Get Hspolicy

Filling out the Hspolicy online is a crucial task for providers working with the Department of Human Services. This guide will walk you through each section of the form, ensuring that you complete it accurately and efficiently.

Follow the steps to successfully complete the Hspolicy form.

1. Click the ‘Get Form’ button to obtain the Hspolicy document and open it in your preferred document editor.
2. Begin by reading the Statement of Understanding in the form. This section outlines your responsibilities in protecting confidential information. Ensure you fully understand it before proceeding.
3. In the 'Provider Representative Signature' field, enter your signature followed by the date. This indicates your agreement to the terms outlined in the Statement of Understanding.
4. Print your name in the 'Provider Representative Name' field to identify yourself clearly on the form.
5. Provide your DHS/DSPD contract number and telephone number in the specified fields for contact reference.
6. Add your preferred email address where the USTEPS team can reach you for any business-related correspondence.
7. The section for Provider Designee(s) requires you to grant access to individuals acting on your behalf. List the names of your designees and ensure they understand their responsibilities.
8. Each designee must initial and date their acknowledgment of the Statement of Understanding. Have them sign their names in the designated fields.
9. Once you have filled out the form completely, review it for any errors or missing information. This helps ensure that your submission is valid.
10. Save your changes and download the completed form. You can choose to print it or share it as required.
11. Finally, email the form to USTEPS@utah.gov or fax it to (801) 538-4279, ensuring that you include 'UPI' in the subject line for proper classification.

Complete your Hspolicy form online today to ensure your compliance and maintain access.