CDS Bonus Request Form

BEFORE SUBMITTING THIS REQUEST:
Please ensure your request meets the following criteria:

HRA must receive this request at least 21 days prior to desired bonus payday.
Request must be consistent with your individual program plan budget.
Sufficient funds must remain within your budget.
Sufficient hours must have been worked to earn bonus.
Bonus must only be for a currently-employed attendant.
**Please note that payroll taxes must be withheld from bonuses. Your attendant's check will be the net of taxes.

Client Name (the person who receives services):*

First NameLast Name

CDS Program Name:*

Attendant Name (person receiving bonus):*

First NameLast Name

Which of the following bonus types are you requesting*

*Hire-on bonus* (must be earned-out within the first 3 months of employment. If employee terminates early, compensation must be made)*Budgeted Bonus**End of fiscal year bonus* (if your budget's fiscal year ends within 30 days, we will analyze your remaining expenses after all timesheets have been received to determine if there are remaining funds accrued from hours worked that can be paid as a bonus. We will advise you of the remaining balance. Checking this options means you understand that these funds will be paid out in the payroll following the pay period containing the end date of your current plan year.)

Bonus amount requested*

If you are requesting and end of fiscal year bonus, please type "remaining balance."

Employer Name (client, employer, or designated representative)*

First NameLast Name

Employer Signature*

Clear

Employer email address*

Where you'd like the confirmation of your request to be sent.