Vendor Applications

VR Standard Vendor Application (RTF)

Group Medical Vendor Application (RTF)
Healthcare organizations seeking registration for the organization and not for individuals of the organization.

Sign Language Interpreter Application (PDF)

Sign Language Interpreter Invoice (PDF)
Sign Language Interpreter Invoice Guidelines (PDF)

Employment Services Application
At this time we are not accepting new applications for Employment Services Providers. If you are interested in becoming an ES provider, please contact with your contact information, and we will contact you once the application process is reopened on July 1, 2017.

Discovery/Customized Employment Provider Application

On-the-Job Training Application for Vendors (RTF)

Vocational Evaluation Providers (RTF) *

Certified Business Technical Assistance and Consultation (self-employment) Provider (RTF) *

Personal Care Assistant Application (RTF) *

Employment Network Application Package (PDF) *

Tutor Application (RTF) *

Transportation Provider

Aircraft Pilot or Aircraft Dispatcher Training School Provider

Rehabilitation Technology Services Application and Manual **

Work Incentive Planning and Assistance (WIPA) Application (RTF)

DirectDepositForm (PDF)
ORIGINAL FORM MUST BE MAILED (address included on form) to the Department of Financial Services (DFS). DFS will not accept this form via fax or email. It must be mailed and include the ORIGINAL signature. Forms received by Vendor Registration WILL NOT BE FORWARDED. Please follow the directions of this form in order to ensure that this request is completed.

* Requires background screening
** Some service provider types require background screening
Go to Background Screening web page for information on requirements.

Additional Information and Forms

Vendor Qualifications Manual (PDF)

Hospital Services Reimbursement Form (RTF)

Psychological Data Sheet (RTF)

VR Provider Manual DRAFT (PDF)
This is a draft of the new VR Provider Marnual. If you are a current VR Provider, please review the document and give us your feedback by May, 5, 2017 at We welcome your input.