Provider Management Forms

Thank you for serving as a vendor for the Georgia Vocational Rehabilitation Agency (GVRA). Your services and goods are vital to the success of the individuals we serve. This letter is to notify you that GVRA will be moving to a new case management software system in spring 2018. The system is called AWARE and we will be providing more information about the system in the coming weeks. Currently, we are in the process of data conversion and we need your assistance to help us complete this process.

According, to our records, you have provided materials or services to our clients over the past two years. In order for us to move forward with our vendor relationship, we will need you to complete the attached documents:

1. Vendor Management Form (VMF) _ Complete sections 1-4 only. Section 2 requires a voided check, signature and date in order for us to process this form.

2. W-9 Request for Taxpayer Identification Number and Certification _. This form must be completed in its entirety.

These forms are required in order to continue doing business with GVRA and in order to receive all future payments. We will be putting a hold on all referrals for new services, until this process has been completed and updated in our payment system. Submit forms to our office no later than April 15, 2018 using the contact information below.

If you do not contact us by April 15, 2018, your vendor number agreement will no longer be valid with our agency and your account will be deactivated in our vendor management system. We will honor any previous authorizations and invoices that were rendered or issued prior to April 16, 2018.

Submit completed forms via fax (770-342-7712) or mail using information below.

Georgia Vocational Rehabilitation Agency

Attn: Fiscal Services—VMF update

1800 Century Center Blvd, Ste. 17200

Atlanta, GA 30345