Redetermination Application

Cuyahoga DD Redetermination Application
Redetermination for Cuyahoga DD services is required at ages 3, 6, 16 and at any time a person has a significant change in his/her needs or abilities. Redeterminaton is a process that assesses if the person is still eligible for services, and, if eligible, which supports and funding the person may receive.

This redetermination application is very important and must be completed and submitted before the person's birthday. If this is not submitted by then, the person's status will be changed to inactive and services/supports will no longer be available.

If you have questions or need help, please call 216-736-2673. We're glad to help. Thank you.
Name of person receiving services

First NameLast Name
Date of birth of person receiving services

MonthDayYear
Date
Current age of person receiving services
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
Preferred way for us to communicate with you during the redetermination process
Current diagnosis of the person receiving services
Name of public school district
This is the public school district that serves your community.
Name of school the person receiving services currently attends
Name of person completing this form

First NameLast Name
Relationship of person completing this form to the person receiving services
(Examples: parent/guardian, school counselor, social worker, doctor, friend, brother/sister, etc.)
Document Upload: Please upload any document, report, etc. that will help us re-determine eligibility.

Browse Files
(This feature is optional. If you chose not to upload documents here, you are encouraged to email them to EligibilityDocuments@cuyahogabdd.org.) Cancelof
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Cuyahoga DD Redetermination Application