| Appendix G SAIH Slot Request Form | Form | pdf | 15 KB | | form | pdf |
| DAAS 20201 Special Assistance Second Party Review Form APPLICATIONS | Form | docx | 34 KB | | form | docx |
| DAAS 20202 Special Assistance Second Party Review Form RECERTIFICATIONS | Form | docx | 32 KB | | form | docx |
| DHB-5001N_UK: СПОВІЩЕННЯ ПРО ВИКОРИСТАННЯ НОМЕРІВ СОЦІАЛЬНОГО СТРАХУВАННЯ | Form | pdf | 139 KB | | form | pdf |
| DHB-5043: ФОРМА ПІДТВЕРДЖЕННЯ ДОХОДІВ ТА ВИТРАТ САМОЗАЙНЯТОЇ ОСОБИ | Form | pdf | 201 KB | | form | pdf |
| DHHS AS 0008 Initial Notice to DA or LE Elec | Form | docx | 43 KB | | form | docx |
| DHHS-AS_6218 Adult Services Intake Inquiry HW 3 2024 | Form | docx | 35 KB | | form | docx |
| DHHS-AS-0001 Adult Protective Services Intake | Form | docx | 75 KB | | form | docx |
| DHHS-AS-0003 Adult Services Notice to Administrator Elec 2024 | Form | docx | 32 KB | | form | docx |
| DHHS-AS-0004 Notice to Reporter of Completion of Evaluation Elec 2024 | Form | docx | 32 KB | | form | docx |
| DHHS-AS-0005 Community Evaluation 2024 | Form | pdf | 1 MB | | form | pdf |
| DHHS-AS-0006_Facility_Evaluation_Elec_2024 | Form | docx | 138 KB | | form | docx |
| DHHS-AS-0007_Diligent_Efforts_Elec_2024 | Form | docx | 44 KB | | form | docx |
| DHHS-AS-0007_Diligent_Efforts_HW_2024 | Form | docx | 32 KB | | form | docx |
| DHHS-AS-0009 Written Report of APS Evaluation Elec 3.2024 | Form | pdf | 187 KB | | form | pdf |
| DHHS-AS-0010 APS Notice to Financial Customer Elec | Form | docx | 39 KB | | form | docx |
| DHHS-AS-0011 Adult and Family Service Plan HW | Form | docx | 44 KB | | form | docx |
| DHHS-AS-0011_Adult_and_Family_Service_Plan _Elec | Form | docx | 48 KB | | form | docx |
| DHHS-AS-0013 Determination of Ability to Consent 2024 | Form | pdf | 205 KB | | form | pdf |
| DHHS-AS-0013 Determination of Ability to Consent HW 3.2024 | Form | docx | 34 KB | | form | docx |
| DHHS-AS-0014 Notice of Request for Record for Adult Protective Services Eval. Elec | Form | docx | 25 KB | | form | docx |
| DHHS-AS-0015 Consent for Financial Records HW | Form | docx | 42 KB | | form | docx |
| DHHS-AS-0016 Consent for Release of Information HW | Form | docx | 38 KB | | form | docx |
| DHHS-AS-5026 Form | Form | pdf | 141 KB | | form | pdf |
| DHHS-AS-6218 Adult Services Intake Inquiry Elec 3 2024 | Form | docx | 44 KB | | form | docx |
| DHHS-AS-6219 Adult Services Face Sheet 3 2024 | Form | docx | 25 KB | | form | docx |
| DHHS-AS-6219 Adult Services Face Sheet Elec 3.2024 | Form | docx | 35 KB | | form | docx |
| DHHS-AS-6220 Annual Services Functional Assessment Elec 2024 | Form | doc | 310 KB | | form | doc |
| DHHS-AS-6220-Annual Services Functional Assessment HW | Form | doc | 210 KB | | form | doc |
| DHHS-AS-6222 Adult Service Contact Activity Log HW 2024 | Form | docx | 17 KB | | form | docx |
| DHHS-AS-6222 Adult Services Contact Activity Log Elec 2024 | Form | docx | 26 KB | | form | docx |
| DHHS-AS-6223 Interim or Quarterly Review Elec 2024 | Form | pdf | 110 KB | | form | pdf |
| DHHS-AS-6223 Interim or Quarterly Review HW 2024 | Form | docx | 26 KB | | form | docx |
| DHHS-AS-6224 Adult Services Annual Assessment Elec 3 2024 | Form | docx | 67 KB | | form | docx |
| DHHS-AS-6224 Adult Services Annual Assessment_HW_3_2024 | Form | docx | 56 KB | | form | docx |
| DHHS-AS-6225 Case Closing Summary Elec 3.2024 | Form | docx | 30 KB | | form | docx |
| DHHS-AS-6225 Case Closing Summary HW 3 2024 | Form | docx | 24 KB | | form | docx |
| DHHS-AS-7016 | Form | pdf | 417 KB | | form | pdf |
| DHHS-AS-Adult and Family Service Plan Elec | Form | docx | 44 KB | | form | docx |
| DHHS-AS-Adult Services Annual Assessment HW 2024 | Form | docx | 56 KB | | form | docx |
| DHHS-AS-Request 5337 VA Request Template | Form | pdf | 366 KB | | form | pdf |
| DMA-5094: ПОВІДОМЛЕННЯ ПРО ВАШЕ ПРАВО ПОДАТИ ЗАЯВКУ НА ОТРИМАННЯ ДОПОМОГИ | Form | pdf | 83 KB | | form | pdf |
| DSS_5027_SIS_Client_Entry_Form | Form | pdf | 1,014 KB | | form | pdf |
| DSS_8173_KO: 기록 공개 동의서 | Form | pdf | 81 KB | | form | pdf |
| DSS_8556_KO: 자격상실 심리 사전 통지서 | Form | pdf | 117 KB | | form | pdf |
| DSS_8587_KO: 행정 자격상실 심리 포기에 따른 조치 | Form | pdf | 107 KB | | form | pdf |
| DSS-0031 SAIH Program Interagency Referral Form | Form | pdf | 141 KB | | form | pdf |
| DSS-0032 SAIH Signature Attestation Form | Form | pdf | 107 KB | | form | pdf |
| DSS-0032sp: Asistencia Especial En El Hogar – Certificación de Firma | Form | pdf | 73 KB | | form | pdf |
| DSS-0033: Appendix E, Supplement 1 | Form | pdf | 136 KB | | form | pdf |
| DSS-0034: Appendix E, Supplement 2 | Form | pdf | 126 KB | | form | pdf |
| DSS-10001_AR: اتفاقية خدمات اللغة (LEP) بالنسبة إلى العميل ذي المھارة المحدودة في اللغة الإنجليزية ، والعميل المصاب بضعف في الحواس | Form | pdf | 89 KB | | form | pdf |
| DSS-10001_DE: Für Kunden mit eingeschränkter englischer Sprachfähigkeit und Kunden mit beeinträchtigten Sinneswahrnehmungen | Form | pdf | 18 KB | | form | pdf |
| DSS-10001_FR: Accord Concernant Les Services Linguistiques | Form | pdf | 19 KB | | form | pdf |
| DSS-10001_KO: 제한적 영어 구사 능력(LEP) 고객 및 감각 장애 고객용 | Form | pdf | 93 KB | | form | pdf |
| 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 Thức | Form | pdf | 108 KB | | form | pdf |
| DSS-10001-ia: СОГЛАШЕНИЕ О ЯЗЫКОВЫХ УСЛУГАХ | Form | pdf | 145 KB | | form | pdf |
| DSS-10001-ia: УГОДА ЩОДО ПОСЛУГ ІЗ ПЕРЕКЛАДУ | Form | pdf | 144 KB | | form | pdf |
| DSS-10001: Language Services Agreement | Form | pdf | 50 KB | | form | pdf |
| DSS-10001ins: Instructions for completing the DSS-10001 | Form | pdf | 426 KB | | form | pdf |
| DSS-10001sp: Acuerdo Sobre Servicios De Lenguaje Para Personas con Capacidad Limitada en el Uso del Inglés Y Personas con Discapacidades Sensoriales | Form | pdf | 51 KB | | form | pdf |
| DSS-1167: Food and Nutrition Services ePass Application Verification Document | Form | pdf | 401 KB | | form | pdf |
| DSS-1168: Locate Data Sheet | Form | pdf | 10 KB | | form | pdf |
| DSS-1321: Statement of Admin. Expenditure for Purchased Service | Form | pdf | 14 KB | | form | pdf |
| DSS-1360: Work First Program Purchase of Services: Referral and Authorization | Form | pdf | 21 KB | | form | pdf |
| DSS-1402: CPS Intake Report | Form | pdf | 428 