forms

Forms for New Employees

Employee Data Sheet

Authorization for Direct Deposit

Form W-4 Employee’s Withholding Allowance Certificate

Form W-4ME Maine Employee’s Withholding Allowance Certificate

Form I-9 Employment Eligibility Verification

HSA (Health Savings Account) Payroll Deduction

 

Forms for Healthcare Providers

Provider Information Sheet

Leclerc Group Confidentiality Agreement

HIPAA Business Associate Agreement

Provider Billing Sheet (please contact us if you prefer a typeable Excel sheet)

Patient Intake Form

CAQH Online Enrollment

Medicare EDI Enrollment Package

Maine Substitute W-9 & Vendor Authorization Form

Form W-9 Request for Taxpayer Identification Number

Patient Health Questionnaire (PHQ-9)

Behavioral HealthCare Program Outpatient Treatment Plan

Tricare Outpatient Request Form

 

Labor Posters

Maine Minimum Wage

Fair Labor Standards Act – Minimum Wage

Family and Medical Leave Act

Whistleblower’s Protection Act

Maine Workers’ Compensation

Maine Unemployment Regulations

Video Display Terminal

Maine OSHA Regulations

Maine Child Labor Laws

Regulation of Employment

Sexual Harassment Policy

Equal Employment Opportunity (Maine)

Equal Employment Opportunity (Federal)

Maine Equal Pay Law

Preventing Flu in the Workplace

USERRA – Veterans’ Rights

Domestic Violence in the Workplace

Maine Supports Nursing Moms

Employee Polygraph Protection

‘No Smoking’ Sign

 

Payroll Setup Forms

Payroll Services Request Form

Electronic Payment Authorization

Maine Application for Tax Registration

IRS Form 8655: Reporting Agent Authorization

IRS Form 8821: Tax Information Authorization

Form ME UC-28: Maine Department of Labor Power of Attorney

 

Other Forms

Bookkeeping Services Request Form

Leclerc Group Auto-Pay Authorization Form

ACH Payment Authorization

Form W-9 Request for Taxpayer Identification Number

Form SS-4 Application for Employer Identification Number

Maine Workers Compensation Application for Waiver

IRS Form 8832: Entity Classification Election

Maine Form 2848-ME: Power of Attorney and Declaration of Representative

 

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