Application for Approval to Become a Provider of BDDS Services for - indiana 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1: General Information. Fill in the date of application, legal name of your entity, and FID or EIN. If applicable, list any 'Doing Business As' (DBA) names and ensure you have the necessary proof of registration.
3. Indicate the type of entity by checking the appropriate box. Provide your main office address, including street address, city, state, ZIP code, telephone number, fax number, and website.
4. Complete the contact information section with your title, name, telephone number, and email address. Also include details about the person who attended orientation training.
5. Move on to Part 2: Service Funding Streams. Ensure all required documentation is prepared and criteria are met before submitting Parts 1 and 2 along with either Part 3 or Part 4.
6. In Parts 3 and 4, check all services you wish to provide and prepare a written service proposal as instructed. Remember that incomplete proposals will be denied.

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