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CA GGRC Worker Application Instructional Packet

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Dear Worker,

Thank you for applying.

GGRC has contracted with PCG Public Partnerships, LLC (PPL) to act as a Financial Management Service (FMS) provider for participants who choose to participant-direct their services. PPL will send out payment once all correct forms have been received and processed. You are not permitted to work prior to your participant receiving their good to go call from PPL.

Please use this instructional packet to fill out your employment forms. When finished, please fax the forms back to PPL at (855)867-1676. You may also email them to us at CAGGRCenrollment@pcgus.com. Your Participant will receive a phone call once the paperwork has been processed to inform them of next steps.

Should you need new forms or additional instructions, these items can be printed from our website: www.publicpartnerships.com. Click on “Select a Program” in the upper-right hand corner of the page. Then select “California” from the drop-down menu. Next, click on the California Golden Gate Regional Center Program. Lastly, click on “Program Documents” link on the right hand side of the page. You may also contact our customer service department at (877)522-1053, Monday through Friday from 8:00am to 6:00pm PST.

We look forward to working with you!

Sincerely,

Public Partnerships, LLC

Instructions for IRS Form W-9

The W-9 form is a form used by the Internal Revenue Service. This form is for individuals providing services as an independent contractor. PPL will not withhold taxes from the amount we pay you as a contractor, so this form is required to ensure that your earnings are reported accurately to the IRS.

When do I send this form? You must fill out this form at the start of employment. PPL will only need this form once, you do not have to submit a new form yearly.

Where can I find this form? For more information, you can go online to www.irs.gov/pub/irs-pdf/fw9.pdf.

What if the employee is under 18? If your state employs individuals under the age of 18, the independent contractor would still be required to fill out a W-9 form. It would be completed the same way that an independent contractor age 18 or over would.

What parts of the form are required? In addition to your signature, several fields are required to complete your W-9. Your name, social security number, and home address (no post office boxes) are all needed for an accurate form. You will see this on page 1 of your W-9 form toward the top of the page. Some of these fields may already be populated on your form; however, if they are not there or are incorrect, you will need to fill them out yourself.

Take a look at the example below to see what a completed W-9 should look like:

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Instructions for IRS Form W-9

Who signs the W-9 form?

Only the independent contractor’s signature is needed to complete the form. Under “Part II” of the first page of the form, you will see a space for you to sign and date your W-9 form.

Are there parts that are not required? The second and third pages of the form W-9 do not need to be sent back. These are instructional pages for your information only. Please be sure to send back the first page to PPL as we will need this on file to issue payments.

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Criminal Background Check & Training Instructions

Criminal Background Check Information/Instructions: The Golden Gate Regional Center Participant Directed Services Program allows participants and employers to request criminal background checks for potential workers.

Note: As a standard practice, PPL runs all potential workers through an OIG (Officeof Inspector General) check. Regardless of the Employer’s preference for a criminal check. The OIGresults do not include a comprehensive criminal history.

If Employer conducts criminal background check, they must submit the check within 5 business days of their worker’s enrollment. B ackground check will be performed through LiveScan technologies. Once the criminal history results are received, PPL must be notified of results within 24 hours. Worker will not be able to perform services until results are received.

Employer and Worker are required to complete the “Request for LiveScan Service” form foundonline. Worker must take the form with them to the nearest LiveScan location for processing.

Understand the cost of processing a criminal background check is at the expense of the employer andwill not be reimbursed by GGRC or PPL. Costs vary from location to location; please see theLiveScan website for more information.

LiveScan locations: http://ag.ca.gov/fingerprints/publications/contact.php

Criminal Background Check & Training Preference Form: Indicate if Criminal Background Check is required or not. (Select one)

OR

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Criminal Background Check & Training Instructions

Training Instructions: Some participants require the workers to be CPR and/or First Aid Certified or have additional training(s).

If so, employer will indicate and require appropriate documentation of CPR, First Aid training, or other participant specific trainings be submitted. These will need to be received by PPL prior to services being performed.

Form will need to be signed and dated by both the Worker and Participant/Employer, then returned to Public Partnerships LLC either by mail or fax.

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Instructions for Direct

Deposit Setup What is the purpose of this form?

