Get Exprs User Enrollment Form

Completing the eXPRS User Enrollment Form is an essential step for DD PSW/Individual In-Home services providers to gain access to the eXPRS system. This guide will walk you through each section of the form with clear instructions to ensure your enrollment process is smooth and efficient.

Follow the steps to complete the eXPRS User Enrollment Form online:

1. Click the ‘Get Form’ button to obtain the eXPRS User Enrollment Form and open it in the document editor of your choice.
2. In the top section of the form, select the type of enrollment action you wish to take by checking the appropriate box: ADD to become a new user, MODIFY to change current permissions, DEACTIVATE to terminate access, or NAME/LOGIN CHANGE to update your user profile.
3. Fill in your personal information in the designated boxes which include: Your Name, Your Phone Number, Your Job Title (such as ‘PSW worker’ or ‘in-home provider’), Your Provider ID Number (the 6-digit number received from DHS), Your Address, Your eXPRS Login (if applicable), and Your Email Address.
4. In the middle section of the form, indicate the user permissions you wish to add or delete by checking either the ADD or DEL box.
5. In the bottom section, print your name, sign, and date the form to complete your enrollment.
6. Once all sections of the form are filled out, choose a submission method: e-mail, fax, or US postal mail, and send your completed form to DHS.
7. Remember to keep a copy of the completed form for your records. You will receive a confirmation email once your enrollment is processed.

Begin your eXPRS User Enrollment Form online now.