The following forms need to be completed by the participant to be set up as an employer with us as the FEA: this allows us to provide payroll services to your hired workers (participant hired workers – PHW).
Please take the time to download, review and complete the Participant/Employer Packet. Return the completed forms to the email and/or fax # provided in the packet.
Participant Employer Packet
Downloadable PDFExample Participant/Employer Packet
Downloadable PDFPHW Wage Change/New Service Form
Downloadable PDFParticipant Employer Change Information Form
Downloadable PDFParticipant Hired Worker Termination Form
Downloadable PDF
The following forms are required to enroll as a Participant’s Hired Worker (PHW). Please take the time to download, review and complete the Participant’s Hired Worker Packet and return the completed forms using the following information:
Email: outreach.wi@outreachfiscalagent.com
Fax: 800-687-3121
Mailing Address:
204 3rd Ave Suite 110
P.O Box 945
Osceola WI 54020
It is very important that you complete these forms and return them as quickly as possible. You cannot provide services or be paid for time worked until these forms have been received and processed.
Participant Hired Worker (PHW) Packet
Downloadable PDFExample Participant Hired Worker (PHW) Packet
Downloadable PDFParticipant Hired Worker Change Information Form
Downloadable PDFTips for Completing the 2021 w-4
Downloadable PDFW-4 Form
Downloadable PDFI-9 Form
Downloadable PDFI-9 Form Instructions
Downloadable PDFDirect Deposit Authorization Form
Downloadable PDFDirect Deposit Cancellation Form
Downloadable PDFMoney Network Card Fee Schedule
Downloadable PDFTimesheet Form
Downloadable PDF
To receive payment, the following forms need to be completed by the vendor that plans to or has provided services to a Participant/Employer.
Please take the time to download, review and complete the Vendor Packet and return the completed forms.
You can email the completed packet to wivendor@outreachfiscalagent.com or fax them to 800-687-3121.
Vendor Packet
Downloadable PDFProvider Application
Downloadable PDFMA Provider Agreement
Downloadable PDFVendor Payment Calendar – 2022
Downloadable PDFSample Vendor Invoice
Downloadable PDFVendor Invoice
Downloadable PDFVendor Direct Deposit
Downloadable PDF
The following forms are used by the Participant’s Hired Worker (PHW) to receive payment. Timesheets must be submitted by email, fax, or through the Time Entry Portal (most preferred method), before midnight on the due date which is listed on the Payroll Calendar.
2022 Payroll Calendar
Downloadable PDFMileage Reimbursement Form
Downloadable PDFPHW Reimbursement Form
Downloadable PDFFFCRA
FFCRA Paid Leave
Downloadable PDFEmployee Educational Material
Downloadable PDFEmployee Claim Form
Downloadable PDF
Helpful guides and information to make your self-directed care a success.
These guides are meant to be a resource for you. Please take the time to download and read these guides.
If you have additional questions, please call us toll free at 877-901-5826 for assistance.