New or Revendor Application Checklist- All new vendors and revendorizations need the following documents for each service code you are applying for. If you are unsure of the service code, please review the Service Code Requirements and/ or contact your resource coordinator. AS OF March 1, 2026 ALL APPLICATIONS FOR ALL SERVICE CODES NEED TO BE SUBMITTED THROUGH STANDARDIZED VENDORIZATION HERE. https://www.sdrc.org/providerforms
Please submit documents in PDF format to ensure they can be opened properly. Please review all below instructions thoroughly. Your Resource Coordinator is your primary point of contact for all vendor file information. If you have any questions, please contact your Resource Coordinator..
DS1890
DS1891
W9
HCBS Agreement
Conflict of Interest Form
Proof of liability insurance with SDRC added as additional insured
Resume and credentials for program director/ administrator as well as any other direct staff (professional license, certifications, and/ or degrees that meet program requirements)
IRS/ business verifications if applicable. This may include DBA or fictious name proof of filing, EIN approval letter, Articles of Incorporation, or Articles of Organization
Ebilling Agreement with voided check and W9
SPP Agreement
Program Design or Scope of Work if required
Sample Report(s) if required
General Application Documents
If you are filling out new documents for a new vendorization or revendorization, please leave any spots that ask for vendor numbers blank. SDRC will assign this to you once your file has been approved. Current providers submitting file updates should fill this in.
DS1891- Applicant Vendor Disclosure Statement
Complete at initial application or revendorization
Submit to resource coordinator every 2 years
Submit if there is a change to address, provider name, or ownership.
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Part 1A- use either your business name or your personal name, whichever you use to report business earnings to the IRS
Fill out part 2A- if you are a sole proprietor or single member LLC, this is just you. Corporations and LLCs may have more than one name if applicable
Parts 2A, 2B, 2C, 3, and 4 are left blank unless applicable to your business
DS1890- Vendor Application
Complete with initial application or revendorization
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Governing Body is only applicable if business name is different than applicant individual name
Facility Capacity can be left blank unless you are operating out of a clinic
Consultants and subcontractors should not be listed unless this has already been discussed with the resource coordinator.
Complete at initial application or revendorization
Complete at initial application or revendorization
For more information on HCBS Final Rule please go here https://www.sdrc-hcbs.info/home
Billing Documents
Complete at initial application or if you have not signed up for Service Provider Portal or revendorization
Complete if there is a change to the account representative
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Vendor Name is the name of the business/ how you report to the IRS
Password is temporary and you will be prompted to change it once you log in
Account Representative is the person that will access the portal. Please make sure this section is filled out and signed
Complete at initial application or revendorization and provide to Resource Coordinator
Complete if there is a change in banking information and provide to Resource Coordinator
Attach W9 and voided check every time submitted
If you do not have a voided check, you can substitute an account verification/ direct deposit letter from your bank. It should contain the name on the account, the account number, and the routing number. It does need to be issued by the bank, not a template that you fill out.----------------------------------------------------------
Service provider name= vendor name. This should also be the name that is used to report to the IRS
User Name is the name of the individual who will be the account representative
Service provider number= vendor number
Only the first column of page 3 bank information should be filled out
Ensure that your account and routing numbers match the numbers on your voided check
Ensure that the TIN is the same one listed on the W9. There should only be one (EIN or SS#)
W9- Tax Identification
Complete with initial application
Submit annually
Submit if there is a change to TIN (EIN or SS#) or a change in name used to report to the IRS
Submit to e.billing@sdrc.org with the ebilling application and a voided check if there is a change in banking information.
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PLEASE REVIEW THE W9 INSTRUCTIONS AND CHECK WITH YOUR CPA OR TAX ATTORNEY IF YOU ARE NOT SURE HOW TO FILL THIS OUT. HOW YOU REPORT TO THE IRS MUST BE HOW SDRC REPORTS.
Line 1 should be the name that you use to report to the IRS (your personal name as a sole proprietor or your business name if a corporation or LLC filing as a corporation or partnership.
Line 2 should be your disregarded entity
if you are a single member LLC this is usually a disregarded entity
Only put one Tax ID Number (TIN) This should be either the EIN or the SS# that you use to report to the IRS
Please check the correct box and fill out all info in box 3a
If your LLC is a Disregarded entity (single-member LLC), you should check the box ‘Individual/sole proprietor’.
If your LLC is treated as a Partnership or Corporation, you should check the box ‘Limited liability company’ and enter the corresponding code to indicate the classification.
C = C Corporation,
S = S Corporation,
P = Partnership
For detailed information, training videos, and troubleshooting, please review the SDRC website under Ebilling and SPP., link in header.
If you need assistance with your portals or billing, please make sure you are reaching out to the correct email address or your request will be delayed. If you are not sure who to contact, please contact your resource coordinator.
e.billing@sdrc.org Only for questions related to portals or changing banking information. If you need to change SPP password you will need to email this contact. If you need to change your ebilling password, you are able to do this yourself. Do not use this for billing or invoicing questions.
ask_pos@sdrc.org For questions related to billing, invoicing, and authorizations, such as discrepancies with payment, missing invoices or missing authorizations, etc.
Accounts may be disabled if you do not log in quarterly or change your password when prompted. You will not be able to log in to the portals until all documents are submitted and processed.
SPP portal Log in here
Lists all service codes, authorizations, client information
SIR online reporting
EBilling portal Log in Here
Where invoices are uploaded and all billing is submitted
Invoices are uploaded on the 1st of the month for the previous month as long as there is an authorization number
If you submit billing by the 5th business day of the month, you will get paid on the 1st pay run, around the 12th business day of the month
If billing is submitted after the 5th business day, you will get paid on the 2nd pay run, the last business day of the month
Invoices may not show if you do not bill on them for 2 months. You will need to reach out to ask_pos@sdrc.org to request they be regenerated.
Other Requirements and Information
$1 million limit for individual
$2 million limit for aggregate
All W2 employees need to be added to worker's comp insurance
SDRC needs to be added as additional insured
4355 Ruffin Rd, Ste 200
San Diego, CA 92123
Submit to resource coordinator annually when new policy is received
All incidents must be reported to SDRC verbally within 24 hours followed by a written report within 48 hours.
Written reports should be submitted digitally via your Service Provider Portal (SPP)
If you do not have access
For detailed information on reportable incidents, training videos, and upcoming SIR trainings, please visit the SDRC website via the link in the header
In addition to the links above, all form templates can also be located here under Required Documents. Please reach out to your Resource Coordinator if you need pdfs sent to you.