Important Notice: EVV is Live in Your State
Using the DCI portal for time entry does not satisfy the EVV requirements. Employees must begin clocking in and out in real-time using the DCI mobile app on a web-enabled smartphone or tablet. Certain programs are also permitted to use an approved landline telephone. Please contact your local Acumen Agent as soon as possible for more information and assistance.
W2 Information
Acumen consistently exceeds 95% Customer Service Ratings across all of the programs we serve throughout the United States.
To contact Acumen Fiscal Agent, please call (888) 221-7014 or fax (888) 249-7023.
Program Website
To contact the program call (435) 752-7242 or (877) 772-7242.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form Employer’s Previous Business Information Form UT Aging Timesheet UT Client & Employer Change Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 752-7242.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 538-4200 or (800) 837-6811.
Participant Employer Forms
*UT DSPD NEW ENROLLMENT PACKET COMPLETE (Fillable) 2678 Form Fingerprint Reimbursement Form Form SS-4 Sample Forms for Employers – UT DSPD Employer’s Previous Business Information Form UT All Change in CT ER Info REV March 2022 UT All ER Secondary Auth Rep Form March 2022 UT DSPD Acumen Authorization Form Rev March 2022 UT DSPD EVV FOB ORDER FORM REV JUNE 2022 UT DSPD Employer Agreement March 2022 UT DSPD Pay Schedule July 2025 to June 2026 UT DSPD Show Me the Money – How Much Can I Pay 7/1/2025 to 6/30/2026 UT DSPD Timesheet Instructions UT DSPD Timesheet UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination FormDirect Care Employee Forms
Augeo Benefits Flyer DHS Code of Conduct – Required for all Employees EVV Live-In Caregiver Attestation FLSA-Employee Live-In Exemption Form Form 2-9C (ABI) Form 2-9C (CSW) Form 2-9C (PD) Form 2-9EA (ABI) Form 2-9EA (CSW) Form 2-9EA (PD) Form W-4 I-9 Form Sample Forms for Employees – UT DSPD UT DSPD Background Screening Application UT DSPD Background Screening Instructions UT DSPD Employee Rate Sheet UT DSPD Fingerprint Locations UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 525-5050.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 525-5050.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 538-6955 or fax (801) 323-1588.
Participant Employer Forms
Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EPAS Employer Agreement UT EPAS Rate Form UT EPAS Timesheet Instructions UT EPAS Timesheet UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 673-3548.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 673-3548.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 229-3800.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 229-3800.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call 800-662-9651, option 6.
Participant Employer Forms
2678 Form Acumen Authorization Form Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT New Choices July 2025 – June 2026 Pay Schedule UT NCW Employer AgreementDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT NCW Employee Rate Information Form UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (385) 468-3200.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 Payment Schedule for the Salt Lake County Aging Waiver Program UT SLC July 2025 – June 2026 Pay Schedule UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT SLC Aging Acumen Authorization FormDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (385) 468-3200.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT SLC Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit FormParticipant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 893-0700 or (888) 899-4447.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 893-0700 or (888) 899-4447.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit FormParticipant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 882-2870.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 722-4518.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay Schedule UT Veterans Acumen Authorization Form UT Veterans Employer Agreement Form UT Veterans TimesheetDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (435) 722-4518.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit Form
Program Website
To contact the program call (801) 625-3770.
Participant Employer Forms
Form 2678 Form 8821 Form SS-4 UT Aging Acumen Authorization Form UT Aging Employer Agreement Form UT Aging Timesheet UT Client & Employer Change Information Form Employer’s Previous Business Information Form UT EMPLOYER/EMPLOYEE ACKNOWLEDGEMENT FORM UT Employee Termination Form UT AgingVeteransEPASNew Choices July 2025 – June 2026 Pay ScheduleDirect Care Employee Forms
Augeo Benefits Flyer Form W-4 I-9 Form UT Employee Change Information Form EE/ER Relationship Disclosure for Tax Exemptions UT Pay Selection and Direct Deposit FormTo contact the program call (801) 625-3770.