Ds 1890 rev 07 2011 electronic version-2026

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The document is a vendor application form from the California Department of Developmental Services, intended for individuals or organizations seeking to provide services related to developmental disabilities. It outlines the necessary information required from applicants, including personal details, type of service, facility capacity, and certifications. Additionally, it specifies the documentation needed for compliance with state regulations and emphasizes the importance of accuracy in the provided information.

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Click ‘Get Form’ to open the ds 1890 rev 07 2011 electronic version in the editor.
Begin by entering your Applicant Name and Federal Tax ID or SSN in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the Name of Governing Body or Management Organization, followed by your Mailing Address, including Street, City, State, Zip, and County.
If your Service Address differs from the Mailing Address, complete that section with the same details required for the Mailing Address.
Provide your Telephone number and specify the Type of Service to be Provided along with Facility Capacity.
Identify any consultants, subcontractors, and community resources you will utilize as part of your service.
Review the Certification section carefully. After confirming all information is accurate, sign and date where indicated.

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2011	4.5 Satisfied (66 Votes)

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