West Virginia
Medicaid Traumatic Brain Injury Waiver
In this section
- Overview
- Program Documents
- Electronic Visit Verification (EVV)
- News
- Contact Information
Program Documents
Web Portal Reference Guides Employee
Participant/Program Representative
Employee Packet
- Employee Letter
- Employee Data Form
- USCIS Form I-9
- USCIS Form I-9 Instructions
- USCIS Form I-9, Spanish (FOR REFERENCE ONLY)
- USCIS Form I 9 Instructions, Spanish (FOR REFERENCE ONLY)
- Checklist To Complete I-9 Form
- IRS Form W-4 2022
- WV Form IT-104 2022
- Medicaid Qualified Support Worker Agreement
- DHHR Protective Services Check Form
- Difficulty Of Care Instructions
- Difficulty Of Care Form
- Employment Agreement
- Tax Exemption Form
- Confidentiality Agreement
- EFT Instructions W/Paycard
- EFT Application
- Criminal Background Check Instructions and Form (2022)
- Timesheet Instructions
- Timesheet (2022)
- PAS Worksheet
- Transportation Invoice (2022)
- WVDHHR Check Instructions
- Live-In Exception Form
- Authorization To Withhold City Service Fees
Enrollment Packet
- Personal Options Employer Guide
- WV TBI Pay Schedule 2023
- Enrollment Packet Cover Sheet
- Enrollment Form
- Emergency Back-up Plan
- Appointment of Representative
- Notice Of Separation Of Employment
- Incident Report
- Grievance Form
- Transfer Request Form
- Wage Notice And Change Request Form
- Timesheet Instructions
- Timesheet
- Transportation Invoice
- Complete Enrollment Packet
- Verification Of City Service Fee Withholding
*Some of the above links may take you to third-party operated websites.