Feedback Form
Thank you for your interest in the D.C. Department on Disability Services (DDS). To ensure that we are effective in fulfilling our goal to provide innovative, high quality services to people with disabilities, please use the Customer Feedback Form to tell us about your recent experience with our agency. It will only take a few minutes of your time and your answers will help us identify areas that we need to improve so that people seeking our services continue to have positive outcomes. Your continued interest in the Department on Disability Services is appreciated.
Please complete all sections
Name of the person receiving the services
Suffix:
*
First Name:
*
Last Name:
Middle Name:
Address 1:
Address 2:
City:
State:
Zip:
Email:
Home Phone:
Are you a :
--- Select Who you are ---
Person seeking service
Parent/Family Member of a person with disabilities
Guardian of a person with disabilities
Advocate
Attorney
Service Provider
Business Services
Other
Name of Person filling out form if you are NOT person receiving services
Suffix:
First Name:
Last Name:
Middle Name:
Address 1:
Address 2:
City:
State:
Zip:
Email:
Home Phone:
Bussiness Phone:
Preferred Contact Method :
--- Select Preferred Contact Method ---
Email
Home Phone
Cell Phone
Which administration were you seeking?
--- Select Which Administration were you seeking ---
Developmental Disabilities Administration (DDA) which assists people with intellectual and developmental disabilities
Disability Determination Division (DDD) - determination of eligibility for social security disability
Rehabilitation Services Administration (RSA) which assists people with disabilities seeking employment and independent living resources
Department on Disability Services (DDS) - questions or concerns regarding human resources, contracts, billing, communication, etc.
Please choose from the list below the description that best fits your reason for contacting DDS:
--- Please Select Which reason best fits for contacting DDS ---
Inquiry: how to receive DDS services
Inquiry: not related to DDS services
Feedback regarding payment of services
Transportation
Vendor inquiry
Feedback about provider services
Feedback about DDS staff services�communication
Feedback about DDS staff services�other
Other
Please provide information regarding your concern:
Was your issue resolved?:
Yes
No
If No, please explain