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    Please tell us if you need assistance because you do not speak English or have a disability. Free language assistance and/or other aids and services are available upon request. To receive free interpreter services, call 866-719-0141 or ask at the DSS local office. After the recorded message, you will reach an operator who can provide you with an interpreter. If you have a disability and need communication assistance, call 866-719-0141 or TTY: 711.

All Social Services Forms

TitleTypeFormatSize hf:doc_tagshf:file_type
Account Annual/Final- AOC-E-506pdf300 KBformpdf
Affidavit for Administrative Search and Inspection Warrant- AOC-CR-913Mpdfformpdf
Application for Letters of Guardianship (GOE, GOP, General, Limited) for an Incompetent Person- AOC-E-206pdfformpdf
APS Monitoring Toolxls786 KBformxls
APS Monitoring Tool Instructionspdf236 KBformpdf
Certificate of Service (Adult Protective Services)- AOC-CV-771pdfformpdf
Certificate of Service- Incompetency Proceeding- AOC-SP-207pdfformpdf
Certification to Financial Institution as required by G.S. 53B-5- AOC-CV-779pdfformpdf
DAAS 0020 Guardianship Status Form Handwrittendocx50 KBformdocx
DAAS 0020 Guardianship Status Report Electronicdocx56 KBformdocx
DAAS 20201 Special Assistance Second Party Review Form APPLICATIONSdocx34 KBformdocx
DAAS 20202 Special Assistance Second Party Review Form RECERTIFICATIONSdocx32 KBformdocx
DAAS 20221 Special Assistance Recertification Budget Sheetpdf563 KBformpdf
DAAS 6220 Adult Services Functional Assessmentpdf1 MBformpdf
DAAS-0001 Adult Protective Services Intakedocx73 KBformdocx
DAAS-0001 Adult Protective Services Intakedocx60 KBformdocx
DAAS-0002 Notice to Reporter: Initial Noticedocx29 KBformdocx
DAAS-0003 Notice to Administrator: Completion of Evaluationdocx31 KBformdocx
DAAS-0004 Notice to Reporter: Completion of Evaluationdocx28 KBformdocx
DAAS-0005 Community Evaluationdocx123 KBformdocx
DAAS-0005 Community Evaluationdocx93 KBformdocx
DAAS-0006 Facility Evaluationdocx132 KBformdocx
DAAS-0006 Facility Evaluationdocx96 KBformdocx
DAAS-0007 Diligent Efforts to Locate Adultdocx39 KBformdocx
DAAS-0007 Diligent Efforts to Locate Adultdocx28 KBformdocx
DAAS-0008 Notice to the District Attorney and/or Law Enforcement: Initial Noticedocx34 KBformdocx
DAAS-0009 The Written Report of Adult Protective Services Evaluationdocx47 KBformdocx
DAAS-0009 The Written Report of Adult Protective Services Evaluationdocx34 KBformdocx
DAAS-0010 Notice to Financial Customerdocx32 KBformdocx
DAAS-0011 Adult and Family Service Planpdf40 KBformpdf
DAAS-0011 Service Plandocx47 KBformdocx
DAAS-0011 Service Plandocx40 KBformdocx
DAAS-0011 Service Plandocx48 KBformdocx
DAAS-0011 Service Plandocx41 KBformdocx
DAAS-0013 Determination of Ability to Consent to Protective Servicesdocx32 KBformdocx
DAAS-0013 Determination of Ability to Consent to Protective Servicesdocx31 KBformdocx
DAAS-0014 Notice of Request for Records for Adult Protective Services Evaluationdocx24 KBformdocx
DAAS-0015 Consent for Financial Recordsdocx36 KBformdocx
DAAS-0016 Consent for Release of Informationdocx32 KBformdocx
DAAS-0031 SAIH Program Interagency Referral Formpdf217 KBformpdf
DAAS-0032 SAIH Signature Attestation Formpdf162 KBformpdf
DAAS-0032: Asistencia Especial En El Hogar – Certificación de Firmapdf152 KBformpdf
DAAS-0040 SA Overpayment Tracking Toolxlsx44 KBformxlsx
DAAS-3000 Appointment Follow-up Letter Regarding SA Assistance Requestpdf129 KBformpdf
DAAS-3001 Special Assistance Notice of County of Residence Reassignment/Transferpdf12 KBformpdf
DAAS-3001sp Notificación sobre reasignación o transferenciapdf40 KBformpdf
DAAS-3002 Agreement to Sell Propertypdf17 KBformpdf
DAAS-3002sp Compromiso de venta propiedadpdf304 KBformpdf
DAAS-3003 Important Information About Your Special Assistance and Your Resourcespdf17 KBformpdf
DAAS-3004 Referral to SSA for Waiver or Reduction of Overpayment Recoupmentpdf16 KBformpdf
DAAS-3005 Documentation Regarding Continuation of Special Assistance When the LOC Is Upgraded, But No Bed Is Availablepdf57 KBformpdf
DAAS-3006 Medical Care Special / Medical Expense Formpdf17 KBformpdf
DAAS-5026 Report to Adult Protective Services Registerxlsx78 KBformxlsx
DAAS-5337-A Request for Patient Information for Veterandocx903 KBformdocx
DAAS-6218 Electronic Adult Services Intake Inquirydocx40 KBformdocx
DAAS-6218 HW Adult Services Intake Inquirydocx31 KBformdocx
DAAS-6219 Electronic Adult Services Face Sheetdocx31 KBformdocx
DAAS-6219 HW Adult Services Face Sheetdocx24 KBformdocx
DAAS-6220 Electronic Adult Services Annual Functional Assessmentdoc323 KBformdoc
DAAS-6220 HW Adult Services Annual Functional Assessmentdoc217 KBformdoc
DAAS-6222 Electronic Adult Services Contact Activity Logdocx26 KBformdocx
DAAS-6222 HW Adult Services Contact Activity Logdocx17 KBformdocx
DAAS-6223 Adult Services Interim or Quarterly Client Reviewpdf529 KBformpdf
DAAS-6223 Electronic Interim or Quarterly Reviewdocx30 KBformdocx
DAAS-6223 HW Interim or Quarterly Reviewdocx22 KBformdocx
DAAS-6224 Adult Services Annual Assessmentpdf1,003 KBformpdf
DAAS-6224 Electronic Adult Services Annual Assessmentdocx62 KBformdocx
DAAS-6224 HW Adult Services Annual Assessmentdocx55 KBformdocx
DAAS-6225 Adult Services Case Closing Transfer Summarypdf49 KBformpdf
DAAS-6225 Electronic Case Closingdocx26 KBformdocx
DAAS-6225 HW Case Closing Summarydocx18 KBformdocx
DAAS-7016 Request for Bond Coverage/Removal from Bondxlsx52 KBformxlsx
DAAS-7016a Notification of Appointment of Corporate Guardianpdf129 KBformpdf
DAAS-7016a Notification of Appointment of Corporate Guardianxlsx34 KBformxlsx
DAAS-8190 SSI/Non-SSI Application Workbookpdf1 MBformpdf
DAAS-8190A SSI/Non-SSI Application Workbook Appendix Apdf162 KBformpdf
DAAS-8191 Special Assistance Re-enrollment Information Noticepdf97 KBformpdf
DHB-5001N_UK: СПОВІЩЕННЯ ПРО ВИКОРИСТАННЯ НОМЕРІВ СОЦІАЛЬНОГО СТРАХУВАННЯpdf139 KBformpdf
DHB-5043: ФОРМА ПІДТВЕРДЖЕННЯ ДОХОДІВ ТА ВИТРАТ САМОЗАЙНЯТОЇ ОСОБИpdf201 KBformpdf
DMA-5094: ПОВІДОМЛЕННЯ ПРО ВАШЕ ПРАВО ПОДАТИ ЗАЯВКУ НА ОТРИМАННЯ ДОПОМОГИpdf83 KBformpdf
DSS_5027_SIS_Client_Entry_Formpdf1,014 KBformpdf
DSS_8173_KO: 기록 공개 동의서pdf81 KBformpdf
DSS_8556_KO: 자격상실 심리 사전 통지서pdf117 KBformpdf
DSS_8587_KO: 행정 자격상실 심리 포기에 따른 조치pdf107 KBformpdf
DSS-10001_AR: اتفاقية خدمات اللغة (LEP) بالنسبة إلى العميل ذي المھارة المحدودة في اللغة الإنجليزية ، والعميل المصاب بضعف في الحواسpdf89 KBformpdf
DSS-10001_DE: Für Kunden mit eingeschränkter englischer Sprachfähigkeit und Kunden mit beeinträchtigten Sinneswahrnehmungenpdf18 KBformpdf
DSS-10001_FR: Accord Concernant Les Services Linguistiquespdf19 KBformpdf
DSS-10001_KO: 제한적 영어 구사 능력(LEP) 고객 및 감각 장애 고객용pdf93 KBformpdf
DSS-10001_VI: Dành Cho Khách Hàng Có Trình Độ Anh Ngữ Hạn Chế (Limited English Proficiency hay LEP) Và Khách Hàng Bị Suy Giảm Nhận Thứcpdf108 KBformpdf
DSS-10001-ia: СОГЛАШЕНИЕ О ЯЗЫКОВЫХ УСЛУГАХpdf145 KBformpdf
DSS-10001-ia: УГОДА ЩОДО ПОСЛУГ ІЗ ПЕРЕКЛАДУpdf144 KBformpdf
DSS-10001: Language Services Agreementpdf50 KBformpdf
DSS-10001ins: Instructions for completing the DSS-10001pdf426 KBformpdf
DSS-10001sp: Acuerdo Sobre Servicios De Lenguaje Para Personas con Capacidad Limitada en el Uso del Inglés Y Personas con Discapacidades Sensorialespdf51 KBformpdf
DSS-1167: Food and Nutrition Services ePass Application Verification Documentpdf401 KBformpdf
DSS-1168: Locate Data Sheetpdf10 KBformpdf
DSS-1321: Statement of Admin. Expenditure for Purchased Servicepdf14 KBformpdf
DSS-1360: Work First Program Purchase of Services: Referral and Authorizationpdf21 KBformpdf
DSS-1402: CPS Intake Reportpdf428 KBformpdf
DSS-1402ins: CPS Intake Report Instructionspdf319 KBformpdf
DSS-1403: North Carolina Requirement to Notify Child Protective Services (CPS) of Substance Affected Infantpdf274 KBformpdf
DSS-1404: Care Management for At Risk Children (CMARC) Referral Formpdf2 MBformpdf
