGNATURE DATE CLIENT ID NUMBER CLIENT / LEGAL REPRESENTATIVE’S PRINTED NAME DSHS 11-055 (REV. 05/2017)
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  • Spring '17
  • Michael
  • DSHS

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