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Service Fee Directory

CSA Service Fee Directory Provider Enrollment Form

Dear Provider:  Welcome to the Service Fee Directory (SFD). The SFD is a web-based electronic system that has been developed to assist local governments purchasing services funded by the Comprehensive Services Act (CSA) and providers of those services to share information regarding the availability of services and fees for the services. Private and public providers of services list information describing their programs, locations and fees. Interested parties have the ability to locate providers based on either 22 pre-defined services or 24 child characteristics.  The SFD lists all providers authorized to receive payment from the Funds Pool except for exemptions listed below: 

CRITERIA FOR INCLUSION IN THE SERVICE FEE DIRECTORY: 

EXEMPTIONS FROM INCLUSION IN THE DIRECTORY INCLUDE: 

You must complete all fields for this form to process and registration to be completed.

Facility Legal Name
Mailing Address
City
State
Zip
Provider Contact
Contact Phone Number
E-Mail Address
Service Offered

 





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This File Was Last Modified: August 02 2006