Application for Accreditation

Thank you for your interest in the DirectTrust Accreditation Program. This is an application to become DirectTrust Accredited.

Each Applicant must select an Accreditation Program to enroll in. To keep the administrative process for the Accreditation Program simple, this application form has three parts.

Part A:  Download the Application Agreement

Part B:  Submit online web Application Form that specifies basic demographic and contact information.  The executed Application Agreement must be included with Application Form.

Part C: Pay online Application Fee or mail a corporate check for the application fee (address below)

Once we have confirmed your eligibility for the Program you have selected to enroll in, you will securely receive an ID and Password to access the Accreditation Program Applicant Access pages to start the Accreditation Process.

If you have any questions, please direct them to

Part A: Download the Application Agreement

Download, print, review, and execute an agreement that binds your organization to the requirements and obligations of the DirectTrust Accreditation Program. The executed agreement must be included with your application.

Note: Only one Accreditation Agreement is required even if the Applicant is enrolling in multiple Accreditation Programs.

Part B: Application for DirectTrust Accreditation

Please complete the Application below.

  1. Select type/s of accreditation applying for HISPRACA
  2. Is this a new accreditation or re-accreditation?
  3. Organization Legal Name
  4. Address
  5. City
  6. State / Province / Region
  7. Zip Code
  8. Phone Number
  9. Primary Contact First Name
  10. Primary Contact Last Name
  11. Primary Contact Email
  12. Primary Contact Phone
  13. Secondary Contact First Name
  14. Secondary Contact Last Name
  15. Secondary Contact Email
  16. Secondary Contact Phone
  17. Annual Gross Revenue
  18. Legal or Tax Classification
  19. HIPAA Privacy and Security Certification Organization
  20. Date of Expiration (if currently certified)
  21. Expected date of completion (if not currently HIPAA certified and in process)
  22. Number of site visits (RA only)
  23. Number of Public Cloud Service Providers
  24. Cloud Service Provider Name/s (Cloud Service Provider must possess FedRAMP authorization at level Moderate or High)
  25. Cloud Service Provider address/es
  26. Upload Application Agreement
  27. Upload company logo
  28. If unable to upload Agreement or logo files, please email them to

  29. Please select payment option

Part C: Pay your Accreditation Application Fee

The DirectTrust Accreditation Fee is valid for two years (i.e. it is not annual).  For new organizations, this is paid as part of the application process.

If you prefer to mail a check, please send payment to:

DirectTrust Accreditation Program Services

PO Box 2885
Blairsville, GA 30514
United States

Make checks payable to: