PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Attachment 3
for the current year.
Attachment 3 Disclosure Statement for Licensed Private Provider Employees - Virginia
What Is Attachment 3?
This is a legal form that was released by the Virginia Department of Behavioral Health & Developmental Services - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Attachment 3?A: Attachment 3 is the Disclosure Statement for Licensed Private Provider Employees in Virginia.
Q: Who is required to complete the Disclosure Statement?A: Licensed Private Provider Employees in Virginia are required to complete the Disclosure Statement.
Q: What information is included in the Disclosure Statement?A: The Disclosure Statement includes information about the employee's criminal history and professional conduct.
Q: Why is the Disclosure Statement necessary?A: The Disclosure Statement is necessary to ensure the safety and well-being of individuals receiving services from licensed private providers in Virginia.
Form Details:
- Released on July 1, 2019;
- The latest edition provided by the Virginia Department of Behavioral Health & Developmental Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Attachment 3 by clicking the link below or browse more documents and templates provided by the Virginia Department of Behavioral Health & Developmental Services.
