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Employer & Employee Forms

Here is a list of publicly available forms used in the CDS option.

If you would like a copy of a complete Employer or Employee Packet please contact your CDS Consultant at In-Home Attendant Services.

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Employee Forms

Employer Forms

Employee Forms

[1724] New Employee Packet Cover Sheet
Open Link
[1725] Criminal Conviction History and Registry Checks
Open Link
[1729] Applicant Verification for Employees
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[1734] Service Provider and Employer Certification of Relationship Status for CDS
Open Link
[I-9] Employment Eligibility Verification USCIS
Open Link
[1728] Liability Acknowledgement
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[W-4] 2024 Employee’s Withholding Certificate
Open Link
Texas Employer New Hire Reporting Form
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[1730] Wage and Benefits Plan Employee Compensation
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[1731] Employee Work Schedule and Assigned Tasks
Open Link
[1737] Employer and Employee Service Agreement
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[1739] Service Provider Agreement
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[1727] Occupational Exposure to Bloodborne Pathogens
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[1733] Employer and Employee Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services
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[1732] Management and Training of Service Provider
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[1732-EMR] Management and Training of Service Provider Addendum
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IHAS System of Payroll
[Download PDF]
IHAS Calendar
[Download PDF]
DPS Computerized Criminal History Verification
[Download PDF]

Employer Forms

[8821] Tax Information Authorization
Open Link
[1736] Documentation of Employer Orientation by FMSA
Open Link
[1720] Appointment of a Designated Representative
Open Link
[1725] Criminal Conviction History and Registry Checks
Open Link
[SS-4] Application for Employer Identification Number
Open Link
[8822-B] Change of address or Responsible Party-Business
Open Link
[2678] Employer/Payer Appointment of Agent
Open Link
[C-1] TWC Status Report Form
[Download PDF]
[C-42] TWC Written Authorization Form
[Download PDF]
[1726] Relationships Definition in CDS
Open Link
[1735] Employer and FMSA Agreement
Open Link
[1722] Employer's Selection for Electronic Visit Verification
Open Link
[1741] Corrective Action Plan
Open Link
Employee Forms
Employer Forms

Search a complete listing of all

Texas State Forms at https://www.hhs.texas.gov/regulations/forms

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