Try for free

Pennsylvania TDDP Certification of Disability

Pennsylvania's Telecommunication Device Distribution Program, run by TechOWL at Temple University's Institute on Disabilities, provides free specialized telephones and wireless equipment to eligible residents whose disability prevents independent phone calls. This one-page Certification of Disability, page 4 of the application packet, is where a professional certifies the disability and that the applicant needs the technology to use telecommunication services independently.

Who completes it

A certifying professional completes the entire form: profession, the disabilities being certified, an explanation for cognitive or physical disabilities, full name, title, agency, Pennsylvania license number if applicable, phone, fax, email, signature and date.

Submitting and payment

How to submit it
Return the completed form to TDDP by email or fax.
Who pays
Equipment is free for qualified applicants, funded by a surcharge on phone bills, and the form lists no fee for the certifier.

Good to know

  • For cognitive or physical disabilities, the certifier explains why a specialized phone or wireless device is needed or names helpful features, such as voice access or photo-labeled memory buttons.
  • Applicants must be Pennsylvania residents aged six or older, with income at or below 200% of the federal poverty level and current or obtainable phone service.
  • The packet also needs proof of residence, phone service and income plus the equipment choice; once chosen, equipment cannot be exchanged.
  • The application packet is published in English, and TDDP provides it in other languages when an applicant asks.

Get the official form

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

Certification of Disability

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can sign the Pennsylvania TDDP Certification of Disability?

An audiologist, physician, physician's assistant, registered nurse practitioner, speech-language pathologist, optometrist, ophthalmologist, vocational rehabilitation counselor, or a service professional from an agency serving deaf, hard of hearing or deafblind people, a Center for Independent Living, or a credentialed assistive technology professional.

Which disabilities can be certified for TDDP?

The form lists cognitive, deaf, blind, deafblind, low vision, hard of hearing, physical and speech. For cognitive or physical disabilities the certifier must explain why a specialized phone or wireless device is needed or identify useful accessibility features.