Forms
The below documents, forms and lists will assist those who wish to become licensed, and those who are currently licensed, to apply for, renew and maintain a license. See Department of Human Services (DHS) Rules opens in a new tab for more detailed information.
Human Services Program Forms
- Program/site initial license application opens in a new tab
- Program/site renewal license application opens in a new tab
- DSPD Certification application – Residential Support opens in a new tab (for use by DSPD-contracted providers only)
- DSPD Certification application – Day Support opens in a new tab (for use by DSPD-contracted providers only)
- Youth Transportation Company Registration application opens in a new tab
- Adult Day Care opens in a new tab
- Child Placing Adoption Agency opens in a new tab
- Child Placing Foster Care opens in a new tab
- Day Treatment opens in a new tab
- General Provisions opens in a new tab
- Intermediate Secure Care (incorporated into Residential Treatment rules)
- Outdoor Youth opens in a new tab
- Outpatient Treatment opens in a new tab
- Recovery Residence opens in a new tab
- Residential Support opens in a new tab
- Residential Treatment (includes Intermediate Secure Care) opens in a new tab
- Social Detoxification opens in a new tab
- Therapeutic Schools opens in a new tab
- DSPD Residential/Day Support checklist opens in a new tab
- DSPD Certified Sites checklist opens in a new tab
- Client Rights Poster opens in a new tab
- Utah Abuse and Neglect Reporting Law opens in a new tab
- Utah Abuse and Neglect Reporting Law (Spanish) opens in a new tab
- Americans with Disabilities Act Notice opens in a new tab
- Americans with Disabilities Act Notice (Spanish) opens in a new tab
- Civil Rights Notice opens in a new tab
- Civil Rights Notice (Spanish) opens in a new tab
- Provider Code of Conduct Notice opens in a new tab
- Provider Code of Conduct Notice (Spanish) opens in a new tab
- Administrative Hearing Request opens in a new tab
- Code of Conduct opens in a new tab
- Código de Conducta (Code of Conduct – Spanish) opens in a new tab
- DHS Incident Reporting Guide opens in a new tab
- DSPD Residential Attestation form for HCBS Waiver opens in a new tab
- DSPD Non-Residential Attestation form for HCBS Waiver opens in a new tab
- DSPD Residential Provider Self-Assessment Tool for HCBS Waiver opens in a new tab
- DSPD Non-Residential Provider Self-Assessment Tool for HCBS Waiver opens in a new tab
- General Provisions Rule Guide opens in a new tab
- Home Inspection Checklist opens in a new tab
- Policy and Procedure Consultation/Approval Request Template opens in a new tab
- Policy and Procedure Requirement Checklist opens in a new tab
- TB Screening Tool opens in a new tab
- Variance Request opens in a new tab
- Youth Education Coordinating Form opens in a new tab
- Youth Education Coordinating Form opens in a new tab
- Foster Care Rule Guide opens in a new tab
- Foster/Proctor Care – Iniitial Family Application for Agencies opens in a new tab
- Foster/Proctor Care Renewal Application for Agencies opens in a new tab
- Foster/Protcor Care – Home Study Update Template for Agencies opens in a new tab
- Foster/Proctor Initial Home Study Template for Agencies opens in a new tab
- ICPC 100A form opens in a new tab
- ICPC 100B form opens in a new tab