How to Fill Out and Submit the OPWDD Eligibility Transmittal Form

The OPWDD eligibility transmittal form, formally titled the Transmittal for Determination of Developmental Disability, is the document you submit to New York State’s Office for People With Developmental Disabilities to request an eligibility determination for services. State regulation requires it to accompany every eligibility request sent to a Developmental Disabilities Regional Office (DDRO).1Cornell Law Institute. New York Comp. Codes R. and Regs. Tit. 14 630.5 – Eligibility for OPWDD Services You can download it from the OPWDD website in English, Spanish, Russian, Chinese, Korean, Bengali, Haitian-Creole, Urdu, Arabic, French, and Italian.2Office for People With Developmental Disabilities. Transmittal for Determination of Developmental Disability Form

Before You Start the Form

Call the OPWDD Infoline at 866-946-9733 and ask to be transferred to the Front Door office for the county where you live.3Office for People With Developmental Disabilities. Front Door Front Door staff walk you through what to collect and connect you with a Care Coordination Organization (CCO) or Service Access Agency (SAA) that helps gather records and submit paperwork.4Office for People With Developmental Disabilities. Eligibility A CCO or SAA will often handle the online submission for you, so getting that relationship started before you touch the form itself saves time.

The reason to line up records first: the form moves nowhere without them. OPWDD needs cognitive scores, adaptive behavior assessments, medical documentation, and a social or developmental history, and some of those must be dated within the past 12 months. Pulling those together usually takes longer than filling in the form.

Filling Out the Four Sections

Every field marked with an asterisk is required. Skipping one will stall the process.

Section 1: Person’s Information

Enter the full legal name, Social Security number, date of birth, sex, county of residence, home address, and phone number of the person seeking services. Include a TABS ID (OPWDD’s internal tracking number) or Medicaid number if the person has one; neither is required if you don’t. Then check where correspondence should go: to the person at home, to a separate mailing address, or to a parent or advocate listed in Section 2.

Section 2: Parents or Advocates

This section is optional unless you selected “Parent/Advocate 1” or “Parent/Advocate 2” as a correspondence recipient in Section 1. If you did, fill in each advocate’s name, address, phone number, and country.

Section 3: Referring Agency

If a provider, school, or other agency is submitting on behalf of the individual, enter the agency name, agency code if known, street address, contact person, and phone number. Self-referrals leave this blank.

Section 4: Services Requested

Check the boxes for services you want considered if the person is found eligible. The options are:

  • Determination only, with no services requested at this time
  • Residential: Individualized Residential Alternative (IRA) or Intermediate Care Facility (ICF)
  • Day programs: Day Habilitation, Day Treatment, or Pre-Vocational services
  • Community supports: Community Habilitation, Individualized Support Services (ISS), or Supported Employment (SEMP)
  • Family supports: Respite, Family Education and Training, Care at Home, Consolidated Supports and Services, or other family supports
  • Other: Case Management such as Medicaid Service Coordination, Environmental Modifications and Adaptive Devices, Article 16 Clinic, PASRR Level II Assessment, or a write-in option

Pay attention to this section even if you’re unsure what services you want. If you’re later found ineligible, OPWDD will offer a Medicaid Fair Hearing only if you checked at least one Medicaid-funded service here.4Office for People With Developmental Disabilities. Eligibility Checking a service you might want preserves your appeal rights.

At the bottom, print the name of the person completing the form, enter the date, and check whether it was filled out by the individual, a parent or advocate, an agency, or a PASRR coordinator.

Documents You Must Submit With It

The form alone is not enough. OPWDD requires records showing the disability existed before age 22 and documenting current functioning. Submit copies, not originals, of the following:5New York State Office for People With Developmental Disabilities. OPWDD Eligibility Guidelines

  • All available cognitive or IQ testing, including full-scale, index, and subtest scores
  • All available adaptive behavior assessments with composite, domain, and subdomain scores; computer-generated reports alone are not accepted and must be accompanied by a clinician’s narrative
  • Medical documentation supporting the qualifying diagnosis from the time it was made, if the diagnosis is something other than intellectual disability
  • A physical or medical summary completed within the past 12 months
  • A social or developmental history showing the disability began before age 22, unless that information already appears in another submitted report
  • A social evaluation completed within the past 12 months

OPWDD also recommends the most recent IEP or 504 Accommodation Plan with any referenced psychoeducational reports, plus mental health intake, discharge, or treatment plans if relevant.5New York State Office for People With Developmental Disabilities. OPWDD Eligibility Guidelines

Additional Documentation for Autism

If the diagnosis is autism, you must provide a comprehensive differential diagnostic report that uses structured autism-spectrum-specific measures based on a licensed clinician’s direct observation. The report needs a full developmental history covering milestones, repetitive behaviors, social interactions, and friendships, along with a detailed observations section describing the person’s behavior during the evaluation. The clinician must specify which symptoms the person has and describe how those symptoms present.5New York State Office for People With Developmental Disabilities. OPWDD Eligibility Guidelines

Submitting Through CHOICES

The form and supporting documents go in electronically through CHOICES, OPWDD’s online portal. The form requests a new or existing TABS ID from your local DDRO. Inside CHOICES, pick your DDRO by hovering over the DDSO field, clicking the magnifying glass icon, and selecting the office that covers your area; the DDRO field then populates on its own. After all fields are complete, click the three-dot menu at the top of the screen, select “Submission Option,” then “Submit Form.” Upload every supporting document through the separate Documentation Submission form within CHOICES so the DDRO has the full packet.6Office for People With Developmental Disabilities. Eligibility Transmittal for Determination of Developmental Disabilities

If you’re working with a CCO or SAA, they typically handle the CHOICES submission. For families going through the Front Door for the first time, Front Door staff can walk you through each step or coordinate directly with the DDRO.

What Happens After You Submit

Once the DDRO has a complete packet, it should issue a first-step decision within 30 days. First-step reviewers either find the person eligible, request more records, or forward the case to a second-step Eligibility Review Committee. If the first-step reviewer isn’t a licensed psychologist or licensed clinical social worker, a decision letter can’t go out until one verifies the determination.5New York State Office for People With Developmental Disabilities. OPWDD Eligibility Guidelines

The second-step committee includes a licensed psychologist and other clinicians. If they need additional records, you receive a written notice listing what’s missing and the deadline to supply it. Once the complete packet is back in hand, they have another 30 days to decide.5New York State Office for People With Developmental Disabilities. OPWDD Eligibility Guidelines

A third-step review is handled by OPWDD Central Office using licensed practitioners who weren’t part of earlier reviews. It happens automatically if you request a Medicaid Fair Hearing, and you can also request it on your own after a second-step denial. Central Office has 30 days from receiving all documentation to make a recommendation, and the DDRO director then has 10 days to notify you of any change.4Office for People With Developmental Disabilities. Eligibility

The most common cause of delay is incomplete documentation. Missing subtest scores, a medical summary older than 12 months, or an adaptive behavior report without the required subscale breakdowns will all trigger a records request and restart the 30-day clock. Before you submit, verify that every required document is included and that reports contain the full score breakdowns OPWDD asks for.

If You Are Found Ineligible

A denial is not necessarily the end. You can schedule a meeting with DDRO staff to discuss the decision and request a third-step review if one hasn’t already happened. If you checked a Medicaid-funded service in Section 4, you can also request a Medicaid Fair Hearing, an independent administrative proceeding outside OPWDD. Requesting a Fair Hearing automatically triggers the third-step review, which is completed before the hearing date.4Office for People With Developmental Disabilities. Eligibility This is why that Section 4 checkbox matters at the moment you fill out the form, not just when services begin.