\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 envelope address;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 envelope return;\lsdsemihidden1 \lsdlocked0 footnote reference;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 annotation reference; Completely fill out the demographic section at the bottom of the form AND attach a copy of your ID and social security card. Salt Lake City, Ut 84116, DLBC Contact Info \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department denies or revokes a license, or denies direct patient access based upon arrest or criminal charges, the Department shall send a Notice of Agency Action to the covered provider and the covered 9c7827248a21f056286502866b8ddaa4d684ffea13e827ed5174849121ad780113b137a4f87862cec94af6fc07a0d537206f7ffef9cdeb1fdfbcfee9cd575fbd \s24\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \lsdpriority45 \lsdlocked0 Plain Table 5;\lsdpriority40 \lsdlocked0 Grid Table Light;\lsdpriority46 \lsdlocked0 Grid Table 1 Light;\lsdpriority47 \lsdlocked0 Grid Table 2;\lsdpriority48 \lsdlocked0 Grid Table 3;\lsdpriority49 \lsdlocked0 Grid Table 4; Until the Office of Licensing has approved the screening, an applicant shall have no direct access to a child or vulnerable adult. Obtaining Utah Criminal History Records. Utah PDF INITIAL REQUIREMENTS INFORMATION SHEET - Utah Department of Health Steps for Entering a Youth Application in DACS, Exemption Declaration (adult substance abuse treatment programs only), Contact Information for obtaining an out of state Central or Child Abuse Registry Check, I understand that my personal information including name, date of birth, social security number and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. How to Request a Background Check - University of Texas at Austin Salt Lake City, UT 84114-8280.
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