Please review the Guide thoroughly, as this will help you determine the documentation required in order to process your application.
If you have questions/concerns, please reach out to our office:
LISS@Penn-Mar.org or 877-282-8202
FY 23 Applicant and Family Guide
FY 23 Applicant and Family Guide – Spanish
Blank LISS Services and Eligibility Application
Blank LISS Services and Eligibility Application – Spanish
DDA Letter of Recommendation
DDA LISS Attestation Form
Estimate Sample for Independent Contractor
Independent Contractor Agreement
Sample LISS Services and Eligibility Application
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 complete the Services Eligibility Application:
Documents may be submitted via mail, email, or fax. Please use the contact information below to submit your application packet.
Penn Mar Human Services
Counties served include: Allegany, Anne Arundel, Baltimore County, Baltimore City, Carroll, Frederick, Garrett, Harford, Howard, and Washington
Penn-Mar Human Services
310 Old Freeland Road
Freeland, Maryland 21053
LISS Fax Number: 1-410-357-4767
LISS Document Submission Email: LISSApps@penn-mar.org
We invite you to reach out via the online contact form: