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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F01201A (12/2022)STATE OF WISCONSINITES PARTICIPANTHIRED WORKER RELATIONSHIP IDENTIFICATION FORM INSTRUCTIONS This form is used by the fiscal
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How to fill out iris participant-hired worker relationship

01
To fill out the iris participant-hired worker relationship form, follow these steps:
02
Begin by identifying the participant and the hired worker. Ensure that the correct names and contact information are provided.
03
Specify the nature of the relationship between the participant and the hired worker. Are they family members, friends, or simply acquaintances?
04
Describe the tasks and responsibilities of the hired worker. Clearly outline the job duties and expectations to avoid any confusion.
05
Determine the payment and compensation details. State how much the hired worker will be paid and the frequency of payments.
06
Include any additional benefits or perks that the hired worker may be entitled to, such as insurance coverage or transportation allowances.
07
Lastly, both the participant and the hired worker should review the form and sign it to acknowledge their agreement and commitment to the stated terms and conditions.

Who needs iris participant-hired worker relationship?

01
The iris participant-hired worker relationship form is needed by individuals who are participating in the iris program and have hired someone to assist them with their daily tasks.
02
This form helps establish a formal relationship between the participant and the hired worker, outlining their roles, responsibilities, and compensation agreements.
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The iris participant-hired worker relationship refers to the arrangement where individuals hire caregivers or workers to assist them with personal care or other services as part of an Individualized Support Plan.
Both the participant who hires the worker and the worker themselves are typically required to file the iris participant-hired worker relationship documentation.
To fill out the iris participant-hired worker relationship, one must complete the designated forms with accurate details about the participant, the hired worker, and the nature of the services provided.
The purpose is to document the working relationship for accountability, funding, and compliance with regulations governing participant-directed services.
The information that must be reported includes the names of both the participant and the worker, their contact details, services rendered, hours worked, and payment information.
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