Get Mo Mo 580-2791a 2011-2026

Filling out the MO MO 580-2791A form is an essential step for vendors engaged in consumer-directed services in Missouri. This guide provides a clear and comprehensive overview of each section of the form, ensuring that all users, regardless of legal experience, can complete it accurately and efficiently.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in an appropriate editor.
2. Begin with Section I: Vendor information. Enter your vendor number if assigned, or leave it blank if this is a proposal application.
3. Input your legal vendor name as filed with the IRS and Missouri Secretary of State; include any DBA name.
4. Fill in your physical address, ensuring all components (street, city, state, zip code) are accurate.
5. Provide your primary telephone number, followed by the fax number for the main office.
6. Enter an emergency telephone number for after-hours contact.
7. Add your email address and the federal employer identification number (EIN) assigned by the IRS.
8. Include your Missouri employer identification number (SEIN) and specify the days and hours of operation.
9. List the counties served by your main office, excluding those covered by any satellite offices.
10. Proceed to Section II: Personnel information. Enter the name of the executive director along with their telephone number and email address.
11. Next, add the CDS coordinator's name, telephone number, and email address.
12. Move to Section III: Fiscal Year. Indicate the month and day when your vendor’s fiscal year begins and ends.
13. In Section IV: Electronic tracking system, indicate whether you are using an automated electronic tracking system. If yes, provide the name of the service provider.
14. Complete Section V: Satellite office information if applicable. Enter details for any satellite offices and note any counties served by these offices.
15. After reviewing the form for accuracy, save your changes, and you will then have options to download, print, or share the completed form.

Complete your MO MO 580-2791A form online today for a streamlined experience.