Vendor Applications

How to Register to Become a Vendor (PDF)

VR Standard Vendor Application (PDF)

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

Sign Language Interpreter Application (PDF)
Sign Language Interpreter Update Administration & Board Member (PDF)
Sign Language Interpreter Employee Contractor Form for Group Agency (PDF)
Sign Language Interpreter Semi-Annual Employee Contractor Report for Group Agency (PDF)

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

Employment Services Application
For more information regarding Employment Services, please visit
the Employment Services Providers web page.

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

Vocational Evaluator Application (PDF) *

Vocational Evaluator Assistant Application (PDF) *

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

Personal Care Assistant Application (PDF) *

Employment Network Application Package (PDF) *

Tutor Application (PDF) *

Transportation Provider (PDF)

Aircraft Pilot or Aircraft Dispatcher Training School Provider (PDF)

Rehabilitation Technology Services Application and Manual (PDF)**

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 (Text)

Hospital Services Reimbursement Form (PDF)