The worker notice referred to in section 16 of this chapter must contain the following:

1. (1) The duties, responsibilities, and obligations of the placement agency, the consumer, and the home care services worker if the home care services worker is determined to be an independent contractor, including:

   1. (A) a statement of the party responsible for the payment of the home care services worker's wages, taxes, Social Security and Medicare contributions, unemployment contributions, and worker's compensation insurance premiums; and
   2. (B) a statement identifying the party responsible for the home care services worker's hiring, firing, discipline, day to day supervision, assignment of duties, and provision of equipment or materials for use by the home care services worker.

2. (2) The telephone number, address, and electronic mail address of the department for inquiries regarding the contents of the notice.

   The department shall determine the content and format of the consumer notice.

As added by P.L.212-2005, SEC.19.