BDI Family Support Vendor Application

BDI Family Support Vendor Application

Please review the BDI Vendor Handbook before completing the Vendor Application. The Handbook will review all services that are offered through the Family Support Program and the Vendor eligibility for each services. The manual will outline all required documentation and provides sample documents for review. Additionally, the Vendor Handbook will outlines the Invoice Submission Requirements. Invoices that do not meet the requirements will not be accepted.

Thank you for your interest in doing business with Bobby Dodd Institute.

PLEASE TAKE A MOMENT TO READ THE BDI VENDOR HANDBOOK BEFORE CONTINUING.

PLEASE TAKE A MOMENT TO COLLECT ALL REQUIRED DOCUMENTATION BEFORE CONTINUING.

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

Business Documentation Requirements:

W9 Form
BDI ACH/Direct Deposit Authorization Form OR Voided Check
Certificate of Insurance
E-Verify Affidavit (Apply for an E-Verify Number)

Additional Business Documentation is required if providing direct personal care services to individuals in the home or community setting, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting. (Does not apply to Nursing and Certified Nursing Assistant (CNA) providers)

Personal Care Home Certification (DCH)
Private Home Care Certification (DCH)

Independent Contractors Documentation Requirements:

W9 Form
BDI ACH/Direct Deposit Authorization Form OR Voided Check
Copy of Driver's License/GA State ID
Background Check
Copy of GED/High School Diploma and/or highest degree achieved.
Resume
Statement of Understanding regarding Disability Related Services: Describe your experience, training, education, and/or the skills necessary to meet the needs of individuals living with disabilities.
CPR/First Aid Certification
Driving Record (if transporting the individual)
Car Insurance (if transporting the individual)

APPLICATIONS MUST INCLUDE ALL REQUIRED DOCUMENTS.

IMPORTANT APPLICATION INFORMATION

BDI will not accept application without ALL required documentation.

Please allow up to 30 days for the vendor approval process to be completed.

Please check your spam/junk email. Approval letters sometimes get caught there.

DO NOT provide updated information via this application. Please use the Family Support Vendor Inquiry Form.

DO NOT submit more than one application as this will slow the review process. Please reach out to the BDI Team via the Family Support Vendor Inquiry Form.

All vendors will be paid via direct deposit only. Invoices must be submitted within 30 days of services for one individual each.

If you have any questions regarding the Vendor Application please email the BDI Team via the Family Support Vendor Inquiry Form.

Registration is required to do business with Bobby Dodd Institute.

Thank you!

BDI Team

VENDOR HANDBOOK VERIFICATION

Before continuing to the Vendor Application please take a moment to review the BDI Vendor Handbook.

If you have any questions regarding the Vendor Application please email the BDI Team via the Family Support Vendor Inquiry Form.

Vendor Handbook Verification*

By clicking below you verify that you have reviewed the BDI Vendor Handbook and understand the vendor requirements for the services/supplies you are intending to provide AND that you will ensure all invoices meet the requirements for reimbursement as part of the Family Support Program.

NEW VENDOR APPLICATION

All information in the application with an asterisk (*) must be provided in order to complete your registration.

How did you hear about BDI?*

Select

SECTION 1: VENDOR INFORMATION

Vendor Name*

Please enter the full legal name of the Business or Independent Contractor as it is listed on Official Tax Documents. Please note this is how you will be listed on our Approved Vendor List.

Vendor Type*

Select

Tax Identification Number*

Independent Contractors please enter your Social Security Number.

Vendor Address 1*

Vendor Address 2

City*

State*

Zip*

Vendor Phone Number*

Phone

Vendor Fax Number

Phone

Please provide your business website and or social media links.

(ie. Vendor Website, Facebook Link, Linked In, or other Social Media Account)

SECTION 2: VENDOR CONTACT INFORMATION

Primary Contact Name*

Primary Contact Phone Number*

Phone

Primary Contact Email*

Secondary Contact Name

Secondary Contact Phone Number

Phone

Secondary Contact Email

SECTION 3: VENDOR SERVICE INFORMATION

BDI works with individuals and families across the Atlanta Metro Area. Please provide the following information regarding the services you offer so that we can best help direct families to the right vendors.

Services Provided*

Select all that apply.

Select

If a provider agency please list your agencies Developmental Disability Professional's name?

If a provider agency please list your agencies Developmental Disability Professional's email?

Do you hold a Certified Nursing Assistant (CNA) Certification?*

Please attach a copy of certification/licensure.

Yes

Do you hold a Direct Support Professional (DSP) Certification?*

Please attach a copy of certification/licensure.

Yes

Are you currently an approved vendor registered with DBHDD?*

Yes

Please indicate if your business has the following licensure from the Department of Community Health.*

This license is required for Business Vendors providing the following services:

Community Access Services
Community Living Support (Social Skills)

If you do have a License please upload a copy as part of your application.

Personal Home Care License - Services Provided at Vendor Location

Private Home Care License - Services Provided at individual's home

No license

Not Applicable

Please select the county(ies) where you provide services. (Select all that apply)*

Select

Additional Counties Information

Please identify the age range that best fits the services you offer.*

Select

Please provide information about the services you offer.*

Families will use this to select vendors for services they need. Please describe the services that you provide, including what you do, some basics about how services are provided and why families should choose you as a vendor.

How do you/does your agency provide services?*

In-Person

Virtual

Both

Are your services available to individuals living with mobility related disabilities?*

Yes

Are your services available to individuals utilizing public Transit?*

Yes

If you provide Community Based Services, do you offer transportation as part of your service?*

Yes

SECTION 4: VENDOR PAYMENT INFORMATION

BDI only accepts Vendors that are willing to accept payment for services via Direct Deposit. Please provide your banking and account information below.

Vendor Bank Name*

Account Type*

Business Checking Account

Personal Checking Account

Savings Account

Name of Vendor as listed on Account*

Bank Routing Number*

Bank Account Number*

SECTION 5: VENDOR SUPPORTING DOCUMENTATION

PLEASE TAKE A MOMENT TO READ THE BDI VENDOR HANDBOOK BEFORE CONTINUING.

If you have any questions regarding the Vendor Application please email the BDI Team via the Family Support Vendor Inquiry Form.

Please Attach Supporting Documents Below*

DO NOT SUBMIT AN APPLICATION WITHOUT ALL REQUIRED DOCUMENTS.

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

If you have any questions regarding the Vendor Application documentation requirements please email the BDI Team via the Family Support Vendor Inquiry Form.

Drag and drop files here or

SECTION 6: VENDOR AGREEMENT

Terms of Agreement*

You must accept the terms of this agreement in order to register as a vendor with BDI. By submitting the vendor registration application, you certify and warrant that you are duly authorized, by the vendor to:

Register the vendor;
Provide all required documentation on behalf of the vendor; and
Enter into this agreement on behalf of the vendor.

Independent Contractors working under this agreement understand that they are not an employee of BDI, and that BDI serves as the Fiscal Intermediary and maintains a record of all required documentation as listed above, for compliance and payment purposes only.

This agreement shall remain in effect for as long as the vendor is registered as a BDI vendor.

You are responsible for notifying BDI of any subsequent changes to the information submitted on this form. To report changes please reach out to the BDI Team via the Family Support Vendor Inquiry Form

Please note that BDI does not file taxes on behalf of vendors. BDI does provide a 1099 at the end of the year for all vendors.

BDI RESERVES THE RIGHT TO CANCEL THE VENDOR’S REGISTRATION AT ANY TIME.

BDI DOES NOT GUARANTEE CONTINUOUS WORK.

By Clicking below I agree to the above Terms of Agreement:

PLEASE NOTE APPLICATIONS RECEIVED WITHOUT ALL THE REQUIRED ATTACHMENTS WILL NOT BE PROCESSED.

Electronic Signature*

By signing you are indicating that you have completed and provided all required information and documentation and are authorized to agree to the Terms of Agreement above.

NEXT STEPS

Application Review Process

Please allow up to 30 days for review of your application.

BDI will review your application and supporting documentation to ensure they met the standards listed in the BDI Vendor Handbook.

An email will be sent regarding your application acceptance or denial within 30 days of application. Please do not request a status update for applications under 30 days.

If approved please note the following:

BDI will add your or your business information to our BDI Empowers Approved Vendor List.

BDI does not set rates of service unless otherwise noted in the BDI Vendor Handbook.

BDI does not market vendors to Family Support recipients. It is the responsibility of the Vendor to provide marketing efforts. If you would like to list that you are a BDI Family Support Vendor on any marketing materials or your website please contact us via the Family Support Vendor Inquiry Form.

BDI will not provide Family Support recipient verification to Vendors. Vendors will need to communicate directly with Family Support recipients to confirm eligibility.

Annually, BDI will issue a 1099 Tax documents to you or your business in compliance with all IRS reporting standards. Please note that Vendors are responsible for all tax withholdings and reporting.

Thank you for your interest in doing business with BDI and helping us to empower people with differing abilities to maximize their potential by securing economic self-sufficiency, independence and inclusion within their communities

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