Cerebral Palsy Massachusetts Pca Form PDF Details

Cerebral palsy is a neurological disorder that affects body movement, muscle coordination, and posture. Cerebral Palsy Massachusetts PCA form provides information about the disability to employers in order to comply with the Americans with Disabilities Act. The ADA protects employees from being fired or forced to quit because of their cerebral palsy. The law also requires employers to provide reasonable accommodations for workers with disabilities so they can do their jobs effectively. Employers are not required by law to give an employee who has cerebral palsy any accommodation that would cause undue hardship on them or result in significant difficulty or expense for the employer's business operation.

If you need to first learn how much time you need to fill in the cerebral palsy massachusetts pca form and the number of pages it's got, here is some basic information that could be useful.

Form NameCerebral Palsy Massachusetts Pca Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesTimesheets, W4, Eligibility, I9

Form Preview Example

Change Form and Supply Request

Cerebral Palsy of Massachusetts - 43 Old Colony Avenue, Quincy, MA 02170 - Phone (877)479-7577 Fax (800)359-2884

This Change Form is submitted to change information for (only check one):



Consumer Number

Last 4 Digits of SSN

Consumer Name

PCA Name

Type of Change (Required)

Consumer Address

Telephone Number

PCA Address


Change Requested By (Required)



PCM Agency


PCA Terminated: Last Day of Work

























Reason for Termination: PCA Quit

PCA Terminated for Misconduct

PCA Terminated - No Misconduct














































































































































































































































































































































































































































































































































































































































































































































































































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Email Address





















































































































































































































































Consumer/Surrogate Name (Print)


























Consumer/Surrogate Signature













































































PCA Name (Print)


























PCA Signature













































































PCM Agency Staff Name & Title (Print)


























PCM Agency Staff Signature














































































































































































Supply Request:









Payment Schedule

Direct Deposit Application

Form W4

I9 (Employee Eligibility Verification)

Change Form

Union Card



Other _____________________________________________










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cerebral palsy pca form empty spaces to complete

Enter the demanded details in the space Email Address, ConsumerSurrogate Name Print, ConsumerSurrogate Signature, PCA Name Print, PCA Signature, PCM Agency Staff Name Title Print, PCM Agency Staff Signature, Date, Date, Date, Supply Request, Timesheets, Payment Schedule, Direct Deposit Application, and Form W.

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