Community Rehabilitation Program Application Form - Utah State Office Of Rehabilitation Page 3
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Does the CRP have a municipal business license?
Is there a legal action pending against this CRP?
If yes, please explain in a separate attachment.
Has the CRP been charged for violation of
state or federal laws?
If yes, please explain in a separate attachment.
Is the financial operation of the CRP audited annually by an independent accountant? If no, please
explain in a separate attachment.
Does the CRP have for proper public liability, worker’s compensation professional liability
insurance?
If transporting clients, does the CRP have auto liability insurance and/or verify employees auto
liability insurance coverage. If so, how? Please include attachment.
Has the CRP read and reviewed USOR CSM Chapter 22?
Will services be provided in a facility operated by the CRP?
Have staff providing SE/SJBT services completed a USOR approved Job Coaching training?
List the names of the facility's administrative staff:
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