Prototype- Louisiana Employer Roles and Information

Louisiana Employer Roles and Information

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Fiscal Employer Agent

The Fiscal Employer Agent (FEA) or Payroll Agent is responsible for processing time records, paying employees, paying payroll taxes, and maintaining employment law compliance.
Employer Agent Name (Read Only)
Phone Number (Read Only)
Human Resources Email (Read Only)
Human Resources Fax (Read Only)
Human Resources Mailing Address (Read Only)
Morning Sun Financial Services of Louisiana
820 Lilac Drive North, Suite 200
Golden Valley, MN 55442
Payroll Email (Read Only)
Payroll Fax (Read Only)
Payroll Mailing Address (Read Only)
Morning Sun Financial Services of Louisiana
9400 Golden Valley Road
Golden Valley, MN 55427
Participant

This is the person that receives services. Other terms include, Consumer, Client, or Person Served
Participant Legal Name*

Legal First NameLegal Last Name
Participant Address*

Street Address

Apartment or Unit Number

CityState

Zip Code
Participant Parish*
Participant Date of Birth*

MonthDayYear
Date
Participant Gender*

MaleFemale
HIDE- Participant Gender (Circle one)

MaleFemale
Louisiana Program*

OAASOCDD CCWOCDD NOWOCDD ROW
HIDE- Louisiana Program (Circle one)

OAASOCDD CCWOCDD NOWOCDD ROW
Is this a transition FROM another Fiscal Agent TO Morning Sun Financial Services?*

NoYes
Other Fiscal Agent Name*
HIDE- Is this a transition FROM another Fiscal Agent TO Morning Sun Financial Services? (Circle one)

NoYes
Does the Participant have a Responsible Representative? If yes, your Support Coordinator will complete and submit to Morning Sun Financial Services*

NoYes
HIDE- Does the Participant have a Responsible Representative? If yes, your Support Coordinator will complete and submit to Morning Sun Financial Services (Circle one)

NoYes
Employer

This is the person that is responsible for supervising an Employee. In some cases, the Employer can be the Participant or their Authorized Representative.
Employer Legal Name*

Legal First NameLegal Middle NameLegal Last Name
Employer Email*
example@example.com
Employer Phone Number*
Please enter a valid phone number.
Employer Address*

Street Address

Apartment or Unit Number

CityState

Zip Code
Employer Parish*
Employer Date of Birth*

MonthDayYear
Date
Employer Social Security Number*
Support Coordinator

The person licensed by Health Standards and has an agreement with Louisiana to provide support coordination services to waiver participants
Support Coordinator Name

Legal First NameLegal Last Name
Support Coordinator Email
example@example.com
Support Coordinator Phone Number
Please enter a valid phone number.
Authorized Representative

This is a person that can act on the Employer's behalf
Authorized Representative Legal Name

Legal First NameLegal Last Name
Authorized Representative Email
example@example.com
Authorized Representative Phone Number
Please enter a valid phone number.
Authorized Representative Address

Street Address

Apartment or Unit Number

CityState

Zip Code
Authorized Representative Parish
Authorized Representative Date of Birth

MonthDayYear
Date
Should be Empty:

Louisiana Employer Roles and Information

Fiscal Employer Agent

Participant

Employer

Support Coordinator

Authorized Representative