Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Fairfax County Local Department of Social Services (LDSS) – Fairfax County, Falls Church, and Fairfax City, Virginia (Department of Family Services) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Fairfax County Local Department of Social Services (LDSS) – Fairfax County, Falls Church, and Fairfax City, Virginia (Department of Family Services) fax number

(804) 717-6294

Local Department of Social Services (LDSS) — Fairfax County / Falls Church / Fairfax City (part of Fairfax County Department of Family Services)

Used for: Submitting DMAS-96 Medicaid LTSS authorization / PAS DMAS-96 forms to the LDSS; LDSS processes these forms and sends related notices or confirmations.

Fax destination details

Department
Local Department of Social Services (LDSS) — Fairfax County / Falls Church / Fairfax City (part of Fairfax County Department of Family Services)
Purpose
Submitting DMAS-96 Medicaid LTSS authorization / PAS DMAS-96 forms to the LDSS; LDSS processes these forms and sends related notices or confirmations.
Form
DMAS-96 — Medicaid Funded Long-Term Services and Supports Authorization Form (DMAS-96)
Address
12011 Government Center Parkway, Pennino Building, Fairfax, VA 22035
Voice phone
703-324-7329

Before you send

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Instructions for completing the DMAS-96 LTSS authorization form are provided by DMAS (DMAS-96) and appear in DMAS guidance/transmittals, including the DMAS-96 instructions (9/2018).

Official form instructions are published as a downloadable file on the organization's website.

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