Maryland Department of Health

Developmental Disabilities Administration (DDA)

 

Wage Exception Form Request

This form is available for anyone who self-directs their DDA services in the State of Maryland. This form can be used to request an Exception to the Published Reasonable and Customary Wages as listed in the Self-Directed Services Manual.


Only the participant's Coordinator of Community Services may complete this form.


Please complete one form per job position.


Please reach out to your DDA Regional Office if you have questions, concerns, or need technical assistance.


*This form was updated May 16, 2025.

 
 
 
 
 

Choose the county the participant live in

 
 

A current employee is someone who currently works for the participant.

 

Reason(s) for the Wage Exception Request

 
 

File Uploads

 
Drop your files here
 

Coordinator of Community Service Attestation

By signing and submitting this Wage Exception Form request, you are attesting that all the contents within the requests are accurate and complete.


Falsification of all or portions of this request is considered Medicaid Fraud and subject to appropriate reporting.

 

By typing my name below, I attest that the Participant/legal guardian/designated representative has made an informed decision.


Note: Completing this form before the participant/legal guardian/designated representative has made an informed choice is considered falsification of the document.

 
 
 

If the person self-directing uses email, include it here.