CDC + > Fiscal/Employer Agent Enrollment Forms

---

CDC+ Consumer Packet

Forms required for the consumer to enroll with the Fiscal/Employer Agent

• Instructions for completing Consumer Packet
  
• IRS forms and sample completed forms:
• IRS Form 2678
• Form 2678 Employer/Payer Appointment of Agent
• Consumer who is able to sign for him/herself
• Consumer who signs with an "X" or mark
• Consumer who is a minor or unable to sign
• IRS Form 8821
• Form 8821-Tax Information Authorization
• Consumer who is able to sign for him/herself
• Consumer who is a minor or unable to sign
• Consumer who signs with an "X" or mark
• Informed Consent Form
• Direct Deposit / rapid! PayCard Request Form
  DOC | PDF

Additional Reference Forms

• Informed Consent Form – Sample Completed Form

---

CDC+ Employee Packet

*** Forms submitted must be in English. Spanish version is provided for reference only.

• Instructions for Completing the Employee Packet
• Affidavit Of Good Moral Character
• Employee Information Form
• IRS Form W-4 (English)
• DHS Form I-9 (English)
• Employee Change of Name/Address Form
• Direct Deposit / rapid! PayCard Request Form
  DOC | PDF

Additional Reference Forms

• IRS Form W-4 (Spanish)
• DHS Form I-9 (Spanish)

---

CDC+ Vendor/Independent Contractor Packet

• Instructions for Completing the Vendor/IC Packet
• Affidavit of Good Moral Character
• Vendor/Independent Contractor Information Form
• IRS Form W-9 (English)
• Vendor Change of Name/Address Form
• Direct Deposit / rapid! PayCard Request Form
  DOC | PDF

Additional Reference Forms

• Vendor/IC Information Form – Sample Completed Form