Skip to form

Frank D. Lanterman Regional Center

isdept@lanterman.org

3303 Wilshire Blvd, Suite 700, Los Angeles, CA, 90010, US

213-383-1300

SeamlessDocs

Dear service provider, Please note that service providers need to be sending updated DS1891s to their vendoring regional centers. As such, the latest FDLRC service provider e-bulletin announcement with the March 1st deadline is specific to FDLRC vendored service providers. Please note however that updating the DS1891 form every 2 years is a requirement for all service providers. Every regional center manages their own provider pool - Thanks

INCOMPLETE FORMS WILL NOT BE ACCEPTED/PROCESSED



By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Your Name HereClick to Sign
Signature HereClick to Sign
04/25/2024Click to Sign

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

x

Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

x

Additional Signatures Required