Provider Service Forms

* If you are looking for a New Provider Enrollment Packet, you can download and print it from the following links below. Everything has to be printed, read thoroughly, and completed in the specified order below before returning portions (as organized below) to our office:

* If you are looking for blank Time Sheets, you can find them by clicking Here. (Note: The eXPRS generated time sheet is required when submission to our office for payment. This document is not acceptable, and is more of a draft).

* If you are looking for blank Mileage Reimbursement Logs, you can find them by clicking Here. (Note: The eXPRS generated mileage log is required when submission to our office for payment. This document is not acceptable, and is more of a draft).

* If you need to file a Incident Report, you can do that by clicking Here.

*If you need to fill out a W4 you can find it Here

*If you need to fill out an I9 you can find it Here .

*If you need to fill out an eXPRS/DHS Employee Change of Information form, you can find it Here.

*If you need to fill out a PEAA (Provider Enrollment Application and Agreement) click Here. Para el Espanol, clic Aqui.

*If you need to fill out an eXPRS UEF (User Enrollment Form) click Here .

*If you need to update your Criminal History Check you can find the form Here. (In order to process you will need to come into the CSI office in person with a valid ID) Para el Espanol, clic Aqui.

*If you need to view the State Payroll Calendar click Here .