Submit a request

Helps us understand who needs assistance.

This helps us get your message to the right place faster.

Helps us get your message to the right place faster.

This will help us get your request to the right place faster!

Please identify the relevant DBHDD Region (1-6) to help us route your ticket faster.

The county of the unit address. Helps route your request to the correct Regional Field Office.

The name of the agency the user belongs to.

Allows us to find the account more quickly.

Address of the unit in question, to help us solve the issue faster.

The CID number will expedite client look up and resolution.

Helps us look up your property for payment inquiries.

Contact phone number for discussion of property requests.

Helps staff look up your claim. If multiple claims, list them all divided by a comma.

Please provide us with complete information about your request so we can help.

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