To expedite the enrollment process, you can begin collecting copies of documents that you will need to include when you submit the completed enrollment form:

	A copy of your FEIN documentation showing both the name and number preprinted (a W-9 is not sufficient for enrollment purposes).
	A list of the facility's or program's owners and/or Board of Directors with addresses.
	A copy of your NPI assignment notification (only if enrolling professional(Physician, NHTD Services, etc)).
	Potential providers who want to provide Home and Community Support Services need to have a Licensed Home Care Service Agency (LHCSA) and Certified Home Health Agency (CHHA).
	Copies of contracts with the Local Department of Social Services (LDSS).
	A confirmation notice for the OMIG Provider Compliance Program may be required. Visit www.omig.ny.gov to determine if the provider must comply. If yes, copy of the confirmation notice (printed from the website) must be included with the enrollment application.

• HCBS/TBI Waiver Services Manual
• ETIN