*Please return this form to Morning Star*
Employer Name: _______________________________
Name of Person Receiving Services:_____________________________
Date of Birth of Person Receiving Services:
Medicaid # of Person Receiving Services:
Please identify which waiver applies: _____ABI
_____ PD
Are you transitioning to Morning Star from another Fiscal Agent? Yes___ No___
How did you hear about Morning Star / Why did you choose Morning Star?
The following forms need to be completed and returned to Morning Star.
Employer Cover Sheet (This form)
Application for Employer Identification Number (Form SS-4) For New Employers ONLY!
Employer/Payer Appointment of Agent (Form 2678)
Tax Information Authorization (Form 8821)
Domestic Employment Status Report (1D)
Morning Star Working Agreement
E-Verify Memorandum of Understanding
The following forms are to be used as resources to you as the Employer. You do not need to
return these forms.
Payroll Schedule
Child Labor Laws
Recruiting and Interviewing
Sample Interview Questions
How Much Can I Pay My Staff?
Instructions for Filling Out the Utah Timesheet
Blank Timesheet Form -- Use this form to make copies of Timesheets for your employee(s)
Application for Employment – Use this form to gather data from your employee(s) to keep on
file in your personal employer records