• Utah Employer EVV Data Information Form

    For questions, please contact Morning Sun Financial Services at 1-844-450-5444
  • Select a Role*
  • Click the print icon in the top right corner to print.

  • Utah Employer EVV Data Information Form

    For questions, please contact Morning Sun Financial Services at 1-844-450-5444

  • Morning Sun as your Fiscal Employer Agent (FEA), is authorized to represent you for purposes of employer tax reporting responsibilities. Morning Sun will also manage the initial setup of the employer, employee's and participant's information within the Electronic Visit Verification system (EVV). Please complete all sections to provide the contact information for the Participant, Employer, and Authorized Representative (if applicable). If you have more than one employee, please enter contact information for ALL employees.

  • Participant

    This is the person that receives services. Other terms include, Consumer, Client, or Person Served
  • Format: (000) 000-0000.
  • Participant Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant Gender*
  • HIDE- Participant Gender (Circle one)

  • Employer

    This is the person that is responsible for supervising an Employee. In some cases, the Employer can be the Participant or their Authorized Representative.
  • Format: (000) 000-0000.
  • Employer Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Authorized Representative

    This is a person that can act on the Employer's behalf
  • Format: (000) 000-0000.
  • Authorized Representative Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Employee

    This is the person that is responsible for providing services to the Participant
    • Employee 1 
    • Format: (000) 000-0000.
    • Employee 1 Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Employee 2 
    • Format: (000) 000-0000.
    • Employee 2 Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Employee 3 
    • Format: (000) 000-0000.
    • Employee 3 Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Employee 4 
    • Format: (000) 000-0000.
    • Employee 4 Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • Employee 5 
    • Format: (000) 000-0000.
    • Employee 5 Date of Birth
       - -
      2 digit month, 2 digit day, 4 digit year
    • HIDE- End 

    • Signatures

      I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/

    • Any changes to personal information above requires a notification to Morning Sun Financial Services using the Employee Change Form, found on our website at www.morningsunfs.com. 

      Your signature means you have read and understand why this is needed. 

    • Date of Signature*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Should be Empty: