Individual Service Providers (ISP)
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The DOR reviews and approves all Individual Service Providers (ISP) applications prior to the provision of services. To apply, the individual must complete, sign and submit the DR 171, STD 204 and the ISP Agreement.
DR 171 - ISP Application (PDF): This double-sided application is the first step in the process. Please see the ISP Handbook for more information on this form.
STD 204 - Payee Data Record (PDF): All new vendors doing business with the state must complete, sign and return this form. The DOR's Accounting section must have this form on file to process your invoice for payment.
ISP Agreement (PDF): This two page document features details on the conduct and professionalism that the DOR expects from its ISP contractors. Both the DOR and the ISP will sign the document.
If an ISP has been approved to provide a service, and there is a need for that service, DOR staff will issue an authorization form and refer a consumer to the ISP for services.
Invoices are submitted at the end of each month. The ISP will use the below forms to bill the DOR for service provision. Please see the ISP Handbook for instructions on this process.
DR 296 - ISP Invoice (PDF): This is the form ISPs use to bill the DOR for services. It is submitted at the end of every month to the branch / district Rehabilitation Counselor. The ISP fills out one invoice per counselor, listing all the consumers that the counselor referred for services.
DR 296A - Worksheet (PDF): This required form goes with the Invoice. It's designed to help an ISP track his / her hours of service per consumer per month. An ISP will fill out one worksheet for every consumer served during the month.
DR 174 - Progress Report (PDF): This is the third form an ISP will submit for monthly billing. This form assists the counselor with tracking the improvement of the consumer. One form per consumer served.