Get Employer's Selection For Electronic Visit Verification (evv). Form 1722 - Dads State Tx

Completing the Employer's Selection for Electronic Visit Verification (EVV). Form 1722 - Dads State Tx is an essential step for Consumer Directed Services Employers in EVV regions. This guide provides clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in the document editor.
2. Enter the individual's name in the designated field at the top of the form.
3. Provide the individual's identification number in the specified section.
4. If applicable, input the employer's name in the field that requests it; fill this out only if it differs from the individual's name.
5. In the next section, indicate your relation to the individual by selecting the appropriate option.
6. Choose your EVV participation option by marking one of the three available choices, whether it is Full Participation, Partial Participation, or No EVV Participation.
7. In the following field, provide a reason for your selection if needed.
8. Sign the form as the CDS Employer in the designated signature area.
9. Insert the date of your signature in the corresponding field.
10. If applicable, have the FMSA representative sign the form where indicated, along with the date.
11. Once you have filled out all required sections, save the changes, and proceed to download, print, or share the form as needed.

Complete your document online today and ensure compliance with EVV requirements.