TTY: Employer of Record - Public Partnerships€¦ · Employer of Record. What lines do I complete? PPL has pre‐populated this form with the information we have received from your

Dear Participant/Representative:

Welcome aboard! Public Partnerships, LLC (PPL) is the Fiscal/Employer Agent (F/EA) that will support you by paying direct care workers (DSWs) and will assume responsibility for managing tax filings on your behalf.

Once you and your DSW review, sign, and complete all required paperwork, PPL will assume responsibility for issuing payments to your DSW(s). PPL is committed to providing you with as much support as possible; however, we must adhere to federal, state, and local tax laws. Therefore, all the Employer of Record, DSW paperwork must be signed and returned to PPL before payments are issued to your DSW(s).

This packet contains the instructions for required employer enrollment paperwork that you need to complete and return to PPL. These forms have been pre-populated with your demographic information. Please review these forms for accuracy then sign, date, and send them to PPL. Please do not use white-out. If you need a new form, please contact your Case Manager who will print you a new packet.

We understand that these forms can be complicated, so please call us toll-free at 1-877-522-1063 or e-mail us at [email protected] if you have any questions. Our customer service team is available Monday through Friday 8:00 am until 8:00 pm EST and Saturdays 9:00 am to 1:00 pm. We look forward to working with you!

Sincerely,

Public Partnerships, LLC

Aetna FL PDO Program Public Partnerships, LLC One Cabot Road, Suite 102 Medford, MA 02155 Phone: 1-877-522-1063 TTY: 1-800-360-5899 Paperw ork Fax: 1-855-663-1370 Paperw ork E-mail: [email protected]

Customer S ervice E-mail: [email protected] Web Site: www.publicpartnerships.com

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Employer of Record

SETTING UP your Employer of Record Account:

This packet contains instructions to help you complete the following required Employer of Record forms.

EOR Cover Sheet

PDO Consent Form

PDO Employer of Record Agreement

IRS Form SS-4

IRS Form 2678

IRS Form 8821

FL DR-1 Form

FL DR-835 Form

PDO Representative Agreement Form

Affidavit of Compliance

Fingerprinting Application Form

All required forms must be signed and returned to PPL.

If you have any questions, please call PPL at 1-877-522-1063.

WHERE TO SEND FORMS:

FAX TO: 1-855-663-1370

Or

MAIL TO: Aetna_FL PDO Program Public Partnerships, LLC One Cabot Road, Suite 102 Medford, MA 02155

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PDO Employer Informational Packet

What is the purpose of this form? This form is used by Public Partnerships, LLC (PPL) to verify the demographic information of the Employer of Record.

What lines do I complete? PPL has pre‐populated this form with the information we have received from your existing F/EA. Please review the information on this form.

If it is correct, the Employer of Record should sign the additional forms in this packet.

If it is incorrect, please call or email customer service immediately so that we can send you a corrected Employer of Record packet.

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What is it for?

This form is an attestation that you agree to act as the Employer of Record in the PDO model, and that you understand your responsibilities. If you will be designating a Representative, you should indicate it on this form, but you, the Participant, will still act as the legal Employer of Record. Instructions to fill out:

Check off either the Participant or Authorized Representative box.

If you are designative a Representative, please print the Representative’s name.

Print your name in the attestation box.

Print your name, sign, and date the Employer of Record Agreement.

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What is it for?

This form tells the IRS that you are going to be an

employer and is used to obtain an Employer

Identification Number (EIN) from the IRS. This EIN

is used to open state employer accounts and

designate all tax deposit and filing responsibility to

PPL.

Why isn’t my address listed on lines 4a and

4b?

Lines 4a and 4b ask for the mailing address to be

attached to this employer account. PPL does not

intend to burden you with IRS paperwork. By establishing PPL’s address as the mailing

address on your employer account, PPL ensures that you will not receive IRS paperwork

relating to this program at your home.

Who are the people listed in the ‘Third Party Designee’ section?

Those are PPL staff members who are experienced obtaining EINs on behalf of Individual

Employers. These three individuals are the only people who can obtain an EIN on your

behalf.

What lines do I complete?

