Publications, Printed Material and Forms

Forms and Sample Documents:

Agency Forms & Resources

Department of Children and Families – Division of Children’s System of Care (CSOC)

The following forms and supporting materials are produced by the Department of Children and Families and are part of the application for eligibility for services provided through the Division of Children’s System of Care (CSOC). The firm posts them here as a resource for families and professionals.

New Jersey Department of Human Services – Division of Developmental Disabilities

The following forms, produced by the New Jersey Department of Human Services’ Division of Developmental Disabilities, are required in order to apply for services and supports. This content, including the descriptive copy under the table of DDD forms, was taken from the DDD Eligibility Application page at DHS/DDD’s website, and was current as of 5/2/13.  It is posted here as a resource for families and professionals.

Complete and Sign

Instructions

DDD Application for Eligibility

Eligibility application including general information (residency, insurance, family, etc.) (4 pages)

Acknowledgement Form

DHS Notice of Privacy Practice

Consent to Release Information

The information received through this release is subject to the confidentiality regulations of the Division and cannot be released outside the Division without written permission unless otherwise provided by N.J.A.C. 10:41 et seq.

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 eligibility, 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.

HF&P Publications

Below is a collection of publications authored by partners and associates at Hinkle, Fingles & Prior, some in collaboration with authors and experts in the community and at advocacy organizations in New Jersey and Pennsylvania.