ND QSP Hub
North Dakota's centralized source of support and information for Qualified Service Providers
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QSP Individual Enrollment

To apply as an Individual Qualified Service Provider, you will need to access the following:

Training Video

Take time to watch the trainings below to get an idea on how to start with the QSP individual process.

  • Session 2: How Do I Become a QSP?
    Duration: 13:13 minutes
    This session will provide you with a basic understanding of the steps involved with getting started as a QSP. It will also provide direction on how to access resources to complete and submit application materials.

Learn How to Complete the Following Forms

  • SFN 1603
    Duration: 26:40 minutes
    This session walks you through how to complete the SFN 1603 application document for the individual QSP application.
  • SFN 583
    Duration: 5:16 minutes
    This session walks you through how to complete the SFN 583 application document for the individual QSP application.
  • SFN 615
    Duration: 2:24 minutes
    This session walks you through how to complete the SFN 615 application document for the individual QSP application.
  • W-9
    Duration: 1:45 minutes
    This session walks you through how to complete the W-9 application document for the individual QSP application.

TrainND

Are you a new or revalidating Qualified Service Provider (QSP) needing assistance with getting your SFN 750 Documentation of Competency signed by a medical provider? TrainND Northeast can help!

If you are applying or revalidating your application to be a self-employed provider to deliver services for which you want to receive public pay, you are eligible to complete training with TrainND Northeast for a $10.00 non-refundable fee.

TrainND Northeast, provider of workforce training through Lake Region State College, has partnered with the North Dakota Department of Human Services Medical Services Division to provide training to individual QSPs. Individual QSPs can obtain the training and competency evaluation they need to complete their application to become or continue as a QSP.

The training is simple. Once you've registered with TrainND, you’ll receive a set of two workbooks to complete. You’ll be assigned to a registered nurse who will contact you to set up an appointment to meet. During the meeting, the nurse will go over the completed workbooks with you, answer any questions you may have, and provide instruction on the skills listed on the SFN 750 Documentation of Competency form. When the training is finished, the nurse will complete the SFN 750 and send it to the TrainND office. Once received, TrainND Northeast will forward the SFN 750 to the QSP Enrollment office on your behalf.

How to Register

Submit a TrainND Referral Form and $10 payment (make checks or money orders payable to Lake Region State College) to the following address:

  • Lake Region State College
    ATTN: TrainND
    1801 College Drive North
    Devils Lake, ND 58301

Or, call the TrainND Northeast office at (701) 662-1578 or 1 (800) 443-1313 ext 21578 to register over the phone.

Additional Resources