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Mo Sds Prefill Employee Packet Request

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46 views2 pages

Mo Sds Prefill Employee Packet Request

Uploaded by

trintea.tal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MO SDS New Employee Pre-filled Packet Request Form

Welcome to Acumen! We are excited to take part in this process with you. Starting a new
employee can be a challenge. If you haven’t already done so, please ensure you read through
the Employee Hiring Guide and New Employee Sample Packet on our website
www.AcumenFiscalAgent.com/Missouri.
Acumen offers several ways to complete the new Employee Enrollment Packet. Your Acumen
team would be happy to pre-fill your Employee packet to help reduce the paperwork burden
to your family! In order to receive a pre-filled packet you will need to answer a few questions
about your employee in the form below. Next, you will need to provide Acumen with a copy
of your Employee's social security card.
Please note, incomplete or incorrect forms or submissions without a legible copy of the
Employee's Social Security Card will not be processed. Please work carefully to ensure all
information provided is accurate and correct to the best of your knowledge. Acumen is not
responsible for incorrect or inaccurate information.
Please indicate on the form below the method you would like Acumen to use, to send your
pre-filled Employee Packet. If "Electronic Signatures" are selected, Acumen will send your pre-
filled packet via Adobe.

Once complete, this form, along with a legible copy of the Employee's Social Security card
should be returned via email at [email protected] or via fax or mail. Once received,
you will receive your pre-filled documents in the method you choose within 2-3 business days.

For the quickest processing, please ensure this form and a copy of the Employee's Social
Security card are sent together. Documents can be returned either by email to
[email protected], by fax to (816) 396 - 6912, or via mail to Acumen Fiscal Agent,
1123 Wilkes Blvd, Suite 230, Columbia, MO 65201.

We look forward to working with you!

~ Your Acumen Fiscal Agent Team


Tell us a little info about your new Employee!

Individual Receiving Services Name (First, Last)


Brinley, Attwood

Employee First Name:


Trinity
Employee Middle Initial:
L
Employee Last Name:
Talmage
Employee Other Last Names Used:
N/A
Employee Birthday (MM/DD/YYYY)
08/29/2005
Employee SSN 492-23-9426
Employee Physical Street Address: 2140 State Hwy N
Employee Physical Address APT Number:
Employee Physical Address City Clever
Employee Physical Address ST: Missouri
Employee Physical Address Zip Code 65631
Employee Mailing Address (if different than above):
Employee Mailing Address APT Number:
Employee Mailing Address City:
Employee Mailing Address ST:
Employee Mailing Address Zip Code:
Employee Phone Number (555-123-1234) (417-755-9007)
Employee Email Address: [email protected]

Employee Service Code 1 MED PA


Employee Rate of Pay 1 $26

Employee Service Code 2 Choose One


Employee Rate of Pay 2
Did you provide a copy of the Employee's Social Security Card? Choose One
How would you like us to send your pre-filled Employee Packet? Email

Employee’s First Day of Hire (MM/DD/YYYY)

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