DSS-1432: Application For Disaster Food and Nutrition Servicespdf188 KBformpdf
DSS-1432sp: División de Servicios Sociales de Carolina del Norte Solicitud de Servicios de Alimento y Nutrición por desastrepdf192 KBformpdf
DSS-1451: Fire and Building Safety Inspection Reportpdf16 KBformpdf
DSS-1463: Title VI, Federal Civil Rights Act of 1964pdf95 KBformpdf
DSS-1464: Statement of Assurance of Compliance with Title VI of Civil Rights Act of 1964pdf23 KBformpdf
DSS-1464a: Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 for Other Agencies, Institutions, Organizations or Facilitiespdf119 KBformpdf
DSS-1473: Request for State Appealpdf318 KBformpdf
DSS-1473a: Request for State Appeal 1473-Addendum for Program Integrity Food and Nutrition Servicespdf263 KBformpdf
DSS-1473b: Request for State Appeal 1473-Addendum for Expedited MAD Medical Determinationpdf248 KBformpdf
DSS-1514: Fire and Building Safety Inspection Report (Institutional Building)pdf16 KBformpdf
DSS-1515: Foster Home Fire Inspection Safety Reportpdf38 KBformpdf
DSS-1515sp: Reporte De Inspeccion Contra Incendios De Casa Fosterpdf38 KBformpdf
DSS-1516: Understanding Foster Care – A Handbook for Youthpdf679 KBformpdf
DSS-1516sp: Entendiendo el Cuidado Foster–Libro para Jóvenespdf641 KBformpdf
DSS-1630: Application for Appointment of Personal Representativepdf21 KBformpdf
DSS-1653: Report of Medical Examinationpdf65 KBformpdf
DSS-1656: Refund Receipt (Collection of Overpayment)pdf133 KBformpdf
DSS-1662: Verification of Change in Situationpdf255 KBformpdf
DSS-1662sp: Verificación de Cambio de Situaciónpdf256 KBformpdf
DSS-1664: Report on Aid Needed by Inmate’s Dependentspdf32 KBformpdf
DSS-1664sp: NC Departmento De Correccion Programa Work Release Reporte de Necesidad de Ayuda para Dependientes de un Internopdf57 KBformpdf
DSS-1665: Work First Cash Assistance Protective Payee Agreementpdf109 KBformpdf
DSS-1665sp: Work First (Trabajar Primero) Asistencia Monetaria Acuerdo de Pago Protegidopdf158 KBformpdf
DSS-1678_AR: إقرار خطي مشفوع بالقسم للاستبدالpdf78 KBformpdf
DSS-1678_DE: Eidesstattliche Erklarung (Ersatz)pdf30 KBformpdf
DSS-1678_FR: Declaration Sous Serment De Remplacementpdf29 KBformpdf
DSS-1678_KO: 재지급 진술서pdf111 KBformpdf
DSS-1678_VI: BẢN TUYÊN THỆ THAY THẾpdf104 KBformpdf
DSS-1678: Replacement/Supplement Affidavitpdf136 KBformpdf
DSS-1678sp: Declaracion Jurada Para Solicitar Reemplazo De Beneficiospdf137 KBformpdf
DSS-1682: Report of Erroneous Issuancepdf219 KBformpdf
DSS-1688_AR: قسم الخدمات الاجتماعية تعيين ممثل مفوضpdf70 KBformpdf
DSS-1688_DE: Ernennung eines befugten Vertreterspdf50 KBformpdf
DSS-1688_FR: Désignation du représentant autorisépdf68 KBformpdf
DSS-1688_KO: 공식 대리인 지정pdf128 KBformpdf
DSS-1688_VI: Chỉ Định Đại Diện Được Ủy Quyềnpdf120 KBformpdf
DSS-1688: Designation of Authorized Representativepdf43 KBformpdf
DSS-1688sp: Designación de un Representante Autorizadopdf102 KBformpdf
DSS-1700: Application Worksheetpdf166 KBformpdf
DSS-1700sp: Hoja De Trabajo (Application Worksheet)pdf148 KBformpdf
DSS-1783: Annual Statistical Report for Residential Child Care Facilitypdf58 KBformpdf
DSS-1789: Voluntary Placement Agreementpdf46 KBformpdf
DSS-1789sp: Acuerdo de Colocacion Voluntariopdf35 KBformpdf
DSS-1796: Agency/Foster Parents Agreementpdf86 KBformpdf
DSS-1797: Inter-County Agreement on the Placement of Childrenpdf172 KBformpdf
DSS-1798: Inter-Agency Adoption Agreementpdf25 KBformpdf
DSS-1800: Petition for Adoption of a Minor Childpdf90 KBformpdf
DSS-1800sp: Peticion De Adopcion De Un Menorpdf65 KBformpdf
DSS-1801: Agency’s Consent to Adoptionpdf48 KBformpdf
DSS-1802: Consent to Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Fatherpdf94 KBformpdf
DSS-1802sp: Consentimiento De Adopcion Por Padre, Guardian Ad Litem, O Guardianpdf50 KBformpdf
DSS-1803: Consent of Child for Adoptionpdf51 KBformpdf
DSS-1804: Relinquishment of Minor for Adoption by Parent or Guardianpdf161 KBformpdf
DSS-1804sp: Renuncia A Un Menor Para Adopcion Por Padre O Guardianpdf144 KBformpdf
DSS-1805: Revocation of Relinquishment for Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Fatherpdf60 KBformpdf
DSS-1805sp: Revocacion De Renuncia Para ADOPCION Por Padre O Guardianpdf156 KBformpdf
DSS-1806: Revocation of Consent to Adoption by Parent, Guardian, or Guidian Ad Litem of the Mother/Fatherpdf29 KBformpdf
DSS-1806sp: Revocacion De Consentimiento Para Adopcion Por Madre, Padre O Tutorpdf27 KBformpdf
DSS-1807: Order for Report on Proposed Adoptionpdf131 KBformpdf
DSS-1808: Report on Proposed Adoptionpdf298 KBformpdf
DSS-1808ins: Instructions for Completing Form DSS-1808pdf254 KBformpdf
DSS-1809: Affidavit of Parentagepdf87 KBformpdf
DSS-1809sp: Declaracion De Paternidadpdf40 KBformpdf
DSS-1810: Guardianship Assistance Agreementpdf65 KBformpdf
DSS-1811: Medical Examinationpdf16 KBformpdf
DSS-1811sp: Examen Medico Como Parte Del Informe A La Cortepdf16 KBformpdf
DSS-1812 Autorización General Para El Tratamiento Y Los Medicamentospdf158 KBformpdf
DSS-1812: General Authorization for Treatment and Medicationpdf238 KBformpdf
DSS-1812ins: General Authorization for Treatment and Medication Instructionspdf225 KBformpdf
DSS-1813: Guardianship Assistance Eligibility Checklistpdf182 KBformpdf
DSS-1814: Decree of Adoptionpdf55 KBformpdf
DSS-1815: Report to Vital Records (Not Stepparent or Adult)pdf39 KBformpdf
DSS-1815sp: Informe Para El Registro Civilpdf82 KBformpdf
DSS-1816: Dismissal of Adoptionpdf105 KBformpdf
DSS-1820: NC Kids Child Registration Formpdf383 KBformpdf
DSS-1820ins: NC Kids Child Registration Form Instructionspdf141 KBformpdf
DSS-1821: NC Kids Family Registration Formpdf327 KBformpdf
DSS-1821ins: NC Kids Family Registration Form Instructionspdf140 KBformpdf
DSS-1837: Interstate Compact on the Placement of Children Request (ICPC 100A)pdf163 KBformpdf
DSS-1837I: Instructions for Completing Form ICPC-100A Interstate Compact on the Placement of Children Requestpdf126 KBformpdf
DSS-1838: Interstate Compact Report on Child’s Placement Status (ICPC 100B)pdf136 KBformpdf
DSS-1838I: Instructions for Completing Form ICPC-100B Interstate Compact Report on Child’s Placement Statuspdf104 KBformpdf
DSS-1839: Regulation 7 Form Order for Expedited Placement Decision Pursuant to the ICPCpdf112 KBformpdf
DSS-1840: Regulation # 7 Case Manager Statement of Interestpdf208 KBformpdf
DSS-1841: Regulation # 2 Case Manager Statement of Interestpdf181 KBformpdf
DSS-2141: Monthly Requisition For Formspdf177 KBformpdf
DSS-2203: Daysheetpdf31 KBformpdf
DSS-2204: Day Summary Sheetpdf25 KBformpdf
DSS-2216: Request for Recordpdf44 KBformpdf
DSS-2239: IV-D Legal Services Billpdf9 KBformpdf
DSS-2249: Affidavit Of Adoption Expenditurespdf23 KBformpdf
DSS-2250: Adoption Assistance Payment Authorization Noticepdf40 KBformpdf
DSS-2435I_AR: شعار بانتهاء السريان ونموذج إعادة اعتماد المقابلة لبرنامج خدمات الطعام والتغذيةpdf254 KBformpdf
DSS-2435I_DE: Mitteilung über Ablauf von Lebensmittelleistungen und Formular für erneute Interviewbestätigungpdf167 KBformpdf
DSS-2435I_FR: Services d’alimentation et de nutrition (FNS) Avis d’expiration et formulaire de renouvellement d’attestationpdf334 KBformpdf
DSS-2435I_KO: 식품 및 영양 서비스(FNS) 만기 통지 및 면접 재인증 양식pdf307 KBformpdf
DSS-2435I_VI: Mẫu Tái Xác Nhận và Thông Báo Hết Hạn và Phỏng Vấn Dịch Vụ Dinh Dưỡng và Thực Phẩm (Food and Nutrition Services hay FNS)pdf368 KBformpdf
DSS-2435I_VI: Mẫu Tái Xác Nhận và Thông Báo Hết Hạn và Phỏng Vấn Dịch Vụ Dinh Dưỡng và Thực Phẩm (Food and Nutrition Services hay FNS)pdf368 KBformpdf
DSS-2435i: Food and Nutrition Services (FNS) Notice of Expiration and Interview Recertification Formpdf349 KBformpdf
DSS-2435isp: Servicios de Alimentos y Nutrición (FNS). Aviso de Expiración y Formulario de Entrevista de Re-Certificaciónpdf374 KBformpdf
DSS-2435R_AR: إشعار بانتهاء السريان ونموذج إعادة اعتماد المقابلة لبرنامج خدمات الطعام والتغذيةpdf249 KBformpdf
