10A NCAC 17D .0205 APPLICATION INFORMATION AND PROCEDURES
(a) Any person interested in receiving an equipment set from the Program may request an application packet by calling or writing the Division at the Division Central Office, or by requesting one from any of the regional centers or downloading one from the Division website. The application packet shall include:
(1) instructions for submitting reports and statements certifying that the applicant is deaf, hard of hearing, speech-impaired, or deaf-blind;
(2) a Conditions of Acceptance form for the recipient to sign indicating that the recipient understands and agrees to the rights and responsibilities of the recipient and desires services of the program. This form includes information for recipients acting for minor users to sign indicating their agreement that equipment sets received under this program may be transferred to the user upon the user's 18th birthday at the request of the minor user; and
(3) an application form calling for the following information:
(A) the full name, address, date of birth, and occupation of the recipient and all users of the equipment set;
(B) telephone number of the recipient;
(C) personal and financial information regarding all family members necessary to determine financial eligibility according to the provisions of Rule .0210 of this Section;
(D) copies of documentation required in Rule .0206 of this Section; and
(E) the disability status of the applicant or the intended user.
(b) To apply for equipment from the TEDP, an eligible applicant must:
(1) answer all of the questions on the application form, sign it, and date it;
(2) make a copy of an item from Rule .0206(b)(1) offering proof of residence in North Carolina to include with the application;
(3) make a copy of an item from Rule .0206(c) offering proof of household income to include with the application;
(4) read the Conditions of Acceptance form, sign and date the form, and include it with the application;
(5) give the Disability Determination form to a certified person listed in Rule .0206(b)(2) to fill out;
(6) read the Equipment Selection form, select the equipment that best fits the applicant's need, and include it with the application;
(7) submit the "Certification of Telecoil Candidacy and Hearing Aid Model Selection" form if applying for a hearing aid; and
(8) submit a written equipment recommendation from a licensed speech and language pathologist, or individual who is exempt from licensure as a speech and language pathologist by G.S. 90-294, applying for equipment for a speech impairment.
(c) Providing false or misleading information on the application shall subject any applicant selected as a recipient to forfeiture of any equipment set provided.
(d) The regional centers shall provide assistance in completing application forms upon request.
(e) Applicants shall complete and sign all forms, attach all necessary documentation, and mail the completed application packet to the address specified on the application.
(f) The Division shall determine an applicant's eligibility within 60 days following receipt of the completed application; except if the Division cannot determine eligibility within 60 days, it shall inform the applicant in writing as soon as possible within the 60-day period indicating the problem and solicit clarification and additional information in order to determine the applicant's eligibility.
History Note: Authority G.S. 62-157; 143B-216.34;
Eff. December 1, 1988;
Amended Eff. December 1, 2009; May 1, 2008; May 1, 2007; April 1, 1990;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 20, 2017.