As a grant recipient, the state considers you a state supplier. This means you must obtain a supplier ID number and complete a Request for Taxpayer Identification Number & Certification (W-9) and Authorization Agreement for Direct Deposit of EFT Payments (OBM-4310-Rev.11/1/2011). Both forms are available through the supplier ID number website.
Note: The information you provide on these forms must match the information you provided under your BWC policy. If your BWC policy information is outdated, you must update it to receive your grant funds.
We will not approve your application without the submission of the signed legal agreement. Download the agreement, sign, and mail the document to the following address:
Workplace Wellness Grant Program
13430 Yarmouth Drive
Pickerington, OH 43147-8310
All signatures must be original.