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This form is for providers who have chosen to use an Alternate EVV System in Connecticut. This form allows providers to:


  • Switch from Sandata EVV to Alternate EVV Vendor
  • Switch from Sandata Agency Management System (SAM) to Alternate EVV Vendor
  • Switch from one Alternate EVV Vendor to Another Alternate EVV Vendor
  • Register an Alternate EVV Vendor for the first time
  • Switch from an Alternate EVV Vendor to Sandata EVV

Please note, if a provider will be using multiple ID’s, the provider will need to complete a separate form for each unique ID number.


*Please complete all fields accurately. Any incorrect information will delay the arrival of your agency/vendor credentials.


For general Sandata Alternate EVV questions or assistance, click here
(this link will take the user to the Sandata General Alternate EVV Form)

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