FOSTER PARENT PRIVATE VEHICLE USAGE REPORT - hsdcfs utah Preview on Page 1

FOSTER PARENT PRIVATE VEHICLE USAGE REPORT - hsdcfs utah 2026

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  1. Click ‘Get Form’ to open the FOSTER PARENT PRIVATE VEHICLE USAGE REPORT in the editor.
  2. Begin by entering your Provider Name and Address at the top of the form. This identifies you as the foster parent responsible for reporting vehicle usage.
  3. Fill in the Client Name, Provider ID, and Client ID. These details are crucial for linking your report to the specific child in your care.
  4. In the Date field, enter the date of travel using MMDDYY format. This helps track when mileage was incurred.
  5. For each trip, record the From and To locations, including city names. This provides context for your mileage claims.
  6. Input Beginning and Ending Odometer readings in whole miles only. Calculate Total Miles by subtracting Beginning from Ending Odometer readings.
  7. Categorize your mileage into Visitation Miles (FTV), Case Activity Miles (FTC), Other Essential Miles (FTP), and Medical Miles (FTM) as applicable.
  8. Ensure that a Medical Provider’s Signature/Stamp is included for Medical Miles claims; initials are not sufficient.
  9. Finally, sign and date the form at the bottom along with your caseworker's signature to certify accuracy before submission.

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Transport to/from childs school of origin (Only mileage to

Utah DHS-DCFS. Revised September 2011. Provider Name: Client Name: Caretaker Name: Address: Client ID: Caretaker Address: FOSTER PARENT PRIVATE VEHICLE USAGERead more

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