Accepting Forms Digitally
To limit contact and provide services efficiently during telework, NMCDHH encourages our clients to complete and return documents electronically. If you have access to a printer and scanner, please print the document, fill it out and sign it, scan it (preferably as a PDF if possible) and email it back to us. If you can print but not scan, we will accept photos of documents – please make sure they are clearly in focus and readable. We are working to make more of our forms fillable PDFs so that they can be completed on your computer or tablet, digitally signed, and returned via email. In any of these cases, please follow up by mailing the original forms to our office for the permanent files – but we will accept the digital forms while we are working remotely.
TEDP Application Information
To apply for a free amplified phone, iPad, alert system, telephone ringer or smoke alarm, please click on the link at the bottom of this page to download the Telecommunications Equipment Distribution Program application.
Below are some FAQs regarding the application:
Why does it ask for a physical address in addition to my mailing address?
Any correspondence will be sent to your mailing address, but the equipment will be sent to your residence via UPS. UPS cannot deliver to a P.O. Box. If your physical address is the same as your mailing address, you don’t need to fill out the physical address information.
What do I check after my phone number? Voice, VP, or TTY?
Voice means a typical phone or cell phone used by hearing or Hard of Hearing individuals. A VP is short for Video Phone used primarily by Deaf individuals that communicate in American Sign Language. TTY is for a teletype device used by Hard of Hearing and Deaf individuals.
Whose information do I put under HIPAA?
Your file is confidential under the Health Insurance Portability and Accountability Act (HIPAA). We will not discuss anything in your file without your permission. If you don’t want anyone else to discuss your information, leave this section blank. If you are a parent, guardian, Power of Attorney for someone, your information will need to be filled out in this section. Also, if it’s just easier to have someone you designate to be a contact, such as a son, daughter, or Social Worker, go ahead and fill in their information.
Do I have to fill in my Gross Household Income?
Yes, your gross household income is one of the qualifications for our program. If this is left blank, your application will not be processed. If you have no income, please write “none” so that area will not be blank. Remember to sign your name in this section.
What kind of device should I get?
You can only have one primary device, which means you must choose an iPad or Phone or Electrolarynx (if you have a speech loss), but the model you choose is up to you to fit your needs. If you have a mild to moderate hearing loss, check the devices listed in the brochure (you can find the PDF on the Overview page) and select the one that has the features you want. Just make sure you pick a phone that matches your hearing loss.
What kind of accessories should I get?
In addition to a phone or iPad, you get up to two accessories for your home and you can choose which ones. Read the descriptions carefully, because you might think you want an answering machine, but the phone may already have one. If you want one accessory only, just check one. If you don’t feel you need any accessories right now, just leave that section unchecked.
Terms and Conditions
Don’t forget to read all the Terms and Conditions and keep a copy. Terms and Conditions are listed in the brochure, so please keep it handy. If for any reason you need assistance there is also the appropriate contact information for support.
Make sure you check that you have included the required documents. It is best that you mail the documents with your application, but if necessary, they can be sent later. Your application will not be processed until all the required documents are received.
Signature, Date, Parent or Guardian Signature
Don’t forget to sign and date your form or it will not be processed. If the applicant is a minor or if the applicant has a Power of Attorney or Guardian, please have that person sign as well.
If you have questions regarding the TEDP, please email Jason Siergey at email@example.com.