Thank you for selecting JG Fiscal to serve as your Fiscal Agent for services you will be receiving through Inclusa, Inc. See below the New Employer Packet. Please download this packet as it contains all of the documents and forms needed to complete the signup process.
See below the full list of documents and forms in the above-linked packet. Use the link above to download the entire packet, or select from the documents below to download the individual files as-needed.
- Welcome/Intro Document
- Self-Directs Supports Timesheet
- Fiscal Employer Agent New Employer Checklist
- Employer/Member Data Form
- Member Authorization Form
- Employer & Fiscal Employment Agency Agreement
- Form SS-4: Application for Employer Identification Number
- Form 2678: Employer/Payer Appointment of Agent
If you have any questions or concerns please don’t hesitate to contact me at your convenience. See below our contact information, or click here to use our online contact form.
673 4th Avenue North
Park Falls, WI 54552
Toll Free: (888) 689-7798
Fax: (715) 744-4999