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Services, whether state or medicaid funded, you must complete this form. Low Intensity Support Services (LISS) do not require an application. If you need help with this application, call Toll Free 1-877-4MD-DHMH * TTY for Disabled - Maryland Relay service 1-800-735-2258 PART I: APPLICANT'S INFORMATION LAST Name FIRST Name Date of Birth (MM/DD/YYYY): MIDDLE Name Social Security Number: Permanent Mailing Address: Apt# Street Address City State Are you a resident of Maryland? Yes Teleph.

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How to fill out the DDA Application online

The Developmental Disabilities Administration (DDA) Application is essential for determining eligibility for various services. Completing this form online is straightforward, and this guide will help you through each section with clarity and support.

Follow the steps to complete the DDA Application online.

  1. Press the ‘Get Form’ button to access the form and open it for completion.
  2. Begin by filling out Part I, which requires your personal information, including your full name, date of birth, social security number, and permanent mailing address. Make sure to provide accurate contact details.
  3. In Part II, conduct a self-assessment by checking off any disabilities you have been diagnosed with. If applicable, attach supporting documentation as indicated in the section.
  4. In Part III, identify any other agencies or programs from which you are currently receiving or have previously received services. Check the appropriate boxes to indicate your status.
  5. Part IV requires you to authorize DDA to obtain relevant information from professionals or agencies by completing the authorization details. Insert necessary information about the individuals you are granting access to.
  6. Provide information about your primary caregiver, legal guardian, or contact person in Part V, ensuring that you select the most appropriate title for their role.
  7. Complete Part VI with statistical information, including the applicant's sex, origin, race, and marital status.
  8. Finally, review and sign the signature section in Part VII, affirming the accuracy of the provided information. Ensure that all sections of the application are filled accurately before submitting.
  9. Once completed, save your changes, download the document for your records, and print or share the form as needed.

Complete your DDA Application online today to ensure timely access to services.

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Developmental Disabilities Administration (DDA) Overview DDA services are varied, among them employment services, assistance providing personal care, respite services, environmental modification, and housing. Contacting DDA: PHONE: 1-800-974-4428.

DDA Form means the Direct Debit Authorisation Form prescribed by the Company for the purpose of authorising the Company to charge any and all Instalments to the Card of the Cardholder, subject to the terms and conditions of the Program (defined below) set out therein; Sample 1.

The Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want.

Disposition and Development Agreement (DDA means an agreement that sets forth requirements for the sale, lease, exchange acquisition, or disposal of real property owned by the Agency, where a specific type of project is developed.

The Maryland Department of Health's Developmental Disabilities Administration (DDA) works together with children and adults who have intellectual and developmental disabilities to get support and resources so that they can have good lives.

The most common developmental disability is intellectual disability. Cerebral palsy is the second most common developmental disability, followed by autism spectrum disorder. Other developmental disabilities may include: Attention-Deficit/Hyperactivity Disorder.

Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. About one in six children in the U.S. have one or more developmental disabilities or other developmental delays.

In order for the DDA to determine whether a person is eligible, the person or someone acting on their behalf must complete the DDA application process. The process includes completing the DDA Application for Eligibility, submitting supporting documentation, an interview by a DDA representative, and a DDA determination.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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