PPL has completed the SS-4 in a way that notifies the IRS that even though you will be

the official employer of your service providers, you will be using PPL to file and deposit

your employer taxes. If you have applied for an EIN in the past, complete lines 16a, 16b

and 16c. You also must sign and date the bottom of the form.

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What is it for?

This form tells the IRS that you give PPL permission to

do some work for you. By signing this form, you

authorize PPL to withhold taxes from your

employees’ paychecks and deposit those taxes with

the IRS. With this form, you delegate the employer

tax responsibility to PPL.

If I appoint you as my agent with the IRS Form

2678, what will you be able to do?

The IRS Form 2678 only allows us to withhold taxes

from your employee’s paychecks and deposit those

taxes to the IRS. This form is only recognized by the

IRS; other tax agencies do not recognize this form.

The 2678 does not authorize us to perform any other

tax responsibilities.

What liability does PPL take on when I sign the 2678?

The IRS Form 2678 subjects PPL to all provisions of law, including penalties that the

employer incurs. When you authorize PPL as your agent with Form 2678, PPL is

responsible by law for correctly representing you. PPL incurs any penalties of misfiling

or incorrectly depositing your employer taxes.

Does the IRS Form 2678 authorize you to file my personal income taxes?

No. PPL only deposits withholding taxes for your employees. PPL cannot handle any of

your personal income tax matters.

What sections do I complete?

Most of this form is completed. All you need to do is review, sign, and date the form,

and return it to PPL.

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What is it for?

This form allows PPL to discuss your employer

withholding account with the IRS. It does not allow

these representatives to sign any documents.

How is this different than the IRS Power of

Attorney form?

The IRS Power of Attorney Form allows PPL’s CPA only

to sign employer tax reports. This form allows 3

specific PPL representatives to talk and write to the

IRS about your employer tax account.

Will PPL be able to discuss my personal tax

account with the IRS?

No. PPL will only be able to discuss the employer tax forms listed in Section 3b. PPL will

never be able to obtain any personal income tax information.

I make all decisions about my life. If I sign this, what decisions can the FRA

make for me?

This form only lets PPL talk and write to the IRS. PPL cannot make decisions about your

personal life.


PPL has completed most information for you, but you must sign and date this form in

Section 7.

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What is it for?

This 9 page form registers you as an employer in the state of Florida and allows PPL to

collect and report taxes in the state of Florida.


PPL has completed most information for you,

but you must sign and date this form at the

bottom of page 8 and 9.

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What is it for?

This form allows PPL to discuss your employer

withholding account with the Florida Department of

Revenue.

Will PPL be able to discuss my personal tax

account with the Florida Department of

Revenue?

No. PPL will only be able to discuss the employer tax

forms listed in Section 3. PPL will never be able to

obtain any personal income tax information.

I make all decisions about my life. If I sign this, what decisions can the FMS

make for me?

This form only lets PPL talk and write to the FL DOR. PPL cannot make decisions about

your personal life.


PPL has completed most information for you, but you must sign and date this form in

Section .

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Employer Instruction Packet

What is it for?

If you are choosing a Representative to assist you in your responsibilities as the Employer of Record, then the Representative must attest that they meet the Florida Statutes section 435.05(2) for qualification of employment. If you are not choosing a Representative, then this form should be skipped. Instructions to fill out:

The Representative should completely read through the Affidavit of Compliance. On Page 1, fill out the Representatives Name, Participant’s name, and the Address of the

Participant. On Page 3, print the Representative’s name in the attestation paragraph, and have the

Representative Sign and Date the form.

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What is it for? If you have chosen a Representative to assist you in your Employer of Record responsibilities, that Representative must have a Level 2 Background Screening (fingerprinting) processed. Public Partnerships, LLC (PPL) uses this form to register the Representative with cogent for electronic fingerprinting. Note: If the Representative has evidence of prior Level 2 Background Screening in the last 5 years, and has not been unemployed for more than 90 days, then they may submit a copy of their prior screening results to fulfill the requirement. Instructions to fill out:

The Representative should fill out all starred (*) fields on the Fingerprinting Application Form and submit it to Public Partnerships for processing.

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TTY: Employer of Record - Public Partnerships€¦ · Employer of Record. What lines do I complete? PPL has pre‐populated this form with the information we have received from your

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