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    • EEDA Board of Directors
  • Services
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  • Contact Us
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  • EEDA CLOTHESELINE
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​SELF DIRECTED SERVICES / FISCAL INTERMEDIARY (FI)

important forms


Employee eVero Help
employee_self_changes_in_evero.pdf
File Size: 131 kb
File Type: pdf
Download File


​Applicant Consent Form for Fingerprinting for Justice Center Criminal Background Check Unit
fi_background_check_updated_3.6.2019.pdf
File Size: 4018 kb
File Type: pdf
Download File


DSP Performance Evaluation
fi_dsp_eval_9.29.20.pdf
File Size: 280 kb
File Type: pdf
Download File

interview_tool_for_dsp_evaluation__1_.pdf
File Size: 561 kb
File Type: pdf
Download File


Family Reimbursement Payment Receipt
family_reimbursed_respite_-_fi_updated.pdf
File Size: 175 kb
File Type: pdf
Download File


Expense Report- Direct Payment
expense_worksheet_-_direct_payment_new_2017.xlsx
File Size: 14 kb
File Type: xlsx
Download File


IDGS Community Class Submission
idgs_community_class_vetting_8-20-2020.pdf
File Size: 126 kb
File Type: pdf
Download File


Participant Mileage Form
mileage_worksheet_blank_5-13-16_fillable.pdf
File Size: 61 kb
File Type: pdf
Download File


Expense Reimbursement Form
expense_worksheet_-_reimbursement_new_2017.xlsx
File Size: 14 kb
File Type: xlsx
Download File


Employment in Self Directed Services/Compensation and Benefits
working_in_sds_salary___time_off_addendum_-_final.docx
File Size: 94 kb
File Type: docx
Download File

Self-Direction Contacts:

Diane Lagoumis 
Director of Self-Direction Services
DianeL@eed-a.org
631-369-7345 ext. 109

Tracy Zimmerman
Manager of Self-Direction
TracyZ@eed-a.org
631-369-7345 ext. 112

​
Sally Easter
Software Support for Self-Direction
SallyE@eed-a.org
631-369-7345 ext. 142

Nicole Reyes
Coordinator of Self-Direction
NicoleR@eed-a.org
631-369-7345 ext. 157

Kimberly Washburn
Coordinator of Self-Direction
KimberlyW@eed-a.org
631-369-7345 ext. 244

Redondo Petion
Coordinator of Self-Direction
RedondoP@eed-a.org
631-369-7345 ext. 259

Lisa Rhyner
Self-Direction Staff Support Specialist
​LisaR@eed-a.org
631-369-7345 ext. 135


Jaime Mescia
Coordinator of Self-Direction
JaimeM@eed-a.org
631-369-7345 ext. 136

Megan Schaal
Coordinator of Self-Direction
MeganS2@eed-a.org
631-369-7345 ext. 216

Cameron Iuliucci
Coordinator of Self-Direction
CameronI@eed-a.org
​631-369-7345 ext. 242

Sharyn Testagrose
Self-Direction Office Assistant
SharynT@eed-a.org
631-369-7345 ext. 161

Out of New York State Services
out_of_new_york_state_services_approval_form_fillable.pdf
File Size: 69 kb
File Type: pdf
Download File

ooss_request_050619.docx
File Size: 18 kb
File Type: docx
Download File


Employee Salary Form
employee_salary_form_updated_1-2020.pdf
File Size: 1088 kb
File Type: pdf
Download File


eVero Designee Form
evero_designee_form_-_8-20-2020.pdf
File Size: 127 kb
File Type: pdf
Download File

Photo taken by Yanet García
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EEDA
107 Roanoke Avenue
Riverhead, NY 11901
Phone: (631) 369-7345
Fax: (631) 369-7346