Department of Human Services | DDD Eligibility Application

All documents on this page must be filled out and returned to the appropriate Community Service Office.

Start the Application Process
Voter Registration Forms and Information
Health Insurance Portability and Accountability Act (HIPAA)

If you prefer, you can begin the application process by completing these forms:

Complete and Sign	Instructions
DDD Application for Eligibility	Initial page of application. (1 page)

Applicant Information Form	General information (residency, insurance, family, etc.) (4 pages)

Acknowledgement Form	DHS Notice of Privacy Practice

Adaptive Behavior Summary/Health and Safety/Risk Summary (AB/HSRS)	The AB/HSRS is intended to capture information that accurately reflects an individual’s functional abilities and health, safety and/or risk concerns. It can be used for an individual applying for DDD eligibility or as necessary for an individual who is eligible to receive DDD services. It should be completed by someone who knows the individual, such as a family member, caregiver or case manager. Please complete and sign the AB/HSRS Acknowledgement Form and include in the packet.

AB/HSRS Acknowledgement Form	Acknowledgement form to be included with the AB/HSRS form.

Authorization for Disclosure of Health Information to Family and Involved Persons	This form authorizes verbal disclosure of individual health information for the care and treatment of the individual served by DDD (including parent(s), guardian(s), involved family members/other persons.)

Once you complete these forms, it is very important that you mail them to the Community Services Office that serves the county in which you live. Address the envelope to the “Division of Developmental Disabilities Intake.”
After DDD receives your completed Application for Eligibility and Applicant Information Form, a staff person will contact you. The rest of the application materials will then be mailed to you. These will include a Documentation Checklist (sample).

You will need to provide DDD with extensive documentation. Some examples are:

medical documentation of your disability
your most recent psychological evaluation including the IQ score
all available psychological reports
Child Study Team or school reports
neurological evaluations
psychiatric evaluations
speech/therapy evaluations
copies of your birth certificate, social security and/or your Green Card or proof of U.S. citizenship.

A family member or other interested person can assist an individual in completing an application for DDD eligibilty, although they cannot apply on the individual's behalf.
Please note: A parent or legal guardian of a minor or the legal guardian of an adjudicated incapacitated adult may apply for services on the individual's behalf. Please see review Division Circular #3 for more details.

Voter Registration Forms and Information
New Jersey Voter Registration Application - English : Spanish
Voter Rights
Health Insurance Portability and Accountability Act (HIPAA)
How to Contact a HIPAA Privacy Officer
If you have questions or a complaint about your privacy rights related to the Health Insurance Portability and Accountability Act (HIPAA)

There may be additional HIPAA forms which you have to submit. Once you speak with an Intake Worker any additional forms will be included in the packet forwarded to you.