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ເຄືອຂ່າຍການດູແລຜູ້ບໍລິໂພກໂດຍກົງໃນລັດຟລໍຣິດາ

FORMS

Forms available in Spanish have a 🌐 icon. To view translated versions of these forms, select Spanish from the top menu.

UnitedHealthcare Forms

Enrollment Packets

Participant Enrollment Forms

Participant Enrollment Packet 🌐

Participant Enrollment Packet Instructions 🌐

Direct Service Worker Enrollment Forms

Direct Service Worker Enrollment Packet 🌐

Direct Service Worker Enrollment Packet Instructions 🌐

Additional Forms and Information

Feedback Form

Feedback Form 🌐

Participant Direction Option (PDO) Information

PDO Guidelines 🌐

PDO Consent Form 🌐

PDO Manual

Payroll Related Forms

IVR Registration Form 🌐

2026 Payroll Calendar 🌐

2025 Payroll Calendar 🌐

Pay Selection Form 🌐

Wisely Pay Card 🌐

I-9 Instructions 🌐

W-4 Form

W-2 Frequently Asked Questions

Fingerprinting Procedures and Information

Fingerprinting Procedures 🌐

Direct Service Worker Information Needed for Fingerprinting 🌐

Representative Information Needed for Fingerprinting 🌐

EVV Notification

EVV Notification to DSW

EVV Notification Letter to Participant

Molina Forms

Enrollment Packet