DSS-2435R_DE: Mitteilung über Ablauf von Lebensmittelleistungen und Formular für erneute Zertifizierungpdf172 KBformpdf
DSS-2435R_FR: Services d’alimentation et de nutrition (FNS) Avis d’expiration et formulaire de renouvellement d’attestationpdf334 KBformpdf
DSS-2435R_KO: 식품 및 영양 서비스(FNS) 만기 통지 및 재인증 양식pdf307 KBformpdf
DSS-2435R_VI: Mẫu Tái Xác Nhận và Thông Báo Hết Hạn Dịch Vụ Dinh Dưỡng và Thực Phẩm (Food and Nutrition Services hay FNS)pdf368 KBformpdf
DSS-2435r: Food and Nutrition Services (FNS) Notice of Expiration Recertification Formpdf334 KBformpdf
DSS-2435rsp: Alimentos y Nutrición (FNS). Aviso de Expiración y Forma de Re-Certificaciónpdf442 KBformpdf
DSS-2435sri_AR: الحقوق والمسؤولياتpdf227 KBformpdf
DSS-2435sri_DE: Rechte Und Verantwortungenpdf51 KBformpdf
DSS-2435sri_KO: 권리와 의무pdf169 KBformpdf
DSS-2435sri_VI: QUYỀN VÀ TRÁCH NHIỆMpdf194 KBformpdf
DSS-2435sri: Rights and Responsibilitiespdf166 KBformpdf
DSS-2435srisp: Derechos Y Responsabilidadespdf112 KBformpdf
DSS-2624: Food and Nutrition Services Referral Formpdf39 KBformpdf
DSS-2625: Food and Nutrition Services E&T Information Transmittalpdf127 KBformpdf
DSS-2807-II: Part II, Report on Local Hearingspdf99 KBformpdf
DSS-2807: Part 1, Report on Local Hearings – Summarypdf13 KBformpdf
DSS-2987_ES: Declaración del Propietariopdf316 KBformpdf
DSS-2abl: First Notice to Work First Families with Two Adult Recipients Able to Workpdf12 KBformpdf
DSS-3431: Request for Financial Informationpdf97 KBformpdf
DSS-3449_DE: Genehmigung für vom Landwirtschaftsministerium der Vereinigten Staaten von Amerika gespendete Lebensmittelpdf19 KBformpdf
DSS-3449_FR: Autorisation de dons de produits alimentaires du Département de l’agriculture des États-Unis (USDA)pdf18 KBformpdf
DSS-3449_KO: 미농무부(USDA)가 기부한 식품에 대한 승인pdf111 KBformpdf
DSS-3449_VI: Uỷ Quyền Nhận Thực Phẩm Được Quyên Góp Của USDApdf124 KBformpdf
DSS-4278: Reunification Referring Agency Referral Formpdf82 KBformpdf
DSS-4279: Intensive Family Preservation Referring Agency Referral Formpdf49 KBformpdf
DSS-4451: Application for Child Support Servicespdf1 MBformpdf
DSS-4451sp: Solicitud De Servicios De Sustento De Menorespdf1 MBformpdf
DSS-4718: CSE Direct Deposit Authorizationpdf47 KBformpdf
DSS-4718sp: Autorizacion Para Deposito Directopdf39 KBformpdf
DSS-5002: Child Welfare Services Corrective Action Planxlsx32 KBformxlsx
DSS-5009: Fatality Notificationpdf314 KBformpdf
DSS-5009A: Instructions for Fatality Notificationpdf204 KBformpdf
DSS-5010: Structured Documentation Instrument for CPS Assessmentspdf1 MBformpdf
DSS-5010a: Continuing Need and Safety Requirementspdf103 KBformpdf
DSS-5010ins: NC CPS Assessments Documentation Tool (DSS-5010) Instructionspdf244 KBformpdf
DSS-5010sp Herramienta De Documentacion De La Evaluatcion De Los CPS De Carolina Del Nortepdf987 KBformpdf
DSS-5012: Adoption Assistance Eligibility Checklistpdf271 KBformpdf
DSS-5012sp: Lista Para Revisar Eligibilidad De Asistencia Por Adopcionpdf227 KBformpdf
DSS-5013: North Carolina Adoption Assistance Agreementpdf204 KBformpdf
DSS-5013sp: Acuerdo De Asistencia Por Adopcion De Carolina Del Nortepdf200 KBformpdf
DSS-5015: Foster Care Facility Action Requestpdf30 KBformpdf
DSS-5016: Foster Home License Applicationpdf538 KBformpdf
DSS-5016sp: Solicitud De Licencia Para Casa Fosterpdf530 KBformpdf
DSS-5017: Medical History Formpdf54 KBformpdf
DSS-5017sp: Forma De Historial Medicopdf103 KBformpdf
DSS-5018 Autorizacion De Hogares De Acogida Formulario De Evaluacion De Seguridad En Relacion Con El Aguapdf186 KBformpdf
DSS-5018: Foster Home Licensing Water Hazard Safety Assessment Formpdf189 KBformpdf
DSS-5018a: Foster Home Licensing Individual Water Hazard Safety Planpdf338 KBformpdf
DSS-5022: Refugee Work Registration Certification, Employment/Refusal and Termination/Denial Noticepdf94 KBformpdf
DSS-5023: Direct Deposit Enrollment Authorization Formpdf183 KBformpdf
DSS-5023sp: Forma de Autorización para Deposito Directopdf205 KBformpdf
DSS-5027: Client Entry Formpdf123 KBformpdf
DSS-5027A: Client Entry – Purchase of Service Provider Formpdf72 KBformpdf
DSS-5030: Confidential Intermediary Agreementpdf68 KBformpdf
DSS-5031: Application for Confidential Intermediary Servicespdf129 KBformpdf
DSS-5032: Consent to Release of Information and/or Contactpdf68 KBformpdf
DSS-5033: Release of Liability and Agreement to Hold Harmlesspdf15 KBformpdf
DSS-5094: Child Placement and Payment Reportpdf132 KBformpdf
DSS-5094a: Foster Care Visit Reportpdf19 KBformpdf
DSS-5094c: Child Placement and Payment Report Continuation Pagepdf24 KBformpdf
DSS-5095: NC DSS Child Placement and Payment System Adoption Assistancepdf26 KBformpdf
DSS-5096A Plan De Hogar Transitoriopdf320 KBformpdf
DSS-5096a: Transitional Living Plan For Youth/Young Adults in Foster Carepdf679 KBformpdf
DSS-5096B: Plan De Hogar Transitoriopdf319 KBformpdf
DSS-5096b: Transitional Living Plan – 90 Day Transition Plan for Youth in Foster Carepdf797 KBformpdf
DSS-5096C: Plan De Hogar Transitoriopdf297 KBformpdf
DSS-5096c: Transitional Living Plan – 90 Day Transition Plan For Young Adults In Foster Care 18 to 21pdf299 KBformpdf
DSS-5096D: Plan De Hogar Transitoriopdf176 KBformpdf
DSS-5096d: Transitional Living Plan – Helpful Resources For Young Adultspdf581 KBformpdf
DSS-5097: Voluntary Placement Agreement for Foster Care 18 to 21pdf362 KBformpdf
DSS-5098 Registro Mensual De Contactospdf287 KBformpdf
DSS-5098: North Carolina Monthly Contact Record For Foster Care 18 to 21pdf421 KBformpdf
DSS-5099: Placement Agreement For Foster Care 18 to 21pdf458 KBformpdf
DSS-5100: Semi-Supervised Independent Living Assessment Toolpdf378 KBformpdf
DSS-5102: NC DSS Non-Identifying Background Informationpdf188 KBformpdf
DSS-5102sp: Historial, Sin Proporcionar Informacion Paraidentificar A Alguna Persona Especificapdf128 KBformpdf
DSS-5103: Adoption Health Historypdf285 KBformpdf
DSS-5103sp: Historial Clínico para Adopción, Parte Ipdf38 KBformpdf
DSS-5104: Report to Central Registry/CPS Applicationpdf152 KBformpdf
DSS-5104a: Responsible Individuals List Formpdf285 KBformpdf
DSS-5104c: Central Registry Report Continuation Page-Childrenpdf176 KBformpdf
DSS-5104d: Modification/Deletion Request Formpdf73 KBformpdf
DSS-5104p: Central Registry Report Continuation Page – Perpetratorpdf42 KBformpdf
DSS-5105: North Carolina Diligent Efforts to Identify and/or Locatedocx36 KBformdocx
DSS-5106: North Carolina Multiple Response System Case Tracking Formpdf37 KBformpdf
DSS-5108A: DSS/Student Contractual Agreement for Continuing Residential Support CARS – Six Month Reviewpdf52 KBformpdf
DSS-5108asp: Contrato de Estudiante/DSS para Apoyo residencial permanente (CARS) Revisión a los seis mesespdf45 KBformpdf
DSS-5112: Adoption Assistance Vendor Payment Request Formpdf37 KBformpdf
DSS-5113: Adoption Services Agreementpdf279 KBformpdf
DSS-5115: Adoption Assistance Vendor Payment Instructions for Providerspdf58 KBformpdf
DSS-5115sp: Programa De Asistencia Para Adopcion Instrucciones De Pagopdf44 KBformpdf
DSS-5118: Denial of Paternitypdf31 KBformpdf
DSS-5118sp: Negacion De Paternidadpdf29 KBformpdf
DSS-5120: Determination of Foster Care Assistance Benefits and/or Medical Assistance Onlypdf439 KBformpdf
DSS-5120A: Re-determination of Foster Care Assistance Benefits and/or Medical Assistance Onlypdf110 KBformpdf
DSS-5120B: Additional Siblings in Removal Homepdf111 KBformpdf
DSS-5120C: Additional Members of the Family Assistance Unitpdf87 KBformpdf
DSS-5120E: Determination Of Foster Care 18 to 21 Assistance Benefits and/or Medical Assistance Onlypdf419 KBformpdf
DSS-5133: Foster Child Notification of Placement (Change) Formpdf169 KBformpdf
DSS-5133ins: Foster Child Notification of Placement (Change) Form Instructionspdf140 KBformpdf
DSS-5135: Foster Child Immediate Enrollment Formpdf137 KBformpdf
DSS-5137: Best Interest Determination Formpdf469 KBformpdf
DSS-5137a: North Carolina Best Interest Determination Meeting Overridepdf208 KBformpdf
DSS-5137sp: Formulario De Determinación De Mejor Interéspdf180 KBformpdf
DSS-5143: Consent/Authorization For Medical/Mental Health Evaluationpdf233 KBformpdf
DSS-5143sp: Consentimiento/Autorizacion Para Evaluacion De La Salud Medica/Mental Programa De Evaluacion Medica Delpdf212 KBformpdf
DSS-5145: State of North Carolina Application for Reimbursement of Non-Recurring Adoption Costspdf200 KBformpdf
DSS-5145sp: Estado De Carolina Del Norte Solicitud Para REEMBOLSO De Costos No Repetitivos De Adopcionpdf169 KBformpdf
DSS-5146: Agreement for Reimbursement of Non-Recurring Adoption Costspdf50 KBformpdf
DSS-5146sp: Estado De Carolina Del Norte Convenio Por Reembolso De Costo Costos No Repetitivos De Adopcionpdf55 KBformpdf
DSS-5150: Foster Home Environmental Conditions Reportpdf54 KBformpdf
DSS-5150sp: Reporte De Condiciones De Casa Fosterpdf40 KBformpdf
DSS-5152-iisp: Componente Del Estado De Salud Del Nino(a)pdf23 KBformpdf
DSS-5156: Medical Evaluationpdf65 KBformpdf
DSS-5156sp: Evaluacion Medicapdf61 KBformpdf
DSS-5157: Foster Home Relicense, Termination and Change Request Applicationpdf182 KBformpdf
DSS-5157sp: Solicitud de Renovacion de Licencia de Casa Fosterpdf203 KBformpdf
DSS-5158: Foster Home Transfer Request Applicationpdf134 KBformpdf
DSS-5158sp: Solicitud De Transferencia De Casa Fosterpdf140 KBformpdf
DSS-5159: Foster Home Change Request Applicationpdf247 KBformpdf
DSS-5159sp: Solicitud De Cambiopdf252 KBformpdf
DSS-5160 Solicitud De Cese Del Hogar De Acogidapdf142 KBformpdf
DSS-5160: Foster Home Termination Applicationpdf102 KBformpdf
DSS-5162: Petition for Adoption of a Minor Child (Step-parent)pdf51 KBformpdf
DSS-5162sp: Solicitud Para ADOPCIÓN De Un(a) Nino(a) Menorpdf31 KBformpdf
DSS-5163: Petition for Adult Adoptionpdf185 KBformpdf
DSS-5163sp: Solicitud Para Adopcion De Adultopdf22 KBformpdf
DSS-5164: Consent to Adoption by Adult Adopteepdf27 KBformpdf
DSS-5164sp: Consentimiento De Adopcion Por Adulto Adoptadopdf18 KBformpdf
DSS-5165: Consent to Adult Adoption by Spouse of Petitionerpdf125 KBformpdf
DSS-5165sp: Consentimiento Para Adopcion De Adulto Por Conyuge De Solicitantepdf18 KBformpdf
DSS-5166: Decree of Adult Adoptionpdf108 KBformpdf
DSS-5167: Report to Vital Records for Adult Adoptionpdf37 KBformpdf
DSS-5167sp: Informe Al Registro Civil Para Adopcion De Adultopdf59 KBformpdf
DSS-5168: Revocation of Child’s Consent to Adoptionpdf19 KBformpdf
DSS-5168sp: Revocacion Del Consentimiento Para Adopcion Del Nino(a)pdf21 KBformpdf
DSS-5169: Consent of Child for Adoption (Step-parent Adoption)pdf91 KBformpdf
DSS-5169sp: Consentimiento Del Nino(a) Para Adopcionpdf22 KBformpdf
DSS-5170: Report to Vital Records (Stepparent Adoption)pdf128 KBformpdf
DSS-5189-iiisp: Departamento de Servicios Sociales ha programado una reunión del Equipo de Acción de Planeamiento de Permanenciapdf96 KBformpdf
DSS-5189-iisp: Notice to Parent Regarding a Change in Placement of Children-Spanishpdf88 KBformpdf
DSS-5189-isp: Notice to Parent Regarding Proposed Change in the Placement of Children-Spanishpdf86 KBformpdf
DSS-5189-ivsp: Notice to Parent Regarding Permanency Planning Review Outcomepdf44 KBformpdf
DSS-5189: Consent to Adoption by Parent Who is Spouse of Stepparentpdf53 KBformpdf
DSS-5189I: Notice to Parent of Proposed Change in Placement of Child(ren)pdf40 KBformpdf
DSS-5189II: Notice to Parent Regarding Proposed Change in the Placement of Child(ren)pdf39 KBformpdf
DSS-5189III: Notice to Permanency Planning Reviewpdf83 KBformpdf
DSS-5189IV: Notice to Parent Regarding Permanency Planning Review Outcomepdf41 KBformpdf
DSS-5189sp: Consentimiento De Adopcion Otorgado Por Padre/Madre Que Es Conyuge De Madrastra/Padrastropdf25 KBformpdf
DSS-5190: Consent to Adoption by Parent Who Is Not the Stepparent’s Spousepdf52 KBformpdf
DSS-5190sp: Consent of Adoption by Parent who is not the Stepparent’s Spouse-Spanishpdf49 KBformpdf
DSS-5191: Affidavit – Disclosure of Fees & Expensespdf41 KBformpdf
DSS-5191sp: Declaracion Jurada Divulgacion De Honorarios Y Gastospdf15 KBformpdf
DSS-5199: Foster Home Request for Waiverpdf40 KBformpdf
DSS-5201: Understanding Foster Care – A Handbook for Parentspdf171 KBformpdf
DSS-5203: Initial Provider Assessmentpdf258 KBformpdf
DSS-5203ins: Initial Provider Assessment Instructionspdf164 KBformpdf
DSS-5203sp: Evaluación inicial del cuidado por parientespdf333 KBformpdf
DSS-5204: Comprehensive Provider Assessmentpdf288 KBformpdf
DSS-5204ins: Instructions for Comprehensive Provider Assessmentpdf180 KBformpdf
DSS-5204sp: Evaluación completa del cuidado por parientespdf39 KBformpdf
DSS-5206: Health Summary Form – Initial Visitpdf46 KBformpdf
DSS-5207: Health History Formpdf188 KBformpdf
DSS-5207ins: Health History Form Instructionspdf43 KBformpdf
DSS-5208: Health Summary Form – 30-day Comprehensive Visitpdf162 KBformpdf
DSS-5209: Health Summary Form – Well-Visitpdf62 KBformpdf
DSS-5211: Special Children’s Adoption Incentive Fund – Request for Paymentpdf44 KBformpdf
DSS-5212: Supplemental Adoption Assistance Agreementpdf87 KBformpdf
DSS-5212sp: Fondo De Incentivos Para La Adopcion De Ninos Especiales Convenio Complementario De Asistencia Para Adopcionpdf38 KBformpdf
DSS-5213: Verification of Child’s Need for Daily Supervisionpdf19 KBformpdf
DSS-5214: Agency Verification of Legal Custody and Child’s Living Arrangement for Past Six Monthspdf24 KBformpdf
DSS-5215: Verification of Child’s Health Conditionpdf17 KBformpdf
DSS-5217: Request for Reimbursement Of Links Special Fundspdf27 KBformpdf
DSS-5218: Consent to Release of Identifying Informationpdf28 KBformpdf
DSS-5219: Certificate of Delivery of Preplacement Assessmentpdf130 KBformpdf
DSS-5219sp: Certificado de entrega de la evaluación previa a la colocaciónpdf37 KBformpdf
DSS-5225: Request for NC KIDS Legal Risk Searchpdf438 KBformpdf
DSS-5225sp: Peticion Para Investigacion De Riesgo De NC KIDSpdf249 KBformpdf
DSS-5226: NC SDM Family Risk ReAssessmentpdf99 KBformpdf
DSS-5226sp: Carolina Del Norte Reevaluacion Del Riesgo Familiar De Abuso / Desciodopdf227 KBformpdf
DSS-5227: NC SDM Family Reunification Assessmentpdf204 KBformpdf
DSS-5227sp: SDM ® Evaluacion De Reunificacion Familiarpdf267 KBformpdf
DSS-5229_ZH-CN: 北卡罗来纳州 家庭能力和需求评估pdf309 KBformpdf
DSS-5229: North Carolina Family Assessment of Strengths and Needspdf155 KBformpdf
DSS-5229sp: Evaluacion De Los Aspectos Fuertes Y Necesidades De La Familiapdf181 KBformpdf
DSS-5230: NC SDM Family Risk Assessment of Child Abuse/Neglectpdf215 KBformpdf
DSS-5230sp: SDM ®Evaluacion De Riesgo Familiar De Abuso/Negligenciapdf126 KBformpdf
DSS-5231: North Carolina Safety Assessmentpdf408 KBformpdf
DSS-5231ins: North Carolina Safety Assessment Instructionspdf129 KBformpdf
DSS-5231sp: Carolina Del Norte Evaluacion De Seguridadpdf437 KBformpdf
DSS-5233: Personalized Domestic Violence Safety Planpdf32 KBformpdf
DSS-5234: Domestic Violence Perpetrator Assessment Toolpdf91 KBformpdf
DSS-5235 – Non-Offending Parent/Adult Victim Domestic Violence Assessment Toolpdf154 KBformpdf
DSS-5236: North Carolina Monthly In-Home Contact Recordpdf218 KBformpdf
DSS-5236ins – North Carolina Monthly In-Home Contact Record Instructionspdf94 KBformpdf
DSS-5237: Children’s Domestic Violence Assessment Toolpdf78 KBformpdf
DSS-5238: DSS Referral Form for Early Intervention Services (CDSA)pdf180 KBformpdf
DSS-5239: In Home Family Services Agreementpdf318 KBformpdf
DSS-5239ins: In-Home family Services Agreement Completion Instructionspdf214 KBformpdf
DSS-5239sp: Acuerdo De Servicios De Familia En Casa De Carolina Del Nortepdf341 KBformpdf
DSS-5239spa: Acuerdo de Servicios para la Familia en el Hogarpdf59 KBformpdf
DSS-5240: Permanency Planning Family Services Agreementpdf370 KBformpdf
DSS-5240ins: Permanency Planning Family Services Agreement Instructionspdf211 KBformpdf
DSS-5240sp: Acuerdo De Servicios Familiares De Planificación De Permanencia En Carolina Del Nortepdf826 KBformpdf
