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Quick Reference - Eligibility Process

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The DDD Eligibility Application Process

How do I fill out the application?

Section Instructions
A Be sure the information provided is about the person applying for services.
B

The contact information for the person helping with the application. The legal guardian’s contact information. The legal guardian is:

  • Parent of the person applying if the person is under 18 years
  • Court-Appointed Legal Guardian
  • DCS Case Manager

If the person helping with the application is not the legal guardian, complete the Authorization for Disclosure of Protected Health Information form. This form can be found on page four (4) of the application packet. The form needs to be signed by the person applying.
C If you have health insurance, provide the information.
D Provide the most recent school information. Provide copies of the most recent Individualized Education Plan (IEP) or 504 plan, and the most recent Multidisciplinary Education Reports (MET).

Authorization for Disclosure of Protected Health Information: The form is the choice of the person applying. It allows DDD to share information with the person helping with the application.

Authorization for Release of Information: This form is the choice of the person applying. It allows DDD to request Protected Health Information from doctors, schools, and others.

When the application is ready, submit it with the following:

  • Proof the person applying lives in Arizona (utility bill, state ID, lease, school record, etc.)
  • Proof of U.S. Citizenship or Lawful Presence (birth certificate, immigration documents) of the person applying
  • A signed application by the person applying or their legal guardian
  • Insurance Card, if the person applying has insurance (copy of the front and back of the card)
  • Medical or Educational Records showing
    • The Qualifying Disability
      • Autism
      • Intellectual (Cognitive) Disability
      • Cerebral Palsy
      • Epilepsy
      • Down Syndrome, and
      • At Risk for a Developmental Disability if the person applying is under age six (6)
    • Three significant limitations for the person applying if the person is over age six (6)
      • Receptive and Expressive Language
      • Learning
      • Self-Direction
      • Self-Care
      • Mobility
      • Capacity for Independent Living
      • Economic Self Sufficiency
    • When the person applying is under age six (6), the person applying may
      • Have one or more of the qualifying diagnosis
      • Have a 50% delay in one developmental area or a 25% delay in two or more developmental areas
    • Developmental Areas include:
      • Physical (fine, gross motor, vision, or hearing)
      • Cognitive (learning, play skills, and problem-solving)
      • Communication (understand language, communicate wants and needs)
      • Self-Help (putting on clothes, feeding themselves, using the toilet)
      • Social-Emotional (plays with others and toys, showing concern for others)

How do I submit the application?

  • Email the records and application to [email protected]
  • Mail, fax, or hand-deliver the records and application to one of the following DDD Eligibility offices:

District North
1701 N. 4th St.
Flagstaff, AZ 86004
Fax: 928-773-8495

District East
125 E. Elliot Rd.
Chandler, AZ 85225
Fax: 480-926-5172

District South
1455 S. Alvernon Way
Tucson, AZ 85711
Fax: 520-145-1257

District Central
11420 N 19th Ave.
Phoenix, AZ 85029
Fax: 602-542-0070

You can drop by one of these offices for help if you have questions.

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