This is an optional form and should be submitted back to Public Partnerships if a worker would

like their payments made via Direct Deposit, they may fill out and submit this form to Public

Partnerships, LLC (PPL). Keep in mind, it will take approximately one to two pay periods for

direct deposit to become active. In the interim, the employee will receive a paper check mailed to

the address on file.

How do I complete this form?

Fill in your Name, Participant/Employer Name, PPL ID (if known), and Social Security Number

in the blanks at the top of the page.

Check off the appropriate box indicating if the request is a new request, Change request, or a

Cancellation request.

Check off the appropriate box indicating if the Direct Deposit is going to a Checking Account,

Savings Account, or a Pay Card.

Check off the “Do NOT Send the Paper Remittance Advice…” box if you prefer to view

your paystubs online.

Attach a Voided Check to the form OR submit documentation from your current financial

entity confirming the account number and routing number. Cancellation request DO NOT

require supporting documentation, but DO require the Participant/Employer name to be listed.

Sign and Date the bottom of the form.

Where to send the form?

Fax E-mail Mail

1-855-867-1676 caggrc@pcgus.com Public Partnerships, LLC Attn: CA GGRC 7776 S Pointe Pkwy W, Suite 150 Phoenix, AZ 85044

Public Partnerships, LLC CA GGRC 7776 S Pointe Pkwy W Suite150 Phoenix, AZ 85044

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PPL E-Timesheet/E-Invoice Notification

Dear Participant and Worker,

The purpose of this letter is to inform you of the benefits of submitting your timesheets and invoices online. Online timesheets/invoices are a fast and easy option to submit timesheets and mileage invoices. This will allow you to avoid faxing or mailing them to us. The online system will catch most errors. That means it most likely will not allow you to submit incorrect timesheets or invoices. You will also be able to monitor your timesheet and invoice status in the online timesheet system. You may also view and print check stubs from this area as well.

Please note: in order to send in timesheets and invoices online, both the Worker and Employer will have to register for an online account. The worker will need to create and submit their timesheet or invoice online. Once they have completed this, the Worker must notify the Employer. The Employer must then sign in and approve the submission. The Employer will also have the option to reject the timesheet or invoice if it has errors.

For more information regarding how to submit online for payment or how to create an account, please visit http://www.publicpartnerships.com/programs/california/GGRC/program.asp. Then, select “Registering For Portal – Employers and Workers. For any additional questions, please contact customer service at (877) 522‐1053 or email us at CAGGRC@pcgus.com Our customer service team is available Monday- Friday 8am-5pm. We look forward to speaking with you!

Sincerely,

Public Partnerships, LLC

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Transportation (Passes, Other) Invoice Instructions

If you submit invoices on paper, it is important that you fill out the invoices clearly and completely, otherwise payment may be delayed. This document will cover how to submit a paper invoice for Transportation (Passes, Other) Invoices Only.

Please Note: If you are requesting reimbursement for bus mileage or trip, please see the document labeled “Transportation Invoices for Mileage & Trip.” Do NOT follow the process listed on these instructions.

For 470 PASS Authorizations ONLY: There are 10 required fields on our Transportation Invoice. All of these fields MUST be completed for the invoice to be paid. This list corresponds to the invoice image that follows.

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Transportation (Passes, Other) Invoice Instructions

Required Fields for Transportation (Mileage, per trip) Invoice

A. Worker’s Name: Enter the name of the person providing services.B. Participant’s Name: Enter the name of the person receiving services.C. Worker ID: This is the PPL ID given to the worker. It begins with the letter “E” and is

followed by 4-6 digits.D. Participant ID: This is the Participant’s ID number. It can be found on the participant’s

Individual Service Plan and should begin with the letter “C”.E. Service Code and Type of Pass: Check the appropriate box for the Service Code

associated with your Participant’s Service Authorization and the type of pass you areinvoicing for.

F. Month of Use: The month that the Pass will be used forG. Amount to be reimbursed: This is the amount of your pass. You must submit a copy of a

receipt to be reimbursed. H. Additional Comments: Any additional comments on the type of pass or reimbursement (if

applicable). I. Date and Worker’s Signature. This is the Worker’s signature and the date that the worker

signed the timesheet. J. Date of Employer’s Signature. This is the Employer’s signature and the date that the

Employer signed the timesheet.

