Thank you for providing respite services for families eligible to receives these services through Community Mental Health of Ottawa County. We hope you find the information on this page helpful to assist you in your work.
Training Required for All Respite ProvidersClick on the links to access the trainings. Once the information has been reviewed please take the tests which are included in the Documents for New Providers and the Annual Provider Update below.
Documents for New Providers
- New Respite Provider Letter
- Documents for New Providers - Please print out the documents, fill them out, sign and return them to the CMH Respite Coordinator by mail, fax or e-mail:
CMH Respite Coordinator
12265 James Street
Holland, MI 49424
Fax (616) 393-5657
- IRS Form W-4
If you have questions about competing the W-4 please visit the IRS website.
- MI-W4 Form
- I-9 Form
Annual Provider Updates
- Annual Documents - Please print out the documents, fill them out, sign and return them to the CMH Respite Coordinator by mail, fax or e-mail. See contact information listed above.
- MI-W4 Form
Respite Payment Request
- Respite Voucher - Please print this document as often as needed to submit your hours of respite services for timely payment.
If you have any questions, please contact the CMH Respite Coordinator at 616-494-5446 or email firstname.lastname@example.org.