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.
- DCF Cover Letter to Parents and Guardians – Applying for Determination of Eligibility for Children with Developmental Disabilities
- DCF Documentation Checklist
- DCF Application for Determination of Eligibility for Children with Developmental Disabilities
- DCF Applicant Information Form
- DCF Adaptive Behavior/Health/Safety/Risk Summary (ABS/HSRS)
- DCF ABS/HSRS – Acknowledgement
- DCF Notice of HIPAA Privacy Practices regarding Protected Health Information
- DCF Notice of HIPAA Privacy Practices – Acknowledgement
- DCF Authorization for Disclosure of Health Information to Family and Involved Persons
- DCF Authorization for Release of Information
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
Eligibility application including general information (residency, insurance, family, etc.) (4 pages)
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.
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.
Acknowledgement form to be included with the AB/HSRS form.
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.
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.
- Health Care Advocacy Across the Lifespan: What Parents of Children with Disabilities Need to Know
An advocacy guide for parents to help them plan for and advocate effectively for health care services over their child with disabilities’ lifespan. Includes information about private and public health care insurance plans, rights and responsibilities, and appeal strategies and processes; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Estate Planning: Preserving wealth for your beneficiaries, and ensuring that end-of-life decisions are carried out according to your wishes.
A brochure describing the basics of estate planning; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Changes to Your Child’s Special Education Program: What Parents Need to Know
A brochure describing children with disabilities’ and parents’ basic rights and responsibilities related special education placements. Focuses on the “Stay Put” rule and what parents need to know when changes in special education placement are made; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Legal Considerations in Planning for Individuals with Autism Spectrum Disorders: A Guide for Siblings and Other Caregivers, 2nd edition
Provides a broad consideration of children’s and adult services, guardianship, estate planning, and other legal issues for siblings and other non-parental care-givers; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Understanding Your Health Care Insurance and Appeal Rights
In collaboration with Special Olympics New Jersey, Hinkle, Fingles & Prior has authored a new guide to help parents understand health coverage and appeal rights, and minimize financial responsibility. © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- What Grandparents Can Do to Help Plan for the Future of a Grandchild with Disabilities
A guide to help grandparents and other relatives make prudent decisions supporting their grandchildren with disabilities; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Pennsylvania Guide to Planning for Siblings and Other Family Members (2nd Edition)
Ira M. Fingles, Esq., and S. Paul Prior, Esq. have authored a guide for Pennsylvania siblings and other care givers who are planning for the future of their loved ones with disabilities; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Planning the Transition from School to Adult Life
Collaborating with ASAH, a not-for-profit organization of private schools and agencies in New Jersey, Herb Hinkle and Ira Fingles join Dorothy Van Horn, Executive Director of Brookfield Schools, in authoring this important new guide to transition services for students with disabilities; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- New Jersey Guide to Planning for Siblings and Other Family Members
Collaborating with Planned Lifetime Assistance Network of New Jersey, Ira M. Fingles, Esq. and S. Paul Prior, Esq. have authored a guide for New Jersey siblings and other care givers who are concerned about how their siblings’ needs will be met after their parents are no longer able to care for them; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- High Court Clears Way for More Assistance
Jonathan Tamari, Gannett State Bureau/Asbury Park Press: March 3, 2007
- Justices reject limits on aid to developmentally disabled
Rick Hepp; Newark Star Ledger/nj.com; March 2, 2007.
- Community-Based Services and Supports for Adults with Intellectual Disabilities
S. Paul Prior, Esq.; published for the Arc of New Jersey, copyright Hinkle, Fingles & Prior, Attorneys at Law; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Herb Hinkle, Thirty Years of Legal Advocacy
Jonathan Jaffe: Families, Spring 2006, published by the New Jersey Council on Developmental Disabilities
- Legal Considerations in Planning for Individuals with Disabilities: A Guide for Siblings
S. Paul Prior, Esq. and Ira M. Fingles, Esq.; published for the Arc of New Jersey, copyright Hinkle, Fingles & Prior, Attorneys at Law; © copyright Hinkle, Fingles & Prior, Attorneys at Law.
- Adults with Autism: The COSAC (Now Autism NJ) Guide to Services and Supports in New Jersey
Leslie Long, and Herbert D. Hinkle, Esq., published for the New Jersey Center for Outreach and Services to the Autism Community; © copyright Hinkle, Fingles & Prior, Attorneys at Law.