DHHS Data Sheet Summary

This is a DHHS Data Sheet form for the Utah Department of Health and Human Services ("DHHS") used for vendor registration and qualification for the Residential Treatment Services contract opportunity. The form requests comprehensive business information from prospective vendors, including legal business name, business addresses for both physical location and mailing, business email address, business phone number, and contact person details including name, title, email, and telephone number. Vendors must also declare whether they have any outstanding tax liens in the State of Utah. The form requires certification by an authorized signatory that all information provided is true and complete to the best of their knowledge.

The contract opportunity itself encompasses residential treatment programs operated under two distinct service lines: DSE (8-bed facility for male youth with moderate-level problematic sexual behaviors) and DMF (12-bed facility for female youth requiring high-level mental and behavioral health services). The form serves as an administrative prerequisite for vendors seeking to provide these specialized residential treatment services to the State of Utah. No specific pricing terms, due dates, contract duration, renewal options, or funding amounts are detailed within this particular data sheet form; it functions solely as a business information and qualification collection document.