Get Ds 1891 - California Department Of Developmental Services - State ... - Dds Ca

The DS 1891 form is essential for applicants or vendors seeking enrollment with the California Department of Developmental Services. This guide aims to provide clear, step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to successfully complete the DS 1891 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part 1, fill out your identifying information. This includes your name, vendor number, service code, business address, and telephone number. Accurately enter details as they appear in official documents.
3. In Part 1B, specify the name registered with the California Secretary of State, if applicable. This must match official records exactly.
4. Complete the National Provider Identifier section in Part 1C, providing your NPI if you have one.
5. For Part 1D, accurately list your Social Security Number, Date of Birth, or Federal Employer Identification Number. For EIN, use the format XX-XXXXXXX.
6. In Part 1E, check the entity type that best describes your organization. Select only one and ensure it corresponds with your business structure.
7. Move to Part 2 to disclose ownership and control interests. In Section A, list the names, titles, and other information for individuals with direct or indirect ownership interests.
8. In Section B of Part 2, indicate any relationships (spouse, parent, child, or sibling) among individuals listed in subsection A.
9. Complete Section C of Part 2 by listing other applicants or vendors in which individuals listed have ownership interests of 5 percent or greater.
10. Proceed to Part 3 to disclose any excluded individuals or entities associated with your application. This is crucial for compliance.
11. If you have subcontractors, fill out Part 4. In subsection A, provide names and relevant details of those with an ownership interest in any subcontractor.
12. In Part 4B, list any subcontractors or wholly owned suppliers involved in significant business transactions within the past five years.
13. Finally, complete the applicant/vendor signature section. Here, the person responsible for the information certifies that the data provided is true and accurate, under penalty of perjury. Sign and date the form.
14. Once all sections are filled, ensure all changes are saved. You have the option to download, print, or share the completed form as needed.

Complete and submit your DS 1891 form online to ensure compliance and expedite your application process.