Standard Vendor Application - DHH

New Jersey Vocational Rehabilitation Services

Standard Vendor Application

 

Please complete this application if you wish to provide vendor services for the New Jersey Department of Labor and Workforce Development, Division of Vocational Rehabilitation Services (DVRS).

To obtain your NJStart number, visit njstart.gov.

Note: any question with an " * " is required to be completed.

Vendor ID and Contact Information

Business Location and Mailing Address

Is the business address the same as the mailing address?

Vendor Business Information

Type of business or service for which you are applying (select all that apply)
Is this business classified as private?
Is the business classified as a non-profit?
Are you a new or existing vendor?

Questions for American Sign Language (ASL) Interpreters & CART Providers

Examples of interpreting assignments:
Vocational training for consumers
Audiology appointments for consumers
DVRS Staff Meetings for deaf staff
DVRS Staff Trainings and Events for deaf staff
Meetings coordinated by NJ State Coordinator for the Deaf

For DVRS consumer assignments, DVRS pays certified interpreters $75/hr. (2 hours minimum) with .47/mile.  If you are interested in working as an interpreter for Deaf staff, you will need to onboard with the NJ state-contracted interpreter agency, Masterword Services, Inc. For more information email masterword@masterword.com, using the subject line “Talent Acquisition Team.”

Counties you are willing to travel to for assignments (select all that apply)
Are you a(n) ASL Interpreter or CART Provider?
For the counties you selected above, do you provide services remotely only or in-person and remotely?
Which of the following are you RID Certified for?

Audiologists, Hearing Aid Dispensers, ENT Doctors Additional Questions

Do you have any Cochlear Implant Specialists on staff?
Do you have any staff who are fluent in American Sign Language (ASL)?
Brands of hearing aids you dispense (select all that apply):
Services you will be providing:

Business Address Information

Type of address.

Staff Info

Counties Served
Counties you are willing to travel to for assignments (select all that apply)
Are you adding or removing a staff member from the list we have on file?
Brands of hearing aids you dispense (select all that apply):
Services you will be providing:

E-Signature

By signing below, I am electronically signing this application and verifying that the information submitted is correct. This electronic signature has the same legal effect as a written signature.