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Your Purchase of Service (POS) Form

This is the form you will use each time you submit a claim for reimbursement.  Once you are onboarded with Passport, we will mail you POS forms customized and barcoded with your name and address, and you should use these forms.  Make plenty of copies so you don’t run out.  Never use another person’s POS form and white out their name, because the bar code will not be accurate.  For instructions on how to complete this form, see How to Submit Claims for Reimbursement.

Support Worker Information Form

This is the form you will probably need the most often.  Every time you hire a new support worker, the Person Managing Funds must complete a Support Worker Information Form before submitting a claim for reimbursement.  This form ensures that the person hired is qualified to be a support worker.  To qualify as a support worker, a person must be over 18, they cannot be the parent or primary care giver for the client, they cannot be the Person Managing Funds, and they cannot be the named Payee of the client (that is, Passport Reimbursements are not going directly into their bank account). If a support worker is employed by a business that invoices separately, you do not need to complete a Support Worker Information Form .  This form is for private support workers that are not employed by a business and are working independently. Both the support worker and the person managing funds should sign this form.  Send the completed form to passport@contacthamilton.ca.

Payee Information Form

This form indicates who will be the person that will receive the reimbursements into their bank account.  The person named as Payee could be the Passport recipient themselves, a parent, a primary care giver, or other, but it cannot be a Support Worker for the recipient.  You will need to complete this form once during onboarding, and then again anytime the recipient’s payee or banking information changes.  The Person Managing Funds must sign this form.  Send the signed form to passport@contacthamilton.ca and always include either a direct deposit form or a void check with the new bank information.

Person Managing Funds (PMF) Form

You will probably complete this form only once, while you are onboarding.  Sometimes, however, circumstances may change.  This form names the person responsible for making decisions about your Passport Funding.  This person may be the recipient themselves, or it may be someone they designate.  It may or may not be the Passport recipient’s primary caregiver, but it does not have to be.  The PMF cannot be a support worker.  The person who signs this form should be the same person who signed the original Service Agreement when you onboarded with Passport.  If you want to change the person managing funds or add a backup, the new Person Managing Funds will need to sign a new Service Agreement, so please contact your coordinator before proceeding.  Submit this form to passport@contacthamilton.ca.

 

Hiring/Dissolving Transfer Payment Agencies, Brokers, and Service Agencies

If you decide to hire a Transfer Payment Agency, Broker, or Service Agency to administer your funding, then the Person Managing Funds will need to complete the appropriate form and submit it to us.  Similarly, if you decide to end your relationship with one of these agencies, the Person Managing Funds needs to complete the Dissolution box on the back of each of the forms listed below.

 

Notification of Transfer Payment Agency Form

Transfer Payment Agencies are ministry-funded agencies that manage passport funding, provide administrative support, and coordinate services.  They will submit invoices on behalf of recipients and are reimbursed directly by the program.  They may charge up to 10% for administrative fees.

 

Notification of Brokerage Form

Brokerages are private agencies that manage and provide administration support for Passport funding, Brokers will coordinate services, and they will submit invoices on behalf of the recipients.  They will be the Payee, receiving Passport reimbursements directly.  They can charge up to 10% for administrative fees.

 

Notification of Service Agency Form

Service Agencies are private agencies that bill clients for their services but do not coordinate services for their clients.  They can charge up to 10% for administrative fees.  Clients must submit their invoices for reimbursement, as services agencies are not paid directly by Passport.

 

If you decide to dissolve your relationship with a Transfer Payment Agency, Broker or Service Agency, take these steps:

  1. The Person Managing Funds (PMF) must sign the Dissolution on the back of the Notification of Transfer Payment Agency, Brokerage, or Service Agency Form and email this form to passport@contacthamilton.ca with thirty-days notice.
  2. The PMF must notify the agency they are dissolving from to ensure that agency submits any outstanding claims in a timely fashion.
  3. The PMF should sign a new Notification form indicating who will now be managing the Passport Recipient’s funds, and forward this form to passport@contacthamilton.ca. If the client no longer wants to use an agency and intends to self-direct their Passport Funding, the PMF will need to contact their coordinator who can advise them on the appropriate forms.

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How to Reach Us:
140 King Street East, Suite 4
Hamilton, ON, L8N 1B2
Phone: 905-570-8888
Email: info@contacthamilton.ca

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