Developmental Disabilities Administration

Electronic Visit Verification Caregiver Exemption Request

The Developmental Disabilities Administration provides an option for people to request an exemption for their live-in caregivers who provide Personal Support and Respite Care Services from Electronic Visit Verification requirements. This applies to both the traditional agency and self-directed services delivery models. The exemption is that the live-in caregiver staff/employee does not have to clock in and out in real time.

 
 

A copy of this form will be emailed to this address.

 

Participant's Full Name as noted in LTSSMaryland

 
 

Do not include spaces

 

The physical address where the person and live-in caregiver live

 
 
 
 

Live-In Caregiver's Full Name as noted on Residency Verification Documents.

 
 
 
 
 
 
 
 
 

The Live-In Caregiver Exception Start Date (Note: Can be no earlier than July 1, 2023)

 
mm/dd/yyyy
 

One form must be completed for each program

 
 

Required File Uploads

Upload the following documents to this form:


A. The DDA Live-In Caregiver Exemption Attestation Form


B. Two (2) Forms of Residency Verification (Choose two from the following):

  • Real-ID or other State-issued identification;
  • Vehicle registration card;
  • Bank account statement;
  • Insurance card;
  • Utility bill;
  • Lease or mortgage statement; and
  • Cable or phone bill.
 
Drop your files here
 

Request Checklist

Please make sure that the required documents are uploaded to this request form.



Check below that the required documents have been uploaded to this request form.

 
 
 

LTSSMaryland Upload Checklist

Please also make sure that the documents shared in this form are uploaded into LTSSMaryland Client Attachments under "Other."


Check below that the documents have been uploaded into LTSSMaryland.

 
 
 

Email Addresses

Add additional email addresses so those individuals receive information as directed by the Participant.