Application for Eligibility

1. By downloading, completing and sending an application form ( Application for Eligibility) to the Regional Eligibility Coordinator.
2. By contacting the Regional Eligibility Team directly at the Intake Referral Number.

Please Note: The region to which the applicant's town belongs can be found under the heading " Find an area office" on our website: www.mass.gov/dds

Below are the addresses and phone numbers for the Department's four regional eligibility offices:

Central/West Region
Regional Eligibility Coordinator
171 State Avenue
Palmer, MA 01069

Intake Referral Number: 413-284-5045
Fax Number: 413-284-1516

Metro Region
Regional Eligibility Coordinator
Fernald Center/North Nurses
200 Trapelo Road
Waltham, MA 02452

Intake Referral Number: 781-314-7513
Fax Number: 781-314-7539

Northeast Region
Regional Eligibility Coordinator
Hogan Regional Center
PO Box A
Hathorne, MA 01937
 
Intake Referral Number: 978-774-5000 x850
Fax Number: 978-739-0420

Southeast Region
Regional Eligibility Coordinator
68 North Main Street
Carver, MA 02330

Intake Referral Number: 508-866-5000
Fax Number: 617-727-7822

• Application for Eligibility (PDF) | Excel