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  • Request For Determination Of Ddd Eligibility Form

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FOR OFFICE USE ONLY DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) Initial DDD NUMBER: Reapplication REQUEST FOR DDD ELIGIBILITY DETERMINATION Applicant Information LAST NAME FIRST NAME MIDDLE NAME/INITIAL.

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A person age 3 years to 6 years must 1) voluntarily apply, 2) be an Arizona resident, and 3) either have one of the following developmental disabilities: Autism Spectrum Disorder, Cerebral Palsy, Intellectual (Cognitive) Disability, Epilepsy, Down Syndrome OR be at-risk for developing one of these disabilities to ...

DDD administers two Medicaid waiver programs, the Supports Program and Community Care Program. Through enrollment in one of these programs, individuals can receive home and community based services based on their assessed needs and individualized budget.

Submit Application In Person or By Mail Hand-deliver or mail the application and copies of all supporting documents to DDD Intake at the Community Services Office for the individual's county of residence.

Division of Developmental Disabilities (DDD)

To meet the functional criteria for a developmental disability, you must provide documentation that you have a chronic physical and/or intellectual disability that began before you were 22 years old, is expected to be lifelong, and limits your ability to care for yourself and live on your own.

The services are based on age and specific eligibility based on federal requirements and referral/application processes. If you have questions regarding eligibility, please contact the Division at toll free 1-844-770-9500 or via e-mail at DDDApply@azdes.gov.

Arizona Long Term Care System (ALTCS) provides physical health care, behavioral health care and long-term care services to eligible Arizona residents who have a developmental disability. Upon eligibility, DDD provides healthcare through either UnitedHealthcare Community Plan or Mercy Care.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232