Get Maryland Dda Application - Dda Dhmh Maryland

This guide will help you navigate the Maryland DDA Application process smoothly. By following these steps, you will be able to complete the application online, providing the necessary information for services effectively.

Follow the steps to successfully fill out the Maryland DDA Application.

1. Press the ‘Get Form’ button to access the application form and open it in the editor for online completion.
2. Begin by filling out Part I, which asks for the applicant's information. Enter the full name, Social Security number, and Medical Assistance number. Specify the start and end date of the assistance.
3. Provide the applicant's permanent mailing address, including the P.O. Box number and any apartment number, followed by the city, state, and zip code.
4. Enter the applicant's telephone number and the signature of the person completing the application along with the date of completion.
5. Indicate the applicant's county of residence by checking the relevant box provided.
6. Fill in the applicant's date of birth, ensuring the month, day, and year are accurately recorded.
7. Select the applicant's sex and race by checking the appropriate options provided in the form.
8. Specify the marital status of the applicant by selecting one of the given choices.
9. Answer the question regarding the onset of disability before age 22 by selecting 'Yes' or 'No'.
10. List the applicant’s disabilities from the provided codes, entering up to six in priority order.
11. Complete the mobility section, indicating how the applicant is able to move about.
12. Fill in the supervision needs of the applicant, choosing the most appropriate level.
13. Describe the ability to communicate, selecting from the options provided.
14. Assess the applicant’s functioning level and skills in activities of daily living by completing the specified sections.
15. Proceed to Part II to fill out details regarding the primary caregiver, guardian, or next-of-kin, including names, addresses, and relationships.
16. Once all sections are completed, review the application for accuracy. Make any necessary changes and ensure that all required information is provided.
17. Save your changes, and if needed, download, print, or share the completed application form.

Complete your Maryland DDA Application online today to ensure you receive the services you need.