DSS-5241: Permanency Planning Reviewpdf452 KBformpdf
DSS-5241ins: Permanency Planning Review Instructionspdf160 KBformpdf
DSS-5241sp: Reviso de la Evaluación de Acuerdo de Servicios Familiarespdf425 KBformpdf
DSS-5242: Family Time and Contact Plan (Visitation)pdf117 KBformpdf
DSS-5242sp: Regimen De Visitas y Contactopdf356 KBformpdf
DSS-5245: Child Education Statuspdf148 KBformpdf
DSS-5245ins: Child Education Status Instructionspdf112 KBformpdf
DSS-5246: Information Sharing Achnowledgementpdf131 KBformpdf
DSS-5246sp: Acuse De Recibo De Informacion Compartidapdf49 KBformpdf
DSS-5247: Information Sharing Partnership Agreementpdf69 KBformpdf
DSS-5248: ICAMA Form 6.02, Notice of Actionpdf63 KBformpdf
DSS-5249: Icama Form 6.01, Notice of Medicaid Eligibility/Case Activationpdf162 KBformpdf
DSS-5250: ICAMA Form 6.03, Report of Change in Child(ren) Family Statuspdf116 KBformpdf
DSS-5251: ICPC Financial-Medical Planpdf66 KBformpdf
DSS-5252: ICPC Sending State Priority Home Study Requestpdf161 KBformpdf
DSS-5253: ICPC Receiving State Priority Home Study Requestpdf231 KBformpdf
DSS-5255: ICPC Checklist for Interstate Placement Requestspdf32 KBformpdf
DSS-5256: Drug Endangered Children Protocol: Initial Medical Assessmentpdf32 KBformpdf
DSS-5257: Drug Endangered Children Protocol – Placement Guidelinespdf151 KBformpdf
DSS-5257: Protocolo para niños en peligro a la exposición de drogas: pautas de colocaciónpdf145 KBformpdf
DSS-5258: Protocol for Field Assessment to Determine Need for On-Scene Decontamination Prior to Transportpdf383 KBformpdf
DSS-5259: Drug Endangered Children Protocol: Exposure Recordpdf38 KBformpdf
DSS-5260: Drug Endangered Children Protocol Feedback Form: Law Enforcementpdf13 KBformpdf
DSS-5261: Drug Endangered Children Protocol Feedback Form: Social Workerpdf15 KBformpdf
DSS-5262: Drug Endangered Children Protocol Feedback Form: Health Care Providerpdf17 KBformpdf
DSS-5263: Drug Endangered Children Protocol Feedback Form: Foster Care Providerpdf13 KBformpdf
DSS-5264: Family Support Parent and Family Questionnaire – Client Satisfaction Surveypdf312 KBformpdf
DSS-5264sp: Encuesta Sobre Servicios al Cliente – Programa de Ayuda a la Familia y Bienestar del Niñopdf49 KBformpdf
DSS-5266: 24 Month Time Limitpdf32 KBformpdf
DSS-5266sp: Estimada familia del programa Work Firstpdf23 KBformpdf
DSS-5267: 60 Month Lifetime Limitpdf15 KBformpdf
DSS-5267sp: Estimada familia del programa Work First Período de por vida de 60 mesespdf22 KBformpdf
DSS-5268: Responsible Individuals List (RIL) Information Requestpdf213 KBformpdf
DSS-5268sp: Solicitud de Información: Lista de Individuos Responsables (RIL)pdf171 KBformpdf
DSS-5271: Individual Criminal Violations Declaration Statementpdf30 KBformpdf
DSS-5271sp: Declaración de Delitos Penales Individualespdf23 KBformpdf
DSS-5272: Facility ID Number Applicationpdf115 KBformpdf
DSS-5273: Verification of Participationpdf35 KBformpdf
DSS-5274: Request for Adjustment to Foster Care Assistance Paymentpdf76 KBformpdf
DSS-5275: North Carolina Residency Declarationpdf24 KBformpdf
DSS-5275sp: Declaración de Residencia en Carolina del Nortepdf23 KBformpdf
DSS-5276: North Carolina Residency Applicant Statementpdf17 KBformpdf
DSS-5276sp: Declaración del solicitante de residencia en Carolina del Nortepdf19 KBformpdf
DSS-5277: Request for Confidential Information Regarding Child Abuse, Neglect and/or Dependencypdf95 KBformpdf
DSS-5278: Request for Placement Evaluation for Infant Born to an Incarcerated Motherpdf88 KBformpdf
DSS-5279: Request for Revocation of a Foster Home Licensepdf161 KBformpdf
DSS-5280: Notice Foster Home Mandatory Criminal History Checkpdf14 KBformpdf
DSS-5281 Critical Incident Reporting Formpdf98 KBformpdf
DSS-5282: Notification of CPS Involvementpdf71 KBformpdf
DSS-5283: Regulatory and Licensing Services Complaint Formpdf22 KBformpdf
DSS-5283sp: División de Servicios Sociales de Carolina del NorteForma de Queja de Servicios de Regulaciones y Licenciaspdf74 KBformpdf
DSS-5285: Child and Family Services Review Protocol for Pilot Countiespdf31 KBformpdf
DSS-5286: Stakeholder Questionnairepdf16 KBformpdf
DSS-5287: NC DSS Child and Family Services Review Protocolpdf72 KBformpdf
DSS-5288: Notice of Extension Hearingpdf21 KBformpdf
DSS-5288sp: Aviso De Audiencia De Extensionpdf26 KBformpdf
DSS-5288sp: Aviso De Audiencia De Extensionpdf26 KBformpdf
DSS-5290-B: Notice of Work First 60-Month State Time Clock Startingpdf62 KBformpdf
DSS-5290-Bsp: Aviso de los 60 meses iniciales de su participación en el Programa Work First (Trabajar Primero)pdf64 KBformpdf
DSS-5290: Notice of Work First 24-Month State Time Clock Startingpdf20 KBformpdf
DSS-5291: Indian Child Welfare Act Compliance Checklistpdf257 KBformpdf
DSS-5292: Work First Participation Summarypdf93 KBformpdf
DSS-5292sp: Resumen De Participacion En El Programa Work Firstpdf26 KBformpdf
DSS-5293: Notice of Hardship Exemption Hearingpdf22 KBformpdf
DSS-5293sp: Aviso De Audiencia De Exencion Por Penuriapdf32 KBformpdf
DSS-5294: Notice of Decision on Hardship Exemption Requestpdf22 KBformpdf
DSS-5294sp: Aviso De Decision Sobre Solicitud De Exencionpdf28 KBformpdf
DSS-5295: Monthly Permanency Planning Contact Recordpdf171 KBformpdf
DSS-5295ins: Monthly Permanency Planning Contact Record Instructionspdf114 KBformpdf
DSS-5295sp: Registro De Contacto Mensual De Padres Foster En Carolina Del Nortepdf233 KBformpdf
DSS-5297: Consent for Release of Confidential Informationpdf52 KBformpdf
DSS-5297sp: Consentimiento para Divulgar Información Confidencialpdf53 KBformpdf
DSS-5298: North Carolina’s Work First Family Assessment of Strengths and Needspdf76 KBformpdf
DSS-5298sp: Porgrama Work First de Carolina del Norte Evaluación de fortalezas y necesidades de la familiapdf90 KBformpdf
DSS-5299: 24-Month Time Limit Checklistpdf41 KBformpdf
DSS-5300: Notice of Decision on Extension Requestpdf22 KBformpdf
DSS-5300sp: Aviso De Decision Sobre Solicitud De Extensionpdf57 KBformpdf
DSS-5301: Extension Hearing Requestpdf19 KBformpdf
DSS-5301sp: Solicitud De Audiencia De Extensionpdf23 KBformpdf
DSS-5302: Work First Extension/Exemption Monthly Reportpdf68 KBformpdf
DSS-5303: Request for NC Kids Child Registration Exemptionpdf252 KBformpdf
DSS-5303sp: Peticion De Excepcion De Registro Para Un Nino Del Programa NC KIDSpdf52 KBformpdf
DSS-5304: Legal Risk Placement Agreementpdf40 KBformpdf
DSS-5305: Purchase of Adoption Services Agreementpdf33 KBformpdf
DSS-5306: Adoption Assistance Suspension Noticepdf53 KBformpdf
DSS-5307: Adoption Assistance Agreement Amendmentpdf46 KBformpdf
DSS-5308: Adoption Assistance Termination Noticepdf63 KBformpdf
DSS-5309: Excused Absence Log (For Unpaid Activities)pdf85 KBformpdf
DSS-5310: Model Court Report for Dispositional and Review Hearingspdf224 KBformpdf
DSS-5311: Model Court Report for Permanency Planning Hearingspdf290 KBformpdf
DSS-5312: Model Court Report for Post Termination of Parental Rights Hearingspdf68 KBformpdf
DSS-5313: Work Registration Indicatorpdf112 KBformpdf
DSS-5313sp: Registro para Trabajarpdf16 KBformpdf
DSS-5314: Sample Letter for Annual Adoptions Assistance Eligibility Reviewpdf37 KBformpdf
DSS-5315sp: Plan de Emancipación de Custodia en Cuidado Fosterpdf160 KBformpdf
DSS-5316: Relative Interest Formpdf145 KBformpdf
DSS-5317: Relative Notification Letterpdf25 KBformpdf
DSS-5318: Relative Search Informationpdf88 KBformpdf
DSS-5320: DSS – Monthly Adoption Reporting Formxlsx75 KBformxlsx
DSS-5320a: Contract Agency – Monthly Adoption Reporting & Payment Formxlsx82 KBformxlsx
DSS-5321: Workers Compensation Fraud in North Carolinapdf32 KBformpdf
DSS-5321sp: Compensacion De Trabajadores en Carolina Del Nortepdf46 KBformpdf
DSS-5322: Report of Injuries to Work First Participants in Work Experience/Community Servicepdf29 KBformpdf
DSS-5324: Adoptive Placement Agreementpdf32 KBformpdf
DSS-5325: Substance Use Behavioral Indicator Checklist IIpdf154 KBformpdf
DSS-5325sp: Lista II De Indicadores De Conducta Por Abuso De Sustanciaspdf102 KBformpdf
DSS-5326: Teen Pregnancy Prevention and Healthy Marriage Initiatives Fact Sheetpdf23 KBformpdf
DSS-5326sp: Volante Informativo Iniciativas Para La Prevencion Del Embarazo En Adolescentes Y Matrimonios Saludablespdf67 KBformpdf
DSS-5327: Learning Needs Screening Toolpdf28 KBformpdf
DSS-5328: Request to Cancel Direct Depositpdf75 KBformpdf
DSS-5328sp: Solicitud de Cancelación de Depósito Directopdf377 KBformpdf
DSS-5329: Complaint Procedures for the Work First Programpdf13 KBformpdf
DSS-5329sp: Procedimiento de Queja del Programa Work Firstpdf13 KBformpdf
DSS-5330: Learning Needs Screening Tool Waiver & Consent Agreementpdf18 KBformpdf
DSS-5330sp: Rechazo al Uso de la Herramienta de Detección de Necesidades en el Aprendizaje y Forma de Consentimientopdf26 KBformpdf
DSS-5331: ICPC Supervision Report – 30 Dayspdf30 KBformpdf
DSS-5332: ICPC Supervision Report – 90 Dayspdf34 KBformpdf
DSS-5333: Americans with Disabilities Act – Did you know?pdf65 KBformpdf
DSS-5333sp: ¿Sabía usted?pdf49 KBformpdf
DSS-5334: Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcementpdf17 KBformpdf
DSS-5334sp: Aviso De Requerimiento De Cooperar Y Derecho Para Reclamar (Claim) Una Causa Justificada Para Reusarse A Cooperar Con El Programa De Manutencion Infantil (Child Support Enforcement)pdf30 KBformpdf
DSS-5335: Consent to Explore American Indian Heritagepdf51 KBformpdf
DSS-5336: Fostering Connections/Tribal Relative Search (DSS-5336) Instructionspdf45 KBformpdf
DSS-5337-C: Request for Patient Informationpdf197 KBformpdf
DSS-5339: CPS Expansion (TANF Transfer to SSBG) Eligibility Documentation Formpdf30 KBformpdf
DSS-5340: TANF Federal Time Clock Verification Requestpdf34 KBformpdf
DSS-5340sp: Peticion De Verificacion Del Reloj Federal Del Programa TANFpdf40 KBformpdf
DSS-5401 Consent Form for a Clinical Assessment of Protective Parenting (CAPP)pdf162 KBformpdf
DSS-5402: Child Welfare Human Trafficking Screening Toolpdf305 KBformpdf
DSS-5758: Supplemental Board Payment for HIV Positive Foster Children Request for Reimbursementpdf71 KBformpdf
DSS-5759: Request for Supplemental Adoption Assistance for HIV Positive Adopted Childrenpdf36 KBformpdf
DSS-5760 Verification of Custody Letterpdf119 KBformpdf
DSS-5800: Unlicensed Kinship Payment Eligibility Checklistpdf252 KBformpdf
DSS-5801: Unlicensed Kinship Form-Facility ID Requestpdf264 KBformpdf
DSS-5802: Unlicensed Kinship Acknowledgmentpdf154 KBformpdf
DSS-5960: Law Enforcement and District Attorney Notificationpdf180 KBformpdf
DSS-6187: Application for State Maternity Funds (Voucher, Social History & Service Plan) Problem Pregnancy Servicespdf88 KBformpdf
DSS-6187I: Instructions for Completing Application for State Maternity Fund DSS-6187pdf33 KBformpdf
DSS-6187sp: Solicitud Para Fondos Estatales Para Maternidadpdf124 KBformpdf
DSS-6188: Notice of Action on Request for State Maternity Home Fundspdf60 KBformpdf
DSS-6189: State Maternity Fund Residential Care Provider Agreementpdf32 KBformpdf
DSS-6190 Rapid Response Team Referral Formpdf128 KBformpdf
DSS-6191 Plan of Safe Care State Formpdf208 KBformpdf
DSS-6191sp Formulario de plan de cuidado seguropdf168 KBformpdf
DSS-6192: Safe Surrender Health and Information Formpdf226 KBformpdf
DSS-6211: State Abortion Fund Eligibility Certificationpdf32 KBformpdf
DSS-6226: NC Division of Vocational Rehabilitation Services and County Social Services Agency/Department Referralpdf234 KBformpdf
DSS-6226sp: División de Servicios de Rehabilitación Vocacional y Agencia de Servicios Sociales del Condado/ Referencia Departamentalpdf237 KBformpdf
DSS-6228: د مسلکي مهارتونو روزنه او د مهارتونو د بیا تصدیق پلانpdf316 KBformpdf
DSS-6228: MPANGO WA MAFUNZO YA UJUZI WA UFUNDI NA UTHIBITISHAJI WA UJUZIpdf275 KBformpdf
DSS-6228: NC Amahugurwa yimyuga nubumenyi Gahunda yo Kwemezapdf286 KBformpdf
DSS-6228: NC Vocational Skills Training and Skills Recertifiation Plan (DSS-6228)pdf283 KBformpdf
DSS-6228: NC የሙያ ክህሎት ስልጠና እና ክህሎት ዳግም ማረጋገጫ እቅድpdf269 KBformpdf
DSS-6228: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ПРОФЕСІЙНО-ТЕХНІЧНОЇ ПІДГОТОВКИ ТА ПЕРЕАТЕСТАЦІЇpdf348 KBformpdf
DSS-6228: آموزش مهارت های حرفه ای NC و طرح تایید مجدد مهارت هاpdf325 KBformpdf
DSS-6228sp: Plan De Recertification Vocacional De Destrezas Y Capacitacion De Destrezas De NCpdf211 KBformpdf
DSS-6229: MAFUNZO YA UJUZI WA UFUNDI NA UTHIBITISHAJI UPYA WA UJUZI MASHRTI YA MPANGO WA UTEKELEZAJIpdf146 KBformpdf
DSS-6229: NC Amahugurwa Yimyuga Yumwuga Nubuhanga bwo Kwemeza Amasezerano Yibisabwapdf142 KBformpdf
DSS-6229: NC Vocational Skills Training And Skills Recertification Agreement Plan of Action Requirements (DSS-6229)pdf143 KBformpdf
DSS-6229: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА ПРО ПРОФЕСІЙНО-ТЕХНІЧНУ ПІДГОТОВКУ ТА ПЕРЕАТЕСТАЦІЮ ВИМОГИ ДО ПЛАНУ ДІЙpdf194 KBformpdf
DSS-6229: الزامات برنامه اقدام برای آموزش مهارت های حرفه ای NC و گواهینامه مجدد مهارت هاpdf166 KBformpdf
DSS-6229: د مسلکي مهارتونو روزنه او د مهارتونو د بیا تصدیقولو هوکړه لیکد عمل د پلان شراېطpdf163 KBformpdf
DSS-6229: የኤንሲ የሙያ ክህሎት ስልጠና እና የችሎታ ማረጋገጫ ስምምነት የድርጊት መስፈርቶች እቅድpdf119 KBformpdf
dss-6229sp: Acuerdo De Los Requerimientos Del Plan De Accion Del Programa De Evaluacion Y Rercertificacion De Destrezas De NCpdf41 KBformpdf
DSS-6230 (pt. A): Gahunda yo Kwihaza mu Muryangopdf175 KBformpdf
DSS-6230 (pt. A): طرح خودکفایی خانوادهpdf184 KBformpdf
DSS-6230 (pt. A): የቤተሰብ ራስን መቻል እቅድpdf205 KBformpdf
DSS-6230 (pt. B): Gahunda yo Kwihaza mu Muryangopdf186 KBformpdf
DSS-6230 (pt. B): طرح خودکفایی خانوادهpdf204 KBformpdf
DSS-6230 (pt. B): የቤተሰብ ራስን መቻል እቅድpdf191 KBformpdf
DSS-6230 Part A: MPANGO WA KUJITOSHELEZA KWA FAMILIA SEHEMU Apdf181 KBformpdf
DSS-6230 Part A: План сімейного самозабезпеченняpdf216 KBformpdf
DSS-6230 Part A: د کورنۍ په ځان بساېنې پلانpdf191 KBformpdf
DSS-6230 Part B: MPANGO WA KUJITOSHELEZA KWA FAMILIA SEHEMU Bpdf187 KBformpdf
DSS-6230 Part B: План сімейного самозабезпеченняpdf233 KBformpdf
DSS-6230 Part B: کورنۍ په ځان بساېنې پلانpdf208 KBformpdf
DSS-6230A: Family Self-Sufficiency Planpdf172 KBformpdf
DSS-6230B: Family Self Sufficiency Planpdf186 KBformpdf
DSS-6230sp: Plan De Autosuficiencia Familiarpdf11 KBformpdf
DSS-6231: Gahunda ya serivisi ya Leta ishinzwe impunzipdf262 KBformpdf
DSS-6231: MPANGO WA HUDUMApdf254 KBformpdf
DSS-6231: NC State Refugee Office Service Planpdf257 KBformpdf
DSS-6231: NC የስቴት የስደተኞች ቢሮ አገልግሎት እቅድpdf248 KBformpdf
DSS-6231: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН НАДАННЯ ПОСЛУГpdf324 KBformpdf
DSS-6231: د کډوالو د دفتر د خدمتونو پلانpdf303 KBformpdf
DSS-6231: طرح خدمات اداره پناهندگان ایالتی NCpdf300 KBformpdf
DSS-6231sp: Plan Para Establecer Metaspdf15 KBformpdf
DSS-6232: MPANGO WA UWEZO WA KUAJIRIWApdf315 KBformpdf
DSS-6232: NC Gahunda yo Guha akazi Ibiro bya Letapdf335 KBformpdf
DSS-6232: NC State Refugee Office Employability Planpdf317 KBformpdf
DSS-6232: NC የስቴት የስደተኞች ቢሮ የቅጥር እቅድpdf367 KBformpdf
DSS-6232: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ПРАЦЕВЛАШТУВАННЯpdf427 KBformpdf
DSS-6232: د استخدام د وړتیا پلانpdf370 KBformpdf
DSS-6232: طرح استخدامی اداره پناهندگان ایالتی NCpdf363 KBformpdf
DSS-6232sp: Programa De Carolina Del Norte Para Asistencia A Refugiados Plan Para Determinar Si La Persona Esta En Condiciones Para Ser Empleadapdf184 KBformpdf
DSS-6233: Client (ELT) Service Planpdf191 KBformpdf
DSS-6233: Gahunda ya serivisi y’abakiriya (ELT)pdf197 KBformpdf
DSS-6233: MAFUNZO YA LUGHA YA KIINGEREZApdf196 KBformpdf
DSS-6233: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ВИВЧЕННЯ АНГЛІЙСЬКОЇ МОВИpdf267 KBformpdf
DSS-6233: د پیرودونکي (ELT) خدمت پلانpdf209 KBformpdf
DSS-6233: طرح خدمات مشتری (ELT).pdf203 KBformpdf
DSS-6233: የደንበኛ (ELT) የአገልግሎት እቅድpdf213 KBformpdf
DSS-6233sp: Plan De Servicio (ELT) Al Clientepdf8 KBformpdf
DSS-6234: ELT Learner Initial Assessment Formpdf257 KBformpdf
DSS-6234: ELT Yiga Ifishi Yambere Yisuzumapdf422 KBformpdf
DSS-6234: MAFUNZO YA LUGHA YA KIINGEREZA FOMU YA MTIHANI WA KWANZApdf420 KBformpdf
DSS-6234: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА НАВЧАННЯ АНГЛІЙСЬКОЇ МОВИ ФОРМА ПОЧАТКОВОГО ОЦІНЮВАННЯpdf502 KBformpdf
DSS-6234: د لومړنۍ ارزونې فورمهpdf445 KBformpdf
DSS-6234: فرم ارزیابی اولیه زبان آموزان ELTpdf450 KBformpdf
DSS-6234: የELT ተማሪ የመጀመሪያ ግምገማ ቅጽpdf939 KBformpdf
DSS-6234sp: Formulario De Evaluacion Inicial Del Estudiante ELTpdf25 KBformpdf
DSS-6235: Case Review Formpdf162 KBformpdf
DSS-6235: FOMU YA UKAGUZI WA MPANGOpdf163 KBformpdf
DSS-6235: Ifishi yo gusuzumapdf163 KBformpdf
DSS-6235: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ФОРМА ПЕРЕГЛЯДУ СПРАВИpdf219 KBformpdf
DSS-6235: د قضیې د بیاکتنې فورمهpdf185 KBformpdf
DSS-6235: فرم بررسی پروندهpdf186 KBformpdf
DSS-6235: የጉዳይ ግምገማ ቅጽpdf189 KBformpdf
DSS-6235sp: Revision Trimestralpdf13 KBformpdf
DSS-6236: Idhini ya Ufahamu ya Kutolewa kwa Maelezopdf181 KBformpdf
DSS-6236: Informed Consent For Release Of Informationpdf175 KBformpdf
DSS-6236: Kumenyeshwa Kumenyekanisha Kurekura Amakurupdf178 KBformpdf
DSS-6236: управління у справах біженців штату північна кароліна Інформована згода на розкриття інформаціїpdf227 KBformpdf
DSS-6236: د مالوماتو خپرولو لپاره آګاهانه رضایتpdf202 KBformpdf
DSS-6236: رضایت آگاهانه برای انتشار اطلاعاتpdf202 KBformpdf
DSS-6236: መረጃን ለመልቀቅ በመረጃ የተደገፈ ስምምነትpdf204 KBformpdf
DSS-6236sp: Consentimiento Con Conocimiento De Causa Para Divulgación De Informaciónpdf14 KBformpdf
DSS-6237: DSS Refugee Client Rights Formpdf132 KBformpdf
DSS-6237: FOMU IKUBIYEMO UBURENGANZIRA BW’UMUKIRIYApdf153 KBformpdf
DSS-6237: FOMU YA HAKI ZA MTEJApdf132 KBformpdf
DSS-6237: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ФОРМА ПРАВ КЛІЄНТАpdf184 KBformpdf
DSS-6237: د مهاجرینو د مراجعینو د حقونو فورمهpdf149 KBformpdf
DSS-6237: فرم حقوق مشتری پناهندگان DSSpdf146 KBformpdf
DSS-6237: የDSS የስደተኞች ደንበኛ መብቶች ቅጽpdf170 KBformpdf
DSS-6237sp: Formulario De Derechos Del Cliente De Carolina De Nortepdf15 KBformpdf
DSS-6238: Refugee Cash Assistance Eligibility Monitoring Guidepdf304 KBformpdf
DSS-6239A: Amasezerano yo Guhana Impunzipdf170 KBformpdf
DSS-6239A: MAKUBALIANO YA UWAJIBIKAJI WA PAMOJA WA WAKIMBIZIpdf170 KBformpdf
DSS-6239A: Refugee Mutual Responsibility Agreementpdf172 KBformpdf
DSS-6239A: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА З БІЖЕНЦЯМИ ПРО ВЗАЄМНУ ВІДПОВІДАЛЬНІСТЬpdf187 KBformpdf
DSS-6239A: د کډوالو د دوه اړخیز مسؤلیت تړونpdf190 KBformpdf
DSS-6239A: موافقتنامه مسئولیت متقابل پناهندگانpdf192 KBformpdf
DSS-6239A: የስደተኞች የጋራ ኃላፊነት ስምምነትpdf194 KBformpdf
DSS-6239B: Impunzi MRA Gahunda y’ibisabwapdf143 KBformpdf
DSS-6239B: MASHARTI YA MPANGO WA UTEKELEZAJIpdf143 KBformpdf
DSS-6239B: Refugee MRA Plan of Action Requirementspdf140 KBformpdf
DSS-6239B: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА ПРО ВЗАЄМНУ ВІДПОВІДАЛЬНІСТЬpdf176 KBformpdf
DSS-6239B: الزامات برنامه اقدام MRA پناهندگانpdf159 KBformpdf
DSS-6239B: د مهاجرینو MRA د عمل اړتیاو پلانpdf160 KBformpdf
DSS-6239B: የስደተኛ MRA የድርጊት መስፈርቶች እቅድpdf154 KBformpdf
DSS-6240_AR: (SNAP) طلب الاشتراك في برنامج المعونة الغذائية المُبسطpdf112 KBformpdf
DSS-6240_DE: Antrag Auf Vereinfachtes Programm Fur Lebensmittelhilfe (SNAP)pdf74 KBformpdf
DSS-6240_KO: 간이 영양 지원 프로그램(SNAP) 신청서pdf238 KBformpdf
DSS-6240: Simplified Nutritional Assistance Program (SNAP) Applicationpdf177 KBformpdf
DSS-6240A_AR: احفظ هذه الصفحة في سجلاتكpdf85 KBformpdf
DSS-6240A_DE: Legen Sie diese Seite bitte zu Ihren Unterlagenpdf34 KBformpdf
DSS-6240A_FR: Programme Simplifie D’Aide Nutritionnelle (SNAP)pdf31 KBformpdf
DSS-6240A_KO: 참조를 위해 이 문서를 보관하십시오pdf141 KBformpdf
DSS-6240A_VI: Thông Tin Chương Trình Và Các Quyền Và Trách Nhiệm Của Bạnpdf118 KBformpdf
DSS-6240Asp: Programa Simplificado De Asistencia Nutricional Información sobre el programa. Derechos y Responsabilidadespdf252 KBformpdf
DSS-6240sp: Solicitud Del Programa Simplificado De Asistencia Nutricional (Simplified Nutritional Assistance Program, SNAP)pdf251 KBformpdf
DSS-6241: Refugee Cash Assistance (RCA) Applicationpdf164 KBformpdf
DSS-6241sp: Solicitud de Asistencia en Efectivo para Refugiados (RCA)pdf365 KBformpdf
DSS-6242: Refugee Medical Assistance (RMA) Applicationpdf159 KBformpdf
DSS-6242sp: Solicitud de Asistencia Médica para Refugiados (RMA)pdf146 KBformpdf
DSS-6246: Affidavit of Paternitypdf39 KBformpdf
DSS-6247: Notification of Refugee Arrival and Intent to Apply for Benefitspdf141 KBformpdf
DSS-6250: Gahunda ya Serivisi ishinzwe amategekopdf220 KBformpdf
DSS-6250: Legal Service Planpdf216 KBformpdf
DSS-6250: MPANGO WA HUDUMA YA KISHERIApdf218 KBformpdf
DSS-6250: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН НАДАННЯ ЮРИДИЧНИХ ПОСЛУГpdf283 KBformpdf
DSS-6250: د حقوقي خدماتو پلانpdf259 KBformpdf
DSS-6250: طرح خدمات حقوقیpdf252 KBformpdf
DSS-6250: የህግ አገልግሎት እቅድpdf240 KBformpdf
DSS-6852: Authorization / Receipt for Direct Paymentpdf10 KBformpdf
DSS-6901: Work First Employment Services Assessment Formpdf368 KBformpdf
DSS-6902: Screening for Child Well Beingpdf191 KBformpdf
DSS-6902sp: Evaluacion De Bienestar De Menorespdf165 KBformpdf
DSS-6904: Work First Information Transmittalpdf37 KBformpdf
DSS-6905: Work Experience/Community Service Agreementpdf296 KBformpdf
DSS-6905sp: Sericios De Empleo Work First Acuerdo de Experiencia Laboral y Servicio Comunitariopdf381 KBformpdf
DSS-6960: Job Search/Verification Logpdf275 KBformpdf
DSS-6960sp: Busqueda De Trabajo y Registro De Verificaionpdf632 KBformpdf
DSS-6961: Verification of Household Compositionpdf43 KBformpdf
DSS-6961sp: La Verificacion De La Composicion Del Grupo Familiarpdf49 KBformpdf
DSS-6962: Workers Compensation Guide for Work First Participants In Work Experience and Community Service Activitiespdf145 KBformpdf
DSS-6962sp: Guía de Compensación Para Trabajadores Participantes en los Programas de Work Experience (Experiencia de Trabajo) y Servicio Comunitariopdf146 KBformpdf
DSS-6963a_bsp: Acuerdo De Responsbilidad Mutua Requerimientos Basicospdf124 KBformpdf
DSS-6963a: Mutual Responsibility Agreement – Core Requirementspdf22 KBformpdf
DSS-6963Asp: Acuerdo De Responsabilidad Mutua – Requerimientos Basicospdf22 KBformpdf
DSS-6963b: Mutual Responsibility Agreement Plan of Action Requirementspdf64 KBformpdf
DSS-6963Bsp: Acuerdo De Responsabilidad Mutua Requisitos Del Plan Accionpdf32 KBformpdf
DSS-6963c: Mutual Responsibility Agreement Plan of Action Requirements for Work First Servicespdf18 KBformpdf
DSS-6964: Program Reference Guidepdf404 KBformpdf
DSS-6964sp: Informacion de Programaspdf146 KBformpdf
DSS-6965: Family Violence Option/Domestic Violence Work First Assessmentpdf301 KBformpdf
DSS-6965sp: Opcion Respecto a Violencia Familiar/Violencia Domestica Evaluacion Work Firstpdf193 KBformpdf
DSS-6966: Notification of Family Violence Optionpdf107 KBformpdf
DSS-6966sp: Notificación de opción de violencia familiarpdf104 KBformpdf
DSS-6967: Family Violence Option Brochurepdf3 MBformpdf
DSS-6968: Screening for Domestic Violencepdf23 KBformpdf
DSS-6968sp: Preguntas de Violencia Domésticapdf490 KBformpdf
DSS-6969: Consent for Release of Informationpdf55 KBformpdf
DSS-6969sp: Consentimiento Para Proporcionar Informacionpdf41 KBformpdf
DSS-8104: Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcementpdf23 KBformpdf
DSS-8104sp: Segundo Aviso De Derecho A Presentar Buena Razon Para Negarse A Cooperar Con El Cumplimiento De La Manutencion Infantilpdf34 KBformpdf
DSS-8105A Programa De Asistencia De Agua-Aviso De Aprobacionpdf177 KBformpdf
DSS-8105A Water Assistance Program-Notice of Approvalpdf179 KBformpdf
DSS-8105A СПОВІЩЕННЯ ПРО СХВАЛЕННЯ ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМpdf184 KBformpdf
DSS-8105A: СПОВІЩЕННЯ ПРО СХВАЛЕННЯ ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМpdf169 KBformpdf
DSS-8105B Programa De Asistencia De Agua-Aviso De Negacionpdf113 KBformpdf
DSS-8105B Water Assistance Program-Notice of Denialpdf114 KBformpdf
DSS-8105B: ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ – СПОВІЩЕННЯ ПРО ВІДХИЛЕННЯpdf130 KBformpdf
DSS-8105B: ПРОГРАММА ПОМОЩИ В ОПЛАТЕ ВОДОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ ОТКАЗЕpdf129 KBformpdf
DSS-8105C Programa De Asistencia De Agua-Aviso De Solicitud Retiradapdf111 KBformpdf
DSS-8105C Water Assistance Program-Notice of Withdrawalpdf113 KBformpdf
DSS-8105C: ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ – СПОВІЩЕННЯ ПРО ВІДКЛИКАННЯpdf130 KBformpdf
DSS-8105C: ПРОГРАММА ПОМОЩИ В ОПЛАТЕ ВОДОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ ОТЗЫВЕpdf130 KBformpdf
DSS-8107_AR: إخطار الموافقة/الرفض برامج الطاقةpdf83 KBformpdf
DSS-8107_DE: Energie Programme Mitteilung Uber Genehmigung/Ablehnungpdf29 KBformpdf
DSS-8107_FR: Programmes Lies A L’Energie Notifcation D’Approbation/De Refuspdf26 KBformpdf
DSS-8107_KO: 에너지 프로그램 승인/거부 고지pdf129 KBformpdf
DSS-8107_VI: CHƯƠNG TRÌNH NĂNG LƯỢNG THÔNG BÁO VỀ PHÊ DUYỆT/TỪ CHỐIpdf135 KBformpdf
DSS-8107-ia: СПОВІЩЕННЯ ПРО СХВАЛЕННЯ/ВІДХИЛЕННЯ УЧАСТІ В ЕНЕРГЕТИЧНИХ ПРОГРАМАХpdf126 KBformpdf
DSS-8107-ia: УЧАСТИЕ В ПРОГРАММАХ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ УТВЕРЖДЕНИИ/ОТКАЗЕpdf157 KBformpdf
DSS-8107: Energy Programs Notice of Approval/Denialpdf26 KBformpdf
DSS-8107b: Energy Programs Action Noticepdf87 KBformpdf
DSS-8107bsp: Programas De Energia Aviso De Accionpdf21 KBformpdf
DSS-8107sp: Programas De Asistencia De Energia Aviso De Aprobacion/Denegacionpdf27 KBformpdf
DSS-8108: Notice of Benefitspdf110 KBformpdf
DSS-8108sp: Aviso De Beneficiospdf109 KBformpdf
DSS-8109: Your Application for Benefits is Being Denied or Withdrawnpdf87 KBformpdf
DSS-8109sp: Su Solicitud De Beneficios Ha Sido Rechazada O Retiradapdf40 KBformpdf
DSS-8110: Notice of Modification, Termination, or Continuation of Public Assistancepdf114 KBformpdf
DSS-8110sp: Aviso de Modificación, Terminación, o Continuación de Asistencia Públicapdf153 KBformpdf
DSS-8113_DE: Gehaltsbestatigungsformularpdf43 KBformpdf
DSS-8113_FR: Formulaire De Verification Des Salairespdf37 KBformpdf
DSS-8113: Wage Verification Formpdf51 KBformpdf
DSS-8113sp: Formulario de Verificacin de Sueldopdf91 KBformpdf
DSS-8115: LIEAP Denial Noticepdf13 KBformpdf
DSS-8115sp: Programa De Asistencia De Energia Para Personas De Escasos Recursos Aviso De Denegacionpdf20 KBformpdf
DSS-8116I: Low Income Energy Assistance Program Eligibility Worksheetpdf147 KBformpdf
DSS-8116Isp: Programa De Asistencia De Energia Por Bajos Ingresos Hoja De Trabajo Para Determinar La Elegibidadpdf177 KBformpdf
DSS-8117: North Carolina’s Energy Programs Brochurepdf150 KBformpdf
DSS-8117: ЕНЕРГЕТИЧНІ ПРОГРАМИ ПІВНІЧНОЇ КАРОЛІНИpdf169 KBformpdf
DSS-8117: ПРОГРАММЫ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯ, NORTH CAROLINApdf178 KBformpdf
DSS-8117sp: Programas De Asistencia De Energia De Carolina Del Nortepdf89 KBformpdf
DSS-8118: Certification Utilities Moratoriumpdf15 KBformpdf
DSS-8118sp: Moratoria De Certificacion De Servicios Publicospdf29 KBformpdf
DSS-8119: Energy Programs Outreach Planpdf86 KBformpdf
DSS-8124: Application for Work First Family Assistance, MA, Refugee, and SApdf98 KBformpdf
DSS-8124a: EIS Application for Work First Family Assistance, MA, Refugee, and SApdf54 KBformpdf
DSS-8124Asp: Application for Work First Family Assistance, MA, Refugee, and SApdf54 KBformpdf
DSS-8124b: Rights and Responsibilitiespdf46 KBformpdf
DSS-8124Bsp: ¿Cuáles son mis derechos? ¿Cuáles son mis responsabilidades?pdf30 KBformpdf
DSS-8127: Work First Family Assistance Reportpdf92 KBformpdf
DSS-8127sp: Informe De Asistencia Familiar Work Firstpdf75 KBformpdf
DSS-8129: Request for Replacement Checkpdf346 KBformpdf
DSS-8129sp: Sistema De Informacion Sobre Elegibilidad y Sistema De Seguimiento De Informacion Sobre Acogimiento De Menorespdf83 KBformpdf
DSS-8131: Change in Situation Reportpdf10 KBformpdf
DSS-8137: Notice of Incomplete Work First Family Assistance Reportpdf26 KBformpdf
DSS-8137sp: Notificacion De Informe Incompleto Del Programa De Asistencia Familiar Work Firstpdf37 KBformpdf
DSS-8146A: Notice of Information Needed to Determine Your Eligibility for Work First Family Assistancepdf61 KBformpdf
DSS-8146Asp: Aviso De Informacion Necesaria Para Determinar Su Elegibilidad Para El Programa Work Firstpdf65 KBformpdf
DSS-8162 LIHWAP Agreementpdf45 KBformpdf
DSS-8162sp LIHWAP Agreementpdf127 KBformpdf
DSS-8163_FR: Accord Sur L’Approvionnement En Energie Domestiquepdf29 KBformpdf
DSS-8163: Energy Provider Agreementpdf358 KBformpdf
DSS-8169: Work First Emergency Assistance Applicationpdf74 KBformpdf
DSS-8169sp: Solicitud Del Programa Work First (Trabajar Primero) De Emergenciapdf74 KBformpdf
DSS-8173_AR: بيان إحصاءpdf54 KBformpdf
DSS-8173_DE: Freistellungserklärung für Auflistungpdf15 KBformpdf
DSS-8173_FR: Communiqué concernant le recensementpdf14 KBformpdf
DSS-8173_VI: Công Bố Cho Mục Đích Liệt Kêpdf101 KBformpdf
DSS-8173: Release For Enumerationpdf14 KBformpdf
DSS-8173sp: Revelación para enumeraciónpdf17 KBformpdf
DSS-8174: Referral for Social Security Number Applicationpdf12 KBformpdf
DSS-8176_AR: نموذج المساهمةpdf67 KBformpdf
DSS-8176_DE: Beitragsformularpdf27 KBformpdf
DSS-8176_FR: Formulaire De Contributionpdf26 KBformpdf
DSS-8176_KO: 기증 양식pdf102 KBformpdf
DSS-8176_VI: MẪU ĐÓNG GÓPpdf97 KBformpdf
DSS-8176: Contribution Formpdf88 KBformpdf
DSS-8176sp: Contribution Form (Spanish)pdf19 KBformpdf
DSS-8178_AR: طلب برامج الطاقةpdf103 KBformpdf
DSS-8178-ia: ЗАЯВКА НА УЧАСТИЕ В ПРОГРАММЕ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯpdf271 KBformpdf
DSS-8178-ia: ЗАЯВКА НА УЧАСТЬ В ЕНЕРГЕТИЧНИХ ПРОГРАМАХpdf280 KBformpdf
DSS-8178: Energy Programs Applicationpdf249 KBformpdf
DSS-8178A: Crisis Intervention Program Worksheetpdf98 KBformpdf
DSS-8178Asp: Hoja De Trabajo De Intervencion De Crisispdf125 KBformpdf
DSS-8178L: Low Income Energy Assistance Program Application (LIEAP)pdf225 KBformpdf
DSS-8178Lsp: Solicitud Para El Programa De Asistencia De Energia Para Personas De Bajos Ingresospdf242 KBformpdf
DSS-8178sp: Solicitud Para Programas De Ayuda Para Energiapdf163 KBformpdf
DSS-8178W: Low Income Household Water Assistance Application (LIHWAP)pdf226 KBformpdf
DSS-8178W: Solicitud Del Programa De Asistencia De Agua Para Familias De Bajos Ingresos (LIHWAP)pdf208 KBformpdf
DSS-8185-ia: Програма допомоги в енергетичній сфері для сімей із низьким доходом / програма кризового втручанняpdf135 KBformpdf
DSS-8185-ia: Программа помощи семьям с низким доходом в оплате энергоснабжения Программа кризисного вмешательстваpdf146 KBformpdf
DSS-8185: Low Income Energy Assistance Program Crisis Intervention Program Information Neededpdf254 KBformpdf
DSS-8185A: Prepare for the Energy Program Application Interviewpdf90 KBformpdf
DSS-8185Asp: Prepárese para la entrevista de la solicitud del Programa de Energíapdf76 KBformpdf
DSS-8185sp: Programa de Asistencia de Energía para Personas de Bajos Ingresos Programa de Intervención en Crisis Se Necesita La Siguiente Informacionpdf154 KBformpdf
DSS-8189: Appointment Noticepdf89 KBformpdf
DSS-8189sp: Aviso De Citapdf24 KBformpdf
DSS-8190ns: State County Special Assistance for Adults Workbook for Non-SSI Recipients Onlypdf318 KBformpdf
DSS-8190s: State / County Special Assistance for Adults Workbook for SSI Recipients Onlypdf163 KBformpdf
DSS-8190sp: Libro De Trabajo De La Ayuda Especial Para Adultos Del Estado/Condado Solo Para Beneficiarios Del SSIpdf299 KBformpdf
DSS-8191i: Work First / Medicaid Notice of Inquirypdf44 KBformpdf
DSS-8191w: Work First / Medicaid Notice of Withdrawalpdf42 KBformpdf
DSS-8191wsp: Aiso De Retiro De Work First / Medicaidpdf18 KBformpdf
DSS-8194: Income Maintenance Transmittal Formpdf127 KBformpdf
DSS-8196: Special Announcement Letterpdf16 KB