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[null,"Request For NJ CAT Reassessment Form"]
[]
[null,"The below info is REQUIRED in order to process:"]
[]
[null,"Date of request:"]
[]
[null,"Please detail your reason(s) for requesting reassessment, including NJ CAT question number(s) and change(s). Use additional paper if necessary. A copy of the NJCAT and any supporting documentation must be submitted with this request form.  "]
{"$rows_empty":20}
[null,"Individual's Information"]
[null,"Name:"]
[null,"DDD ID# (if known): "]
[null,"Agency (if applicable):"]
[null,"Address:"]
[null,"Phone Number:"]
[null,"Contact Person:"]
[]
[null,"Informant Information - Please ensure to include email address (if applicable) "]
[null,"Name:"]
[null,"Address:"]
[null,"Email Address:"]
[null,"Phone Number:"]
[null,"Relationship to Individual:"]
[null,"Would you need the survey provided to you in an alternate language?    Yes       No"]
[null,"What is the preferred language?"]
[]
[null,"Please submit requests by email to DDD.DDPIAssessmentRequests@dhs.nj.gov or by mail to NJ Division of Developmental Disabilities, PO Box 726, Trenton, NJ 08625-0726, ATTN: NJCAT Reassessment Unit "]

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[]
["County","Year"]
["Atlantic",2015]
["Bergen",2016]
["Burlington",2017]
["Camden",2018]
["Cape May",2019]
["Cumberland",2020]
["Essex",2021]
["Gloucester",2022]
["Hudson",2023]
["Hunterdon"]
["Mercer"]
["Middlesex"]
["Monmouth"]
["Morris"]
["Ocean"]
["Passaic"]
["Salem"]
["Somerset"]
["Sussex"]
["Union"]
["Warren"]

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