Get Form 1734

Filling out the Form 1734 is a crucial step in the Consumer Directed Services process. This guide provides a clear and supportive walkthrough to help you complete the form accurately and efficiently.

Follow the steps to complete the Form 1734 successfully

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the service provider name in the designated field. This should be the full legal name of the individual or entity providing services.
3. Enter the maiden name of the service provider if applicable. This information helps in verifying identity.
4. Input the service provider's social security number carefully, ensuring accuracy to avoid any processing delays.
5. Fill in the name of the individual receiving services. This is critical for establishing the relationship for certification.
6. Complete the employer name field, indicating the person or organization responsible for hiring the service provider.
7. Indicate the service provider’s relationship to the individual by selecting the appropriate option from the provided list.
8. If applicable, add the designated representative (DR) information. This person may be involved if the individual requires additional support.
9. Respond to the questions regarding the service provider’s status and relationship. Check 'Yes,' 'No,' or 'N/A' for each statement as it applies to your situation.
10. Review your answers carefully to ensure all provided information is both complete and accurate, as this will impact eligibility.
11. The employer and service provider must certify the accuracy of the responses by adding their printed names, signatures, and the respective dates.
12. Finally, save your changes. You may then download, print, or share the completed form as necessary.

Start completing your Form 1734 online today.