ModivCare Individual Transportation Participant Enrollment
This file contains the necessary steps and documents required for enrolling as an Individual Transportation Participant (ITP) with ModivCare. It includes the enrollment packet, forms, and instructions for submission. Follow the detailed guidance to complete and submit the application.
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How do I fill this out?
To fill out this form, begin by completing the ITP Information Page with your personal details. Then, fill out the Client/ITP Information Page and ensure all required signatures and documentation are included. Finally, submit the completed forms and additional documents as instructed.
How to fill out the ModivCare Individual Transportation Participant Enrollment?
1
Fill out the ITP Information Page.
2
Complete the Client/ITP Information Page.
3
Include all required signatures.
4
Attach copies of required documents.
5
Submit the completed forms and documents.
Who needs the ModivCare Individual Transportation Participant Enrollment?
1
Individuals seeking to provide transportation services for ModivCare.
2
Non-family members requiring a criminal background check and motor vehicle driving record check.
3
Current drivers wishing to renew their participation.
4
Applicants needing to update their information.
5
People looking for a flexible transportation job.
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What are the instructions for submitting this form?
To submit the forms, mail the original signed documents to ModivCare, ATTN: ModivCare, 12234 N. Interstate 35, Plaza 35, Building B, Suite 175, Austin, TX 78753. Fax additional documents to 1-877-931-4757. For email submissions, send to Tx.credentialing@modivcare.com. Ensure all signatures are original and all required documents are included to avoid delays.
What are the important dates for this form in 2024 and 2025?
Ensure your forms are submitted promptly. Check the specific deadlines for 2024 and 2025 on the ModivCare website for updated information.
What is the purpose of this form?
The purpose of this form is to enroll individuals as Individual Transportation Participants (ITP) with ModivCare. It provides a structured process to gather necessary personal, vehicle, and insurance information. Completing this form allows ModivCare to conduct required background checks and authorize participants for transportation services.
Tell me about this form and its components and fields line-by-line.
- 1. ITP Information Page: Fill out your personal details, including name, address, SSN, and driver’s license information.
- 2. Client/ITP Information Page: Provide additional information about the transportation participant.
- 3. Terms and Conditions of Participation: Read and sign the terms and conditions agreement.
- 4. Driver’s License: Attach a copy of your current and valid Texas driver’s license.
- 5. Auto Insurance Card: Attach a copy of your current and valid Texas auto insurance card.
- 6. Social Security Card: Attach a copy of your Social Security card.
- 7. Vehicle Registration: Attach a copy of your vehicle registration.
What happens if I fail to submit this form?
Failure to submit this form properly can result in delays or denial of authorization for transportation services.
- Delay in Processing: Incomplete or incorrect forms may cause delays in your application processing time.
- Denial of Application: Failure to submit all required documents may result in denial of your application to become an ITP.
How do I know when to use this form?
- 1. New Enrollment: For individuals applying for the first time to be an ITP.
- 2. Renewal: For current ITPs renewing their participation.
- 3. Update Information: For participants updating their personal, vehicle, or insurance information.
- 4. Background Check: For non-family members requiring background check authorizations.
- 5. Change of Status: For participants changing their ITP status or details.
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What documents are required for the ModivCare ITP enrollment?
You need the ITP information page, Client/ITP information page, Terms and Conditions signature, copies of your driver's license, auto insurance card, Social Security card, and vehicle registration.
What should be done if I need help filling out the forms?
Call the ModivCare Contact Center at the provided numbers for assistance.
Can I fax the documents for ITP enrollment?
Yes, you can fax documents to the provided fax number for certain forms.
Where do I mail the completed ITP enrollment forms?
Mail the completed forms to ModivCare, ATTN: ModivCare, at the provided address in Austin, TX.
How do I opt-in for gas reimbursement?
Select the 'Opt In' option for Gas Reimbursement App on the ITP Information Page.
What happens if my driver's license and Social Security card names do not match?
Ensure the names on both documents match to avoid processing delays.
Can I update my information after submitting the ITP enrollment forms?
Yes, you can update your information by submitting the necessary changes following the same process.
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