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ACT Memo - COVID-19: DDD Eligibility Update - Verbal Signatures (Update #10)

Please review the updates from AzEIP regarding verbal signatures. Also, there is additional guidance from ACT.


Good afternoon Early Intervention Leaders,

The AzEIP team has been working collaboratively with the DDD Eligibility Unit to ensure that we have a clear pathway for families to apply for DDD during the time that we are not going into homes. As previously stated in an email, we expect that teams continue to utilize the most updated DDD eligibility application when working with families.

Today I'd like to share some clarification regarding verbal signatures. We will expect that SCs and teams complete applications and attempt to get electronic signatures when possible. When a family does not have capability to use the electronic signature format a verbal signature is going to be accepted with the following process:

Read aloud to the applicant the following statements found on the DDD Eligibility Application:

By signing below, I agree that:

  • I have been informed of the services provided by this agency.

  • I understand that if I am referred to AHCCCS for an ALTCS eligibility determination, I must cooperate in this determination process.

  • As part of my application to this division, I have been informed of the DDD eligibility criteria and of my rights relevant to the application process.

  • Applicants are required to assign rights to insurance benefits in accordance with R6-6-1303. If I am eligible and assigned to services, I authorize the release of information necessary to file a claim to my insurance company.

  • I attest that everything I have stated in this application is true.

  • An applicant over 18 years of age without a court appointed legal guardian

  • A biological or adoptive parent applying for a minor child (Including children in foster care where parental rights have not been terminated)

  • A Child Safety Specialist from the Department of Child Safety, for children in foster care if the biological/adoptive is unavailable (must have documentation showing reasonable efforts to obtain biological/adoptive parent signature)

  • A legal guardian, appointed by a court (need to have documents of guardianship) As a Cooperative, we set the standard for success in the early childhood community. Page 2 of 2.

Once the statements are read to the parent, guardian or appropriate individual, ask the applicant if they agree to verbally sign the DDD Eligibility Application.

If Yes, type the name of the applicant in the signature line along with the following statement: "applicant has verbally signed the application."

The signature needs to be documented exactly as indicated so that the application can be accepted for processing by the DDD Eligibility Unit.

Please send this out to SCs and other team members who regularly complete DDD applications.

Thanks, and have a great day,

Alicia Amundson Quality Improvement Manager Arizona Early Intervention Program


1. Documents are sent to the family and team for signatures

2. Documents are set up to automatically resend every 2 days

3. If documents are not signed within 3 weeks, we will ask the SCs to make a call to the family, verify email, and ask them to check their inbox and spam just in case it was missed and letting them know that if it is not signed in one week, we will accept this as their verbal consent.

4. SCs will document the conversation regarding the conversation or message regarding needing these documents.

5. After 4 weeks, if the documents have not been signed, Amber/Kristin will change the status of the documents in DocuSign so that it bypasses the family and the team members can sign. Once the team members sign, all team members, including the family are automatically sent a copy, since we have changed their status from "needing to sign" to "cc - copy received"

6. Amber/Kristin will download the history of the documents from DocuSign (see attached for an example) which shows all attempts to obtain a signature and upload to CR. 7. SCs will upload all documents into CR.

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