Also to DDD (Division of Developmental Disabilities) andor DMHAS - nj 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I – Demographics. Enter the applicant's name, Social Security Number, and current location address. Ensure all fields are completed accurately.
3. Proceed to Section II – Mental Illness Screen. Answer each question carefully, marking 'Yes' or 'No' as applicable. Provide any necessary diagnoses based on DSM-5 or ICD criteria.
4. In Section III, if the outcome from Section II is positive, complete the Mental Illness Primary Dementia Exclusion questions. Document any relevant details regarding dementia diagnosis.
5. Move to Section IV for Intellectual Disability/Developmental Disability/Related Conditions Screen. Answer all questions truthfully and provide explanations where required.
6. Finally, review your entries in Sections V through X for accuracy before submitting the form via fax to OCCO and DDD/DMHAS as indicated.

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