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Dshs eligibility review form

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The document is a notification from the Developmental Disabilities Administration (DDA) regarding the review of eligibility for clients with developmental disabilities. It outlines the need for additional information to maintain eligibility under specific conditions such as Intellectual Disability, Cerebral Palsy, Epilepsy, Autism, or similar neurological conditions. Clients are instructed on how to provide consent for DDA to obtain necessary documentation and are warned that failure to respond may result in termination of eligibility. A Required Documentation Table is included to specify what information is needed.

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Click ‘Get Form’ to open the Notification of Eligibility Review in the editor.
Begin by entering the date at the top of the form. This is essential for tracking your eligibility review timeline.
Fill in your name and address in the designated fields. Ensure that all information is accurate to avoid any delays.
Next, provide your representative's name and address if applicable. This section is crucial for communication purposes.
Review the conditions listed (Intellectual Disability, Cerebral Palsy, etc.) and check any that apply to you.
Complete the consent form by indicating which providers DDA may contact for additional information. Include their contact details as required.
Sign the consent form electronically within our platform to validate your request.
Finally, submit your completed forms using the provided envelope or upload them directly through our platform for a seamless process.

Start filling out your form online today for free and ensure your eligibility review is processed smoothly!

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