One of the greatest limitations that we experience is the shortage of providers willing to provide services to the individuals and families that we serve. We appreciate your interest in becoming a Qualified Provider for Self-Determination Resources, Inc. (SDRI).

Enclosed in you will find all the paperwork required to enroll you as a Qualified Provider, including a handy checklist of all required elements. Please note that in addition to completing the paperwork enclosed; if you'll be driving customers in your personal vehicle, we will need a copy of your valid driver's license and auto insurance card. Hopefully, you will use the checklist when mailing everything back to SDRI so everything is included and we can get you qualified with a minimum of correspondence and fuss.

We need to have a resume on file for all providers. If you have a current resume please include it in the papers you return to us. If you do not have a resume, please use the sheet enclosed to provide us with your relevant skills, employment/experience and education. Oregon Rules also require we do a reference check. Please complete the reference request form. If you have at three references listed on your resume, you do not need to complete the reference request form.

One of the necessary components for qualifying as a provider is a criminal history check. Until we receive the criminal clearance from the Department of Human Services Criminal Records Unit, we can neither authorize nor pay you for any work performed before the date of the clearance. We encourage you to submit your criminal history check promptly as it takes approximately 4-8 weeks for the application to be processed. We want to use your services as soon as possible.

If you have any questions about filling out this paperwork, please give us a call at 503-292-7142. You can also eMail our office manager, Kitty, at kitty@sdri-pdx.org with any questions that may arise.

Again, we thank you for your interest in becoming a Qualified Provider with us. We look forward to working with you to provide quality service to our customers.

1. Self-Directed Support Services Brochure [ MS Word ]
   
2. SDRI Brochure [ Adobe PDF ]
   
3. a) Mandatory Abuse Reporting brochure (Explains what constitutes abuse. Not available online; please get a copy of the brochure from a staff member.)
   b) Mandatory Abuse Reporting card (Not available online; please get an Abuse Reporting card from a staff member.) Contact info [ MS Word ]
   
4. a) Memo to Potential Independent Contractors [ MS Word ]
   b) Metro Brokerages Independent Contractor Guidelines [ Adobe PDF ]
   
5. a) References Request Form [ MS Word ]
   b) Information Sheet [ MS Word ]
   
6. a) Independent Contractor Statement [ MS Word ]
   b) Independent Contractor Validation [ MS Word ]
   c) Sanctions Memo/Affidavit [ MS Word ]
   d) Sanctions Info [ MS Word ]
   e) Protective Service Investigations [ MS Word ]
   
7. a) Memo regarding Criminal History Check [ MS Word ]
   b) Criminal History Check request forms [ Adobe PDF ]
   
8. a) Instructions on how to complete I-9 form [ Adobe PDF ]
   b) I-9 form, Employment Eligibility Verification [ English Adobe PDF ] [ Spanish Adobe PDF ]
   c) Sample I-9 form (filled out, not available online)
   
9. a) W-9 form, Request for Taxpayer Identification Number and Certification [ Adobe PDF ]
   b) Sample W-9 form (filled out, not available online)
   
10. IC / Agency Billing Calendar [ Adobe PDF ]
    
11. a) Invoice Standards / Example [ MS Word ]
    b) Memo regarding Rates [ MS Word ]
12. Disability Compass web site questionnaire & authorization (optional) [ Adobe PDF ]
    
13. Self-addressed envelope (not available when filling out online).
    

Click on any of the above links to view, download, save and/or print them individually.
(Note: You will need programs capable of reading documents in Adobe Acrobat .PDF format and/or Microsoft Word .DOC format in order to view, edit or print the above documents.)

• Resume
  
• Application for Criminal History Check
  
• References Request Form (optional if at least 3 references already provided on resume)
• Independent Contractor Information Sheet
  
• Independent Contractor Statement
  
• Independent Contractor Validation
  
• Signed Memo regarding Sanctions
  
• Completed I-9 Form
  
• Completed Form W-9, Request for Tax Identification
• Signed acknowledgement of receipt [last page]of Metro Brokerage Independent Contractor Guidelines.
  
• Copy of valid drivers license, if driving customers
  
• Copy of current automobile insurance card/verification, if driving customer