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FORMS

Following are all of the forms available on this site grouped by Payee Services, Bill Paying Service, Co-EmployER and Co-EmployEE.
Representative Payee Services (Alta Regional Center):
Document Description
Record of Consumer P&I Funds at Facility This form is used by board & care providers to track the funds they are holding for their consumers. 
Board and Care Intake Packet This file contains all of the required Board & Care forms. 
Independent Living Intake Packet This file contains all of the required Independent Living forms. 
Authorization for Client Check Deposit Authorizes Tracy Stein Management Services, Inc. to deposit money into your client trust account on your behalf. 
Change in Living Arrangement Forms These forms are used to inform Tracy Stein Management Services, Inc. of a change in living arrangement. 
Consumer Wage Notification Form This file contains the Consumer Wage Notification Form. 
Independent Living Budget Form  
Representative Payee Services (Redwood Coast Regional Center):
Document Description
Record of Consumer P&I Funds at Facility This form is used by board & care providers to track the funds they are holding for their consumers. 
Board and Care Intake Packet This file contains all of the required Board & Care forms. 
Independent Living Intake Packet This file contains all of the required Independent Living forms. 
Authorization for Client Check Deposit Authorizes Tracy Stein Management Services, Inc. to deposit money into your client trust account on your behalf. 
Change in Living Arrangement Forms These forms are used to inform Tracy Stein Management Services, Inc. of a change in living arrangement. 
Consumer Wage Notification Form This file contains the Consumer Wage Notification Form. 
Independent Living Budget Form  
Representative Payee Services (Valley Mountain Regional Center):
Document Description
Record of Consumer P&I Funds at Facility This form is used by board & care providers to track the funds they are holding for their consumers. 
Board and Care Intake Packet This file contains all of the required Board & Care forms. 
ATTENTION!! In addition to these documents, you must complete a client trust packet found on the VMRC P Drive. This document needs to be signed and approved and must accompany these forms.
Independent Living Intake Packet This file contains all of the required Independent Living forms. 
ATTENTION!! In addition to these documents, you must complete a client trust packet found on the VMRC P Drive. This document needs to be signed and approved and must accompany these forms.
Valley Mountain Check Disbursement Request This form is used to request Bill Paying Services. 
VMRC Trust Disbursement Request  
Authorization for Client Check Deposit Authorizes Tracy Stein Management Services, Inc. to deposit money into your client trust account on your behalf. 
Change in Living Arrangement Forms These forms are used to inform Tracy Stein Management Services, Inc. of a change in living arrangement. 
Consumer Wage Notification Form This file contains the Consumer Wage Notification Form. 
Independent Living Budget Form  
Representative Payee Services (Tri-Counties Regional Center):
Document Description
Record of Consumer P&I Funds at Facility This form is used by board & care providers to track the funds they are holding for their consumers. 
Board and Care Intake Packet This file contains all of the required Board & Care forms. 
Independent Living Intake Packet This file contains all of the required Independent Living forms. 
Authorization for Client Check Deposit Authorizes Tracy Stein Management Services, Inc. to deposit money into your client trust account on your behalf. 
Change in Living Arrangement Forms These forms are used to inform Tracy Stein Management Services, Inc. of a change in living arrangement. 
Person Served Wage Notification Form This file contains the Person Served Wage Notification Form. 
Payee Check Disbursement Request Form This file contains the Payee Check Disbursement Request Form. 
Burial Account Information Form This file contains the Burial Account Information Form. 
Independent Living Budget Form  
Self-Directed Services:
Document Description
Self-Directed Services Intake Packet This file contains Self-Directed Services Intake Forms. 
TSM Check Request Form This form is used to request Bill Paying Services 
Bill Pay Change Sheet The form is used to request a change of contact information. 
Mileage Form This form is used to track mileage. 
IRS W-9 IRS W-9 Form 
Co-EmployER Forms:
Document Description
Complete Co-EmployER Packet This PDF contains all of the forms below. 
TSM Check Request Form This form is used to request Bill Paying Services 
Service Agreement for Co-EmployER services This agreement details the relationship between you and Tracy Stein Management Services, Inc.. It must be completed and returned to TSM before we perform any services on your behalf. 
Notice to TSM of New EmployEE This letter is completed by you before the job is offered to the person you want to hire. 
Performance Evaluation I have provided you with this form to use when you are evaluating your employee's performance. You should complete a performance evaluation once a year for every employee. 
EmployEE Warning This form is used when you are unhappy with the work an employee is doing for you. This form can be used for both a verbal or written warning. 
Notice to EmployEE of Change in Relationship This form is sent to TSM when an employee either quits or is fired. 
Co-EmployER Change Sheet
  • This form is completed by the Co-EmployER to tell TSM about any of the following changes in the Co-EmployER's information
 
EmployEE Handbook Each Co-Employer is sent a copy of the handbook. This handbook details all of the things a person needs to know as an employee. It is important that you as an employer understand it as well. 
EmployEE Posters As the Co-Employer you must have a copy of these posters in your home if you have employees working there. 
Wage Order 15 This is the Industrial Welfare Commission wage order we are working under. 
Payroll Processing Calendar This shows you each pay period, when you need to have your employee timesheets to TSM and what the pay day is for each period. 
EmployEE Change Sheet This form is used to notify me of changes with respect to things like your Address, Name or to be removed from Direct Deposit. 
EmployEE Forms:
Document Description
Complete EmployEE Packet This PDF contains all of the forms below. 
EmployEE Handbook This is your employee handbook. 
Employment Application This is the application you need to have filled out before being formally considered for a job. 
Criminal Background check release (Release Authorization) A criminal background check will be run on all individuals hired by Tracy Stein Management Services, Inc. (TSM). No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense and surrounding circumstances and relevance of the offense to the position(s) applied for may, however, be considered. 
IRS W-4 This form is for your taxes. 
Department of Justice I – 9 form Department of Justice Employment Eligibility Form 
Confidentiality Agreement This is a confidentiality agreement between you and your employer. 
On Duty Meal Period Agreement. This is a meal agreement between you and your employer. 
Direct Deposit Application This is an optional direct deposit application so your paycheck can be deposited directly into your bank account if desired. 
Mandated Reporter California law REQUIRES certain persons to report known or suspected abuse of dependent adults or elders. As an employee or volunteer at a licensed facility, you are one of these persons — a ';mandated reporter'.  
Payroll Processing Calendar Pay periods are semi-monthly. This calendar shows you all of the paydays and what days time sheets must be turned in for each pay period. 
Time Sheet This is the timesheet where you record your hours. 
EmployEE Change Sheet This form is used to notify me of changes with respect to things like your Address, Name or to be removed from Direct Deposit. 

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