How to Complete the NJ DDD Support Coordination Agency Selection Form

The NJ DDD Support Coordination Agency Selection Form is a one-page document that tells the New Jersey Division of Developmental Disabilities which agency you want managing your home and community-based services. You list up to two preferred agencies (or check the auto-assign box), fill in your DDD ID and signature, and submit it by email to DDD.SCAChoice@dhs.nj.gov or by mail to DDD’s central office in Trenton.1New Jersey Department of Human Services. Support Coordination Agency Change Form Assignments are processed at the beginning of each month and can take up to 30 days to go through.2New Jersey Department of Human Services. Division of Developmental Disabilities – Support Coordination Agency Change Form

What You Need Before You Fill It Out

Two things have to be in place first: a DDD ID number and the names of the agencies you want to list.

The DDD ID is issued during the eligibility determination process. It is not your Social Security number and not your Medicaid ID. If you don’t have one yet, contact your county DDD intake office to start the application and complete the New Jersey Comprehensive Assessment Tool. The selection form cannot be processed without that number.

For agency names, use DDD’s iRecord provider database. You can filter by county, zip code, language, and the acuity level of populations an agency works with, and you can print a full list that shows each agency’s current participant census and active staff count.3NJ DDD iRecord. Provider Search DDD recommends calling the agencies directly to confirm they serve your area and are accepting new participants before you put them on the form.4New Jersey Department of Human Services. Division of Developmental Disabilities – Support Coordination (Care Management)

One boundary to be aware of while you narrow your list: federal Medicaid rules require conflict-free case management, meaning the agency coordinating your services cannot also be the agency delivering your direct care.5eCFR. 42 CFR 441.301 – Contents of Request for a Waiver If an organization already provides your residential or day services, you cannot pick that same organization as your support coordination agency.

Filling Out the Form

You can download the form from the DDD website or request a copy from your county intake office. Every field on the single page needs to be completed:

  • Individual’s full legal name as it appears on your DDD records.
  • Date of birth in month/day/year format.
  • DDD ID — the number specific to DDD’s system, not your SSN or Medicaid ID.6New Jersey Division of Developmental Disabilities. Support Coordination Agency Selection Form
  • First-choice agency, written exactly as the name appears in the iRecord directory.
  • Second-choice agency, used if the first choice cannot accept you because of capacity or geographic limits.
  • Auto-assign box, if you have no preference. Auto-assignment cannot accommodate a language preference, so skip this box and name agencies if language matters.6New Jersey Division of Developmental Disabilities. Support Coordination Agency Selection Form
  • Signature, printed name, phone number, and email. DDD uses the email address for notifications.

If a legal guardian or authorized representative signs for the individual, that person fills in their own name and contact details in the signature section. A guardian’s authority to act on public benefits matters has to come from the court order appointing them; a healthcare-only power of attorney is not enough.

The most common processing delay comes from mismatched agency names. Copy the agency name directly from the iRecord search results or the printable list. A misspelling or an outdated name sends the form back to the queue.

Where to Send It

DDD accepts the completed form two ways. Email is preferred and generally faster.

Submit the form only once. Sending the same form twice, or sending both an email and a mailed copy, creates processing errors instead of speeding anything up.1New Jersey Department of Human Services. Support Coordination Agency Change Form There is no fax option and no online portal. If you mail the form, use a tracking service so you have proof of delivery.

When Your Assignment Takes Effect

DDD processes agency assignments at the start of each month.2New Jersey Department of Human Services. Division of Developmental Disabilities – Support Coordination Agency Change Form If your form arrives mid-month, the assignment typically goes into effect on the first of the following month, and the full request can take up to 30 days. If your first-choice agency cannot accept you, DDD assigns your second choice. If you checked auto-assign, DDD picks an available agency in your area.

Once assigned, the agency gives you a dedicated support coordinator. That coordinator usually puts together an individualized service plan within the first 30 days, connects you with approved DDD providers, and monitors the services going forward. If a provider isn’t working out or your needs change, the coordinator handles the paperwork and keeps Medicaid billing current.

Changing Your Agency Later

You can change agencies at any time, and you do not have to give a reason. Use the Support Coordination Agency Change Form, which is a separate document from the initial selection form but asks for the same core information: name, date of birth, DDD ID, and your first and second choice for a new agency.2New Jersey Department of Human Services. Division of Developmental Disabilities – Support Coordination Agency Change Form Send it to the same email address or mailing address you used for the initial selection.

Changes also take effect at the beginning of the month. A change request submitted on March 10, for example, would typically take effect on April 1. Your current coordinator stays responsible for your services until the new agency officially takes over, so coverage should not lapse during the transition.