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Family and Social Services Administration

DDRS Home > Developmental Disability (BDDS) > Developmental Disabilities Bureau of Developmental Disabilities (BDDS) Provider Relations

BDDS New Providers

DDRS no longer holds New Provider Orientation Sessions; enrollment is now open year around. All components of the New Provider Proposal Packet must be completed in order for an application to be considered. If any portion of the packet is incomplete, the proposal will be denied.

An agency/individual may submit BDDS provider application proposals for approval up to three (3) times within a twelve (12) month timeframe.  If the third and final proposal is also denied, twelve (12) full months must pass from the date of the last proposal submission before a new proposal will be accepted.

Proposals should be submitted to:
Director of Provider Relations
DDRS - Division of Disability and Rehabilitative Services
402 W. Washington St., RM 453, MS 18
Indianapolis, IN 46207
BDDSprovider@fssa.IN.gov
 

BDDS New Provider Proposal Packet

Getting Started

Required Forms (Open and print each of them to complete the packet)

  1. Application for Approval to Become a Provider of BDDS Services for Individuals with Developmental Disabilities SF 53869 (R 11-10)
  2. Case Management Surety Bond form - (only for Case Management Proposals) (8-12)
  3. FSSA Provider Data Form
  4. State of Indiana Automated Direct Deposit Authorization Agreement SF 47551 (2/96)
  5. DDRS Provider Agreement  SF 55006 (6-12)
  6. W-9, Taxpayer Identification Request Form (Revised 10/2007) Dept. of Treasury IRS

References

BDDS Existing Providers

Provider Re-Approval

  • Summary
  • General
  • Behavioral
  • Medical
  • Sentinel
  • Technical Guide
  • Provider Review Profile (Excel document)

    • Supervised Group Living Conversion Information