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 Healthcare Provider Questionnaire Introduction

Colorado Revised Statute § 8-4-125 requires staffing agencies furnishing services to healthcare facilities in Colorado to submit semi-annual reports to the Division of Labor Standards and Statistics (DLSS). DLSS shares the data with the Colorado Departments of Public Health and Environment (CDPHE) and Health Care Policy and Financing (HCPF). In an effort to identify which agencies need to report, CDPHE and HCPF gather information about agencies being utilized from healthcare providers. The purpose of this questionnaire is to update the list of staffing agencies used by healthcare providers in the state.
You do not need to complete this questionnaire because you did not use a Supplemental Healthcare Staffing Agency in 2024. 

 Healthcare Provider Questionnaire - Staffing Agencies Used

Healthcare Provider Information





e.g. XXX-XXX-XXXX

e.g.(@somplace.com)

Your Contact Information


E.g., General Counsel, Compliance Director, etc.

e.g.(@somplace.com)

Healthcare Provider Questionnaire - Staffing Agencies Used

Please review the list below and select each supplemental healthcare staffing agency (“SHSA”) you have done business with in Colorado in 2024.

NOTE: If you do not see an agency that you use, please select " My agency is not listed" at the bottom of the list and provide the agency information.

Please use the space below to enter the information of the supplemental healthcare staffing agency (“SHSA”) you have done business with.





e.g. XXX-XXX-XXXX

e.g.(@somplace.com)


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