public partnership pay rate sheet Preview on Page 1

Rate sheet form 2026

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  1. Click ‘Get Form’ to open the rate sheet in the editor.
  2. Begin by filling out the DCW Information section. Enter the worker’s name, address, and Social Security number accurately.
  3. In the Service/Rate Information section, indicate whether this is a new service, change of existing service, new rate, or change of existing rate by marking the appropriate box.
  4. Enter the hourly rate for the DCW in the designated field. Ensure that you do not list rates in increments of 15 minutes and exclude employer tax.
  5. Complete the signatures section by having both the Common Law Employer (CLE) and Direct Care Worker sign and date the form where indicated.
  6. Finally, review all entries for accuracy before mailing the completed form to Public Partnerships, LLC at the provided address.

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