Self-Determination Program: Standardized Vendorization Packet for Pre-Enrollment Supports

Downloadable Documents

• Self-Determination Program: Standardized Vendorization Packet for Pre-Enrollment Supports
  • Enclosure A – Vendor Packet Checklist
  • Enclosure B – General Self-Directed Supports Qualifications and Agreement Form
  • Enclosure C – Financial Management Services Self-Directed Supports Qualifications and Agreement Form
  • Enclosure D – DS1890 Vendor Application with sample form and FAQs
  • Enclosure E – DS1891 Applicant/Vendor Disclosure Statement with sample form
  • Enclosure F – Conflict of Interest Form with FAQs
  • Enclosure G – Business Associate Agreement/HIPAA Form with FAQs
  • Enclosure H – Home and Community-Based Services Provider Agreement Form with sample form
  • Enclosure I – W-9 Request for Taxpayer Identification Number and Certification