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Service Provider Application

To reach our mission of giving the people we serve the best possible care and attention, the Information Center works with a variety of service providers.

If you have any questions, please contact Creista Wilcher through our contact page.

Contact Us

"*" indicates required fields

Part 1: Application Cover Letter

(No P.O. Boxes)
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Office Location set up

Please provide answers to the following questions:

1. Is your agency Medicare certified?
2. Has your agency previously been a contracted provider for The Information Center?*
3. Is your agency able to provide services to all of The Information Center's service area (34 communities of southern/western Wayne County)?*
6. Does your agency have a bid agreement with another Area Agency on Aging or Waiver Agency?*
10. Do you have a Registered Nurse (RN) licensed by the State of Michigan on staff?*
11. Do you currently have Certified Nursing Assistants (CNA) employed at your agency?*
12. Is your agency a staffing company that contracts direct care workers out?*
13. Does your agency W2 all of the direct care workers that are employed at your agency?*
15. Does your agency keep I9 information on file for all employees?*
16. Does your agency have current insurance (i.e. general liability, worker’s comp, etc)?*
17. Would your agency be willing to purchase additional insurance in order to become a vendor with The Information Center (i.e. cyber liability, third party crime bond, etc) if applicable?*
18. What services can your agency provide? Check all applicable*

General Selection and Approval Process for All Applicants

A. Only complete applications submitted within the established timeframes will be considered for enrollment into the Purchase of Service (POS) vendor pool. The Provider Network Coordinator and/or other Compliance department staff will determine if an application is complete. Requested application documents must be emailed to creistad@theinfocenter.info.

B. Before the application is approved, an introductory meeting may be scheduled with applicable TIC staff.

C. Submission of this initial application does not guarantee admission into the vendor pool. Additional documentation may be requested as part of the application process.

D. Agreements for new vendors are effective on the date of the Chief Executive Officer’s signature and remain in effect per the terms of the Agreement.

E. If an application is approved, the vendor agency will be provided with a POS Agreement to complete and submit for processing.

F. Once the applicant agency becomes a POS vendor, TIC staff is provided with relevant bid information. TIC staff will purchase service from vendors on a case-by-case basis, taking into consideration participant preference, staff availability, location, and other relevant factors.

G. Applications will be processed and applicants notified of the outcome within 60 days of TIC's decision and/or receiving a complete application with all supporting documentation.

H. Applicants may email creistad@theinfocenter.info no more than once every 30 days to request an update on the application status.
I. Entry into the POS vendor pool does not guarantee that services will be purchased.*
This field is for validation purposes and should be left unchanged.

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