Unpaid, full-time caregivers of a person with a developmental disability can receive respite vouchers through Oklahoma DDS, and this two-page form verifies the disability. The physician or school designee lists all diagnoses, confirms the developmental disability and age at diagnosis, and marks whether it will continue indefinitely and which functional areas are substantially limited.
A physician or school designee completes questions 1 to 5 and signs, with name, title, phone and mailing address. The caregiver completes the care recipient and caregiver details and signs the release at the top.
Download the current version from the source each time; forms change without notice.
Respite Voucher Program Developmental Disabilities Verification
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The verification section must be completed by a physician or a school designee. They verify that the information about the care recipient is correct and sign, adding their name, title, phone number and mailing address.
Yes. When the developmental disability is autism, the form asks for documentation verifying the level of autism. Question 2 also asks the age at diagnosis and the name of the developmental disability.
Yes. Oklahoma Human Services posts a Spanish version numbered 06RP005S on its forms site. It is an older edition dated 9/21/2022, while the English 06RP005E is dated 4/1/2026. Both collect diagnoses, functional limits and the physician or school designee signature.