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Individual provider contractor intake form 2026

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The document provides intake instructions for Individual Providers (IPs) contracted with the Department of Social and Health Services (DSHS) in Washington State. It outlines the requirements for completing the Contractor Intake form, including necessary identification, client information, and suitability checks. The form is mandatory for individuals providing personal care or respite care to DSHS clients and includes sections on contractor information, state employee status, and ethics certification for current or former state employees.

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Click ‘Get Form’ to open the individual provider contractor intake form in the editor.
Begin with Part A, where you will provide your Contractor Information. Fill in your name as it appears on your Social Security card, along with your birth date and contact details.
In the Specific Client Information section, if applicable, enter the name of the client you will be providing services for.
Complete the Suitability section by answering all questions honestly. If any apply to you, attach a detailed explanation.
Proceed to Part B and indicate whether you are a current or former Washington State employee. Provide termination dates if applicable.
If required, complete Part C for Ethics Certification by confirming that your role does not conflict with your duties as a state employee.
Review all sections for accuracy before signing and dating the form at the end.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (191 Votes)
2015	4 Satisfied (26 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is it better to do a 1099 or W9?

The best practice for businesses is to ask contractors to fill out a W-9 form on the day you hire them. Although you will not need to submit the W-9 to the IRS, you will need that information later to fill out the contractors 1099. Keep it on file so you can resurrect it at years end.

What form does an independent contractor have to fill out?

Form W-9. If youve made the determination that the person youre paying is an independent contractor, the first step is to have the contractor complete Form W-9, Request for Taxpayer Identification Number and Certification.

What is a provider enrollment form?

Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting.

What is the $600 rule for 1099?

Initially included in the American Rescue Plan Act of 2021, the lower 1099-K threshold was meant to close tax gaps by flagging more digital income. It required platforms to report any user earning $600 or more, regardless of how many transactions they had.

Where can I create an intake form?

Create a client intake form using Google Forms. In Google Forms, click the plus sign. Click the Untitled form header box. Enter a name and description for the form.

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Do independent contractors fill out a W9 or 1099?

The main differences between W-9 and 1099 tax forms are that a W-9 is filled out by the supplier or independent contractor to provide their tax and payment information to the payer, whereas 1099 forms are provided by the payer to document the supplier or contractors gross earnings and any backup withholding after

What is a provider intake form?

An intake form is a document that gathers important information from a person before starting a service or consultation. Businesses, healthcare providers, law firms, and agencies use intake forms to understand a clients needs, history, or concerns. Think of it as the first step in a process.

Individual provider contractor intake form 2026

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