Do you have a disability and need a reasonable modification or communication assistance to access DFCS services?

To request a reasonable modification, communication assistance, or extra help, please complete the form below. You are not required to complete this form or tell us your disability in order to receive reasonable modifications, communication assistance, or extra help.

Persons with Disabilities Information
Name of the person with a disability who needs a reasonable modification, communication assistance, or extra help.
Please check the DFCS program(s) that apply
Medicaid and PeachCare for Kids®
Do you need a reasonable modification because of a disability?
Do you or your companion need communication assistance because of a disability? If yes, please tell us so that we can assist you. (Select all that apply)
(Not related to language assistance)
(Email)
Do you need this reasonable modificaton, communication assistance, or extra help:
Requester's information