One cabot drive, suite 102, medford, ma 02155



Dear Personal Support Worker:The United States Department of Labor (USDOL) Application of the Fair Labor Standards Act to Domestic Service, Final Rule takes effect January 1, 2015. As a result of the Final Rule, Personal Service Workers (PSWs) who serve individuals enrolled in Illinois Department of Human Services’ Home-Based Service and Supports program must receive overtime pay for any time that exceed 40 hours in a week. The overtime pay rate is 1.5 times the workers regular pay rate. Overtime provisions begin January 1, 2015. However, there are two scenarios where workers will not be required to receive overtime.Scenario #1: Companionship Service Exemption. In order to meet the meet the Companionship Exemption, a worker cannot: Spend more than 20% of their workweek performing care services (e.g., Activities of Daily Living (ADLs) such as dressing, grooming, feeding, bathing, toileting and transferring; and Instrumental Activities of Daily Living (IADLs) which are tasks that enable a person to live independently at home, such as meal preparation, driving, light housework, managing finances, assistance with the physical taking of medications, and arranging medical care.); Perform performing “household work” that benefits other members of the household during the workweek; andProvide “medically related services” which are typically performed by trained personnel. Scenario #2: Live-in Domestic Services Exemption. A worker is entitled to this exemption if the PSW resides in the employer’s home permanently or for an extended period of time and are employed by an individual, family, or household. To qualify for this exemption:The PSW resides on the employer's premises permanently when he or she lives, works, and sleeps on the employer's premises seven days per week and therefore has no home of his or her own other than the one provided by the employer under the employment agreement. Or,The PSW resides on the employer's premises for an extended period of time when he or she lives, works and sleeps on the employer's premises for five days a week (120 hours or more). If a PSW spends less than 120 hours per week working and sleeping on the employer's premises, but spends five consecutive days or nights residing on the premises, this also constitutes an extended period of time.If you have questions concerning the overtime rule or the possible exemptions, please contact your service facilitator or our customer service department at 1-888-866-0582. You may also try the DOL website at WWW. or call them toll free at : 1-866-487-2365. In order to process pay for PSWs after January 1, 2015, all workers must check one box below and return this page to PPL by November 14, 2014. All workers must complete this page for each of their employers.You may scan and e-mail, fax, or mail the completed form to these respective addresses: E-mail: ildd@Fax: (866) 826-7287 Mail: PCG Public Partnerships, Attn: ILDD, One Cabot Drive, Suite 102, Medford, MA 02155Positive Attestation Required With the assistance of your consumer’s Service Facilitator and your Employer of Record, please check the following that apply:I do qualify for overtime pay live-in exemption under the “Residency Test”.I do qualify for the overtime pay and minimum wage companionship exemption under the “Duties Test”.I do not qualify for overtime pay and minimum wage exemption either under the “Residency Test” or the “Duties Test”.I do qualify for an overtime pay exemption, but I do not choose to use the exemption.The above statement is true and complete to the best of my knowledge and belief.EMPLOYEE SIGNATURE:_____________________________________________________DATE: _______________________________________________________________________EMPLOYER SIGNATURE:_____________________________________________________DATE: _______________________________________________________________________Thank you,PPL Customer Service Team ................
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