General Suggestions

• Fill out all required fields for invoice clearly. If the machine cannot be read and needs to becorrected it may delay your payment.

• Do not use markers or pencil. Markers tend to bleed and can cause invoice errors.

• If you work with more than one participant, make sure you submit separate invoices.

• For any invoice requiring backup documentation (Passes) make sure you submit a copy of yourpass or receipt along with your invoice.

• Do not use white-out on any of the document they will be rejected.

• Submit your invoices within 30 days of delivering the service.

• If you need additional space, please add any extra lines to a separate invoice sheet. Double sidedinvoices may not be processed in their entirety.

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Transportation (Passes, Other) Invoice Instructions

Obtaining New Invoices

We have included copies of both invoices with this packet. You can make copies of the invoices we give you but make sure they are full-size.

You can print copies of blank invoices from the Web Portal. (See Web Portal Instruction packet). You can also call customer service and ask them to send you invoices.

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CA GGRC Participant Directed Program Transportation (Passes, Other) Invoice

Worker Name: Worker ID Number:

Participant Name: Participant ID Number:

FOR MONTHLY PASS AUTHORIZATIONS: Please select the authorized service code from the list, if not listed pleasesupply the service code per the Participant’s Service Authorization under “OTHER”. Workers are also required to fill out theDate of Purchase, and Amount to be Reimbursed sections. Additional Comments are optional

Service Code (Please Check One)

Type of Pass

470

1PI BART Pass - per item1MM Senior/Disabled 31-Day Transit Pass for Marin LocalMSF1 Monthly Pass - SF MUNI Disabled PassMSM1 Monthly Pass - Samtrans "Eligible Discount"MSM2 Monthly Pass - Samtrans "Adult - Into SF" TAFT Monthly TAFT Pass OTHER: Detail:

ALL PASSES AND TRIP INVOICES MUST BE ACCOMPANIED WITH APPROVED BACKUP DOCUMENTATION (A COPY OF THE PASS, OR A RECEIPT FROM PURCHASE OF PASS)

PLEASE KNOW THAT FAILURE TO FILL OUT THIS FORM COMPLETELY AND ACCURATELY CAN RESULT IN DELAY OF PAYMENT.

Worker Signature Date Employer Signature Date

FAX OR MAIL INVOICE REQUEST TO: FAX: (855)-867-1676 MAIL: PPL, CA GGRC, 7776 S Pointe Pkwy W, Suite 150, Phoenix, AZ 85044

Month of Use Amount to be Reimbursed Additional Comments (If Applicable)

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Transportation (Mileage, Per Trip) Invoice Instructions

If you submit invoices on paper, it is important that you fill out the invoices clearly and completely, otherwise payment may be delayed. This document will cover how to submit a paper invoice for Mileage, per trip ONLY.

Please Note: If you are requesting reimbursement for bus passes, please see the document labeled “Transportation Passes, Other.” Do NOT follow the process listed on these instructions.

For Mileage, Per Trip: There are 14 required fields on our Transportation Invoice. All of these fields MUST be completed for the invoice to be paid. This list corresponds to the invoice image that follows.

Transportation (Mileage, Per Trip) Invoice Instructions

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Required Fields for Transportation (Mileage, per trip) Invoice

A. Worker’s Name: Enter the name of the person providing services.B. Participant’s Name: Enter the name of the person receiving services.C. Worker ID: This is the PPL ID given to the worker. It begins with the letter “E” and is

followed by 4-6 digits.D. Participant ID: This is the Participant’s ID number. It can be found on the participant’s

Individual Service Plan and should begin with the letter “C”.E. Service Code: Check the appropriate box for the Service Code associated with your

Participant’s Service AuthorizationF. Date of Service: This is the date the trip took place. It should be in dd/mm/yy format.G. Authorized Rate: Enter the rate authorized by the Participant’s Service AuthorizationH. Starting and Ending Address: You must include Street Address, City, State, and Zip on

the two lines provided.I. Roundtrip (Y/N): If the trip is a roundtrip, place a “Y” in this box. Otherwise put an “N”.J. Total Trip Mileage: Enter the total miles of the trip. Note: The trip must take the most

direct route.K. Trip Amount: Enter the total amount (in dollars) to be reimbursed for the trip.L. Total Amount to be Invoiced For: The total of all the items in the “Trip Amount”

column.M. Worker’s/Person Being Reimbursed Signature and Date: This is the Worker’s

signature and the date that the worker signed the timesheet.

General Suggestions

• Fill out all required fields for the invoice clearly. If the machine cannot read your invoice and itneeds to be corrected, it may delay your payment.

• Do not use markers or pencil. Please use only black or blue ink.• If you work with more than one Participant, make sure you submit separate invoices for each.• For any invoice requiring supporting documentation, make sure you submit a copy of your

receipt along with your invoice.• Do not use white-out on any invoice, it will not be paid.• Submit your invoices within 30 days of delivering the service. • If you need additional space, please add any extra lines to a separate invoice sheet. Double sided

invoices may not be processed in their entirety.

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Transportation (Mileage, Per Trip) Invoice Instructions

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Obtaining New Invoices

You may print copies of blank invoices from the Web Portal. (See Web Portal Instruction packet). You may also print blank invoices from our website in the forms section at www.publicpartnerships.com. Lastly, you may call customer service to request blank invoices be mailed to you.

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CA GGRC Participant Directed Program Transportation (Mileage, Per Trip) Invoice

Worker Name: Worker ID Number:

Participant Name: Participant ID Number:

FOR BOTH PER TRIP AND MILEAGE AUTHORIZATIONS: THE WORKER MUST SELECT THE AUTHORIZED SERVICE CODE BEING INVOICED FOR AND LIST THE DATE OF SERVICE, RATE FORTHE SERVICE, AND THE TOTAL AMOUNT BEING INVOICED. THE WORKER MUST ALSO ENTER THE START AND END ADDRESSES OF EACH LOCATION. IF THE TRIP IS A ROUNDTRIP, PLACEA “Y” IN THE ROUNDTRIP COLUMN. THESE LOCATIONS MUST BE APPROVED BY GGRC AND INCLUDED IN THE CONSUMER’S IPP. TRAVEL FROM THE CONSUMER’S HOME TOINTERDISCIPLINARY TEAM APPROVED DESTINATION(S) AND RETURN TO THE CONSUMER’S HOME, AS INDICATED HERE-IN MUST USE THE MOST DIRECT ROUTE.

FOR MILEAGE (MR/2MR) AUTHORIZATIONS ONLY: You must enter the Total Trip Miles FOR PER TRIP AUTHORIZATIONS ONLY: You must attach a copy of the receipt if available.

Please Select your

Service Code

MR Mileage

2TOSM TRIP - REDI-WHEELS Lifeline fare 3TOM TRIP - GOLDEN GATE TRANSIT ZONE 2-5 2MR Mileage 3TOSF TRIP - SF Paratransit – ADA Fare 4TOM TRIP - GOLDEN GATE TRANSIT MARIN Local Fare 1TOB TRIP - BART per one-way trip 1TOM TRIP - WHISTLESTOP WHEELS 5TOM TRIP – WHISTLESTOP WHEELS SPEC. ROUTE

1TOSM TRIP - REDI-WHEELS/REDI-COAST 2TOM TRIP – WHI. WHEELS EXTENDED TRIP 6TOM TRIP – WHISTLESTOP WHEELS (INTERCOUNTY)

Trip # Date of Service

Authorized Rate

Address Roundtrip Total Trip Miles (MR/2MR)

Trip Amount Start End (Y/N) (in Dollars)

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TOTAL AMOUNT BEING INVOICED: $___________._______

PLEASE KNOW THAT FAILURE TO FILL OUT THIS FORM COMPLETELY AND ACCURATELY CAN RESULT IN DELAY OF PAYMENT.

Worker/Person being reimbursed Signature Date FAX INVOICE REQUEST TO: FAX: (855)-867-1676 or MAIL: PPL, CA GGRC, 7776 S Pointe Pkwy W, Suite 150, Phoenix, AZ 85044

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