Consumer Information - Inland Regional Center | Serving ...



IRC CIE Face Sheet for VendorsConsumer InformationConsumer NameUCI#SSI#BirthdayService CodeService CoordinatorVendor InformationVendor NameVendor NumberPurchase of ServiceCIEP / CIE6 / CIE12Employment InformationEmployer NameAddressStart DateType of EmploymentType of WorkType of Employment SupportsHourly Wage/SalaryHours Worked per WeekBenefits InformationSick Leave (y/n)Holiday (y/n)Vacation (y/n)Medical (y/n)Dental (y/n)Vision (y/n)Other Benefits ................
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