Get Ds 1891

Filling out the DS 1891, or Applicant/Vendor Disclosure Statement, is an essential part of applying for vendorization with the Department of Developmental Services in California. This guide will provide you with clear, step-by-step instructions to complete the form accurately and effectively online.

Follow the steps to complete the DS 1891 form online.

1. Press the ‘Get Form’ button to access the DS 1891 form. This will open the document for your review and completion.
2. Begin by completing Part 1, which requires the applicant or vendor’s identifying information. Include your name, vendor number, service code, business address, and telephone number.
3. Next, specify the capacity in which you, as the applicant or vendor, are doing business. Ensure this name matches any applicable licenses.
4. If applicable, provide your National Provider Identifier and Social Security Number or Employer Identification Number, following the specific formats outlined in the instructions.
5. In Part 2, detail the ownership and control interests by listing the individuals connected to your organization, including title, address, SSN, and date of birth as required.
6. Complete Part 3 by disclosing any excluded individuals or entities, detailing any relevant names, titles, and addresses.
7. If relevant, fill in Part 4 regarding subcontractors, providing the necessary information about any entities with which you have significant business transactions or ownership.
8. Lastly, review all information for accuracy. Once completed, you can save your changes, download a copy, print, or share the form as needed.

Complete your DS 1891 form online today to ensure a smooth vendorization process.