DCF Credentialing Forms & Resources
DCF is accepting applications for all services except CHAP/CHEER & General Livery Transportation.
Resources
- Regional Contact Information (DCM)
- Quick Reference Guide - Region Specific Invoice Submission Guidelines
- DCF Training Academy: Community Partners Catalog
- CTSBDC Connecticut Small Business Development Center
- The Governor's Prevention Partnership
Technical Assistance
Forms
- DCF Credentialed Provider Referral Form
- Documentation for Credentialed Providers
- DCF Credentialed Provider Documentation Form (For Therapeutic Support & Support Staff Service)
- DCF Credentialed Provider Documentation Form (For Supervised Visitation)
- Supervision Guidelines
- Supervisory Agreement Template
- Supervision Note
- Provider Information Change Form
- Site Visit Letter to Providers
- DCF Credentialed Provider Review Tool
- Provider Assessment Tool
Billing Procedures
- Aging Statement - SAMPLE
- DCF Invoicing Requirements
- Direct Deposit Set-Up
- Region Specific Invoice Submission Guidelines
- Credentialed Provider Invoice (Excluding Transportation)
- Connecticut False Claims Act
- Relevant Sections of the CT False Claims Act
Policies and Provider Notices
- DCF Credentialing for Service Providers Policy
- Letter to Providers (DCF CPS Background Check)
- Memo to Contracted Providers (Consolidated Administrative Case Review Meetings)
Application Supplements
- DCF Mandated Reporter Training
- DCF CPS Background Check (CPS)
- State Police Record Request Form (DESPP)
- DMV Record Check (For CHAP Providers only)
- Staff Roster
- Statement of Experience Form
- DCF Confidentiality Statement and Ethics Agreement
- Professional Review Questionnaire
- Release of Confidential Disciplinary Records (Consent Form)
- W9
- Race/Gender/Ethnicity Form
FAQ
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