Forms

Request a Background Screening

To request a background screening, please complete and submit the Informed Consent and Liability Form, along with a copy of your driver’s license to the address on the top of the form or fax to 801-538-3993.  For additional information, or if you have questions, please contact Nora Wilson, Background Screening Specialist at 801-538-4466 or by email at norawilson@utah.gov.

Request Copies of Case Records

To request copies of case records, please visit Records Requests for instructions on completing a GRAMA Request.

Provider-Only Payment Forms

To request a one-time/special needs payment, complete the DHS-DCFS One-Time Provider Form 295F form and submit it  to your caseworker.

To submit an invoice for services provided, complete  the DCFS 520 form and submit it to your caseworker.

Complete the Foster Parent Private Vehicle Usage Report for mileage reimbursement and submit it to your caseworker.

If you are a provider and want to sign up for electronic funds transfer for your DHS CAPS payments, please complete the Direct Deposit Electronic Funds Transfer.

Please complete the Check Loss Affidavit and Agreement if you are a provider and you have lost your check or your check has been lost in the mail.