Get Az Ddd-1972a Packet 2020-2025

The AZ DDD-1972A Packet is crucial for individuals seeking eligibility for developmental disabilities services in Arizona. This guide provides a detailed, step-by-step approach to completing the packet online, ensuring that you have the necessary information to submit a comprehensive application.

Follow the steps to fill out the AZ DDD-1972A Packet online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully read the instructions provided within the form to understand the requirements before starting. Make sure you have the relevant documentation on hand.
3. Begin filling out Section A, which requires applicant information. Include the person's name, date of birth, AHCCCS A number (if applicable), primary language, sex, home address, city, state, ethnicity, and phone number.
4. In Section A.1, list the professionals who can provide the necessary records for the qualifying disabilities. Include their names and contact information.
5. Proceed to Section B if applicable. Fill in the details for the parent or foster parent, including their name, phone number, relationship to the applicant, and email.
6. Complete Section C by providing information about health insurance coverage, the name of the health plan, the policy holder's name, ID/group number, and effective date.
7. If applicable, fill out Section D which requests early intervention and educational history. Include the type of support, dates attended, school name, and school district.
8. Review your information carefully to ensure accuracy. After confirming that all fields are complete, sign the application in the designated area.
9. Once finished, you have the option to save changes, download the form, print it, or share it according to your submission preference.

Start your application online today to ensure a smooth submission process.