Selected Applicants

LISS Documents Checklist

• Proof of Identity including, if applicable, Parent or Legal Guardian identification (for applicants under the age of 21)
• Proof of Residency
• Proof of Developmental Disability and/or Intellectual Disability
• Completed, Signed and Dated Attestation Form
• LISS Services Eligibility Application
• Invoices, Receipts or Online Printouts for Services
  • Important: When submitting your Services Eligibility Application and required documents for each eligible service category, you must also submit Proof of Identity (Of the Applicant and if applicable), Parent or Legal Guardian, Proof of Residency and Proof of a Developmental or
    Intellectual Disability, with your packet.
  • Important: For any Health or Mental Health Related services eligible for LISS Program funding, the invoices must indicate the license number of the professional who is licensed by the respective State of Maryland Licensing Board.
• Health Insurance Information: Coverage or Non-coverage including Co-pay, (e.g. Explanation of Benefits from health insurance provider, If applicable)
• Professional Letter of Recommendation (If applicable)
• W-9 Form from company/independent contractor (If applicable)

If the above documents are not submitted with your application packet, your application will be delayed as the LISS Provider waits for the required documentation. Your application will be placed with the applications received and /or completed until the date the provider receives the documentation.

If the LISS Provider does not hear back from you after requesting additional information or does not receive the required documents, then your application will be denied.

How to Video

How to complete the Services Eligibility Application: