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ODSP Form 3203E: Hearing Aid Exceptional Circumstances

Ontario's Ministry of Children, Community and Social Services uses form 3203E when an ODSP recipient needs hearing aid services, devices or items outside the standard ODSP Hearing Aid Benefit because of exceptional circumstances. The authorizer describes what is requested, its cost and the clinical rationale, and the ministry must pre-authorize the request before anything is dispensed. The ministry sends its decision by letter to both the authorizer and the applicant.

Who completes it

Only a registered Assistive Devices Program (ADP) hearing aid authorizer may complete it, filling in Sections A to C with their ADP registration and CASLPO or AHIP member number and the vendor's details. The applicant, or someone lawfully authorized to sign for them, signs the Section D declaration and consent.

Submitting and payment

How to submit it
The authorizer mails the completed form, with a copy of the Hearing Aid Benefit Authorization Form, to the ministry's ODSP Hearing Aid Benefit Program (Exceptional Circumstances) at the address on page 1.
Who pays
No completion fee appears on the form; the ministry posts a Schedule of Fees for Hearing Aids, Devices and Services alongside it in the Central Forms Repository.

Good to know

  • Pre-authorization and approval must be obtained before dispensing or providing any service, device or item requested under the exceptional circumstances policy.
  • Section A asks for the applicant's ODSP member ID and the invoice number from the Hearing Aid Benefit Authorization Form, a copy of which must be attached.
  • For a child under 16, the declaration and consent must be signed by the social assistance applicant or recipient, or another person with lawful custody of the child.
  • The application will not be processed if the Section D declaration and consent is not signed, so check the signature before sending.

Get the official form

Download the current version from the source each time; forms change without notice.

ODSP Hearing Aid Benefit (Exceptional Circumstances)

Prestation pour prothèses auditives du POSPH (cas exceptionnels)

Official pagePDFVersion française

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Frequently asked questions

Who can complete ODSP form 3203E?

Only a registered Assistive Devices Program hearing aid authorizer, for example an audiologist. Section B asks for the authorizer's ADP registration number and CASLPO or AHIP member number, plus the ADP vendor's name and registration number, and the authorizer signs the request in Section C.

What must a 3203E request include?

A copy of the Hearing Aid Benefit Authorization Form and the completed 3203E with a description of the services, devices or items requested, their cost, the clinical determination and rationale, and the applicant's signature in Section D. The ministry's ODSP Hearing Aid Benefit Program (Exceptional Circumstances) reviews every request.

Is form 3203E available in French?

Yes. The Central Forms Repository posts a French version, 3203F, next to the English form, along with the Schedule of Fees for Hearing Aids, Devices and Services. The current edition is 3203E (2022/11), a fillable PDF that needs an up-to-date version of Adobe Reader.