Form 1724 New Employee Packet Cover Sheet - Texas

Form 1724 is a Texas Health and Human Services form also known as the "New Employee Packet Cover Sheet". The latest edition of the form was released in August 1, 2015 and is available for digital filing.

Download a fillable PDF version of the Form 1724 down below or find it on Texas Health and Human Services Forms website.

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Form 1724
August 2015-E
Consumer Directed Services
New Employee Packet Cover Sheet
Employer Name
Name of Individual Receiving Services
Employee Name
Date of Hire
First Day of Work
Employer
Agency
FMSA
Document Description / Form Information
Before Hire: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
DADS
DADS Form 1725, Criminal Conviction History and Registry Checks
DADS Form 1729, Applicant Verification for Employees;
DADS
DADS Form 1734, Service Provider and Employer Certification of Relationship Status for CDS
USCIS
USCIS Form I-9, Employment Eligibility Verification
DADS
DADS Form 1728, Liability Acknowledgement
DADS
Professional license verification (nursing, professional therapies)
At Time of Hire: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
IRS Form W-4, Employee’s Withholding Allowance Certificate — Due before first payroll check is
IRS
calculated; provide to the Financial Management Services Agency (FMSA) on date of hire.
OAG
Texas Employer New Hiring Reporting Form (www.employer.texasattorneygeneral.gov)
DADS Form 1730, Wage and Benefits Plan Employee Compensation, and any court-ordered
DADS
garnishment(s); DADS Form 1731, Employee Work Schedule and Assigned Tasks; DADS Form
1737, Employer and Employee Service Agreement; DADS Form 1739, Service Provider Agreement
CLASS, DBMD and MDCP only: Cardiopulmonary resuscitation (CPR) certification — Effective
DADS
at time of service delivery initiation, and maintained. Verify again before expiration date.
Texas Department of Public Safety driver’s license (if transporting client) — Verify again before
DADS
expiration date.
DADS
Proof of minimum auto insurance (if transporting client)
CDC
DADS Form 1727, Occupational Exposure to Bloodborne Pathogens (Acknowledgement: Hepatitis B
OSHA
Vaccination and Universal Precautions)
TWCC
Notice to Employees Concerning Workers’ Compensation in Texas (TWC Notice 5)
DADS
If hiring a nurse: DADS Form 1747, Acknowledgment of Nursing Requirements
CDS
If applicable: DADS Form 1733, Employer and Employee Acknowledgement of Exemption from
DADS
Nursing Licensure for Certain Services Delivered through Consumer Directed Services
DADS Form 1732, Management and Training of Service Provider — Initial training must be
DADS
conducted within 30 days of hire.
Ongoing: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
DADS Form 1732, Management and Training of Service Provider — Evaluation, employment status
changes, documentation of training, documentation of conflict and job performance issues.
DADS
(The employer must send the original or a copy to the FMSA within 30 calendar days of an initial
orientation or annual evaluation and when an action affects the service provider's continued status
with the employer, e.g., termination, change in payment.)
DADS Form 1732-EMR, Management and Training of Service Provider Addendum — Must be signed
DADS
by the employee within five days of hire.
Time sheets/service logs — DADS Form 1745, Service Delivery Log with Written Narrative/Written
DADS
Summary, or facsimile approved by the FMSA
Vendors
Receipts and invoices
Code
Action
Code
Agency
CDC
Centers for Disease Control and Prevention
Employer checks off each item for the personnel file and retains
original or copy.
CDS
Consumer Directed Services
DADS
Texas Department of Aging and Disability Services
Employer checks each required item when completed and sends
IRS
Internal Revenue Service
original or copy to the FMSA as indicated. Employer retains
OAG
Office of the Attorney General, State of Texas
original or copy.
OSHA
Occupational Safety and Health Administration
Items the employer is not required to send to the FMSA, but
TWCC
Texas Workers’ Compensation Commission
which the employer must maintain on file in the employee’s
U.S. Citizenship and Immigration Services (formerly known as
personnel file.
USCIS
the INS, Immigration and Naturalization Services)
Form 1724
August 2015-E
Consumer Directed Services
New Employee Packet Cover Sheet
Employer Name
Name of Individual Receiving Services
Employee Name
Date of Hire
First Day of Work
Employer
Agency
FMSA
Document Description / Form Information
Before Hire: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
DADS
DADS Form 1725, Criminal Conviction History and Registry Checks
DADS Form 1729, Applicant Verification for Employees;
DADS
DADS Form 1734, Service Provider and Employer Certification of Relationship Status for CDS
USCIS
USCIS Form I-9, Employment Eligibility Verification
DADS
DADS Form 1728, Liability Acknowledgement
DADS
Professional license verification (nursing, professional therapies)
At Time of Hire: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
IRS Form W-4, Employee’s Withholding Allowance Certificate — Due before first payroll check is
IRS
calculated; provide to the Financial Management Services Agency (FMSA) on date of hire.
OAG
Texas Employer New Hiring Reporting Form (www.employer.texasattorneygeneral.gov)
DADS Form 1730, Wage and Benefits Plan Employee Compensation, and any court-ordered
DADS
garnishment(s); DADS Form 1731, Employee Work Schedule and Assigned Tasks; DADS Form
1737, Employer and Employee Service Agreement; DADS Form 1739, Service Provider Agreement
CLASS, DBMD and MDCP only: Cardiopulmonary resuscitation (CPR) certification — Effective
DADS
at time of service delivery initiation, and maintained. Verify again before expiration date.
Texas Department of Public Safety driver’s license (if transporting client) — Verify again before
DADS
expiration date.
DADS
Proof of minimum auto insurance (if transporting client)
CDC
DADS Form 1727, Occupational Exposure to Bloodborne Pathogens (Acknowledgement: Hepatitis B
OSHA
Vaccination and Universal Precautions)
TWCC
Notice to Employees Concerning Workers’ Compensation in Texas (TWC Notice 5)
DADS
If hiring a nurse: DADS Form 1747, Acknowledgment of Nursing Requirements
CDS
If applicable: DADS Form 1733, Employer and Employee Acknowledgement of Exemption from
DADS
Nursing Licensure for Certain Services Delivered through Consumer Directed Services
DADS Form 1732, Management and Training of Service Provider — Initial training must be
DADS
conducted within 30 days of hire.
Ongoing: (1) Original or Copy for Employer’s Personnel Files and (2) Original or Copy to FMSA
DADS Form 1732, Management and Training of Service Provider — Evaluation, employment status
changes, documentation of training, documentation of conflict and job performance issues.
DADS
(The employer must send the original or a copy to the FMSA within 30 calendar days of an initial
orientation or annual evaluation and when an action affects the service provider's continued status
with the employer, e.g., termination, change in payment.)
DADS Form 1732-EMR, Management and Training of Service Provider Addendum — Must be signed
DADS
by the employee within five days of hire.
Time sheets/service logs — DADS Form 1745, Service Delivery Log with Written Narrative/Written
DADS
Summary, or facsimile approved by the FMSA
Vendors
Receipts and invoices
Code
Action
Code
Agency
CDC
Centers for Disease Control and Prevention
Employer checks off each item for the personnel file and retains
original or copy.
CDS
Consumer Directed Services
DADS
Texas Department of Aging and Disability Services
Employer checks each required item when completed and sends
IRS
Internal Revenue Service
original or copy to the FMSA as indicated. Employer retains
OAG
Office of the Attorney General, State of Texas
original or copy.
OSHA
Occupational Safety and Health Administration
Items the employer is not required to send to the FMSA, but
TWCC
Texas Workers’ Compensation Commission
which the employer must maintain on file in the employee’s
U.S. Citizenship and Immigration Services (formerly known as
personnel file.
USCIS
the INS, Immigration and Naturalization Services)

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