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Self-Directed Services - Request for Qualifications

The Department of Developmental Services (DDS) is inviting interested entities to submit a verification of qualifications as set forth in the Request for Qualifications (RFQ) to obtain an Affidavit of Certification as a Financial Management Service (FMS) provider. The Self-Directed Services (SDS) program requires that participants have an individually selected FMS provider to assist in meeting their responsibilities under the employer and budget authorities afforded by the SDS program. In order to provide services to participants, all FMS’ must first be certified by DDS and, conditional upon certification, vendored by a regional center. Applicants may apply as either a Vendor Fiscal/Employer Agent (F/EA) or an Agency-With-Choice (AWC) provider.

• Fiscal/Employer Agents (PDF)
• Agency-with-Choice Providers (PDF)
• Financial Management Services Definitions (PDF)
• Responses to RFQ Questions (PDF)
• Schedule of Events (PDF)

Criminal History Background Clearance

Please read the applicable instructions carefully. Failure to provide the requested information may result in a processing delay.

California Applicants

• California Instructions (PDF)
• Request for Live Scan Service Form BCII 8016 (PDF)
• SDS Criminal Record Declaration Form DS 1831 (PDF)
• SDS Provider Information Release Form DS 1832 (PDF)
• SDS Criminal Record Clearance Action Form DS 1833 (PDF)

Out-of-State Applicants

• Out-of-State Instructions (PDF)
• Applicant Transmittal Form JUS 203 (PDF)
• Request for Exemption Form BCII 9004 (PDF)
• SDS Criminal Record Declaration Form DS 1831 (PDF)
• SDS Provider Information Release Form DS 1832 (PDF)
• SDS Criminal Record Clearance Action Form DS 1833 (PDF)

Affidavit of Certification

The Affidavit of Certification must be signed and notarized as part of the certification process to be an FMS provider in Self-Directed Services. The applicant’s signature on the Affidavit certifies that the information included in the application packet is true and correct to the best of your knowledge and that all responses to the questions are complete, omitting no material information.

• Fiscal/Employer Agent Affidavit (PDF)
• Agency-with-Choice Provider Affidavit (PDF)

RFQ Deadline: The notification of evaluation results deadline (previously August 22, 2008) has been extended to September 30, 2008.

Please direct your questions regarding the RFQs to Stella Bertrand.