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enter in A, B and C of this section. See 42 CFR 455.101 for additional definitions. • • • • • “Indirect Ownership Interest” means an ownership interest in an entity that has an ownership interest in the applicant or vendor. This term includes an ownership interest in any entity that has an indirect ownership interest in the applicant or vendor; “Managing Employee” means a general manager, business manager, administrator, director, or other individual who exercises operationa.

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APPLICANT/VENDOR DISCLOSURE STATEMENT GENERAL INSTRUCTIONS. Every applicant or vendor must complete and submit a current Applicant/Vendor Disclosure Statement, DS 1891 (disclosure statement) as part of a complete application packet for vendorization or upon request of the vendoring regional center.

A “vendor” or “provider” is an organization that works with regional centers to provide services to people with intellectual or developmental disabilities. Vendors can use this site as a resource to help DSPs mitigate risk, reduce Special Incident Reports, and prevent other adverse events.

Becoming a Service Provider. ... Send the Letter of Intent to NRSPO@inlandrc.org. ... Complete the Program Design. ... Vendorization Walkthrough (*does not apply to all services) ... Vendorization Application. ... Rate Determination.

Vendorization is the process for identification, selection, and utilization of service providers based on the qualifications and other requirements necessary in order to provide the services.

Submit a letter of interest and a resume, outlining experience in the developmental disabilities services system, and completed education and trainings. Also, submit a completed Vendor Disclosure Form. This document will be submitted to OIG for a Medi-Cal fraud and abuse background check.

Regional centers are nonprofit private corporations that contract with the Department of Developmental Services to provide or coordinate services and supports for individuals with developmental disabilities.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232