Provider Sign-Up

Sign up to be paid by TrueCare FMS for services you provide to Self-Determination Program participants. We’ll only ask what applies to you. Fields marked * are required.

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Getting started

A few quick questions so we only ask what applies to you.

Is your business open to the general public — not only people with disabilities? *

For example: a gym, bowling alley, swim school, camp, class, store, or rideshare that anyone can use.

Business information

Business name *

Doing Business As (DBA)

Is your business located in California? *

Federal EIN / Tax ID *

Federal tax classification *

For year-end 1099 reporting — this should match your W-9.

Primary contact

Primary contact name *

Title

Email *

Phone *

Business mailing address *

Where we send mail. If this is a PO box or private mailbox, tell us the physical operating address below.

Business-license rules are set by the city (or county) where you actually work — not where you get mail. Tell us that place so we ask you for the right license.

City where you physically operate *

The city you work out of / are based in. For in-home services, that’s usually your own city.

County

Helps when the work is in an unincorporated area, where the county issues the license.

Your services

What you provide, and how. Your answers here decide which documents California DDS requires from you — we’ll show you exactly what to attach, and nothing you don’t need.

Name of the participant you’re providing services for (optional)

If you’re registering to serve a specific participant, name them here so we can link you up faster. Registering on your own? Leave this blank — our team will connect you to participants during review.

Independent contractor or employee?

TrueCare pays you as an independent business — you invoice us, and we don’t run payroll. California law (the “ABC test”) requires us to check that you’re an independent contractor, not an employee. Answer honestly: if your answers look more like an employee, you can still submit, and we’ll call you to talk it through.

Documents

Only what applies to you, based on your answers. PDF, Word, or a clear photo — up to 15 MB each.

Anything marked * is required — DDS makes the FMS verify these before you can be paid. Missing something? Your answers are saved on this device (except bank and tax numbers), so you can gather it and come back to finish.

W-9 *

For year-end 1099 reporting — should match the tax classification you gave us. Don’t have one? Download the blank IRS form below, fill it in, and upload it here.

Download a blank W-9 (IRS · PDF)

Choose filePDF, Word, or a photo

Business license *

The license issued by the city or county where your business is located. DDS requires one wherever the local jurisdiction issues them.

Choose filePDF, Word, or a photo

No business license?

The city or county where my business is located does not require a business license for this service.

Tick this only if it’s true — we verify it, and DDS holds the FMS responsible for the answer.

Payment details

Name payment shall be made to

Payment type *

Provider directory (optional)

TrueCare keeps a directory that participants and their facilitators browse when they are looking for someone to hire. Listing is entirely optional and you can change your mind at any time — just tell us.

Would you like to be listed in the provider directory? *

We would show your business name, the services you provide, your city, and the contact details above. Never your address, tax ID, or banking details.

By signing below, I certify that the information provided in this registration is true, complete, and accurate to the best of my knowledge, and I agree to TrueCare FMS’s provider terms.

Signature

I have read and agree to the above, and I intend my typed name below to be my legal electronic signature.Type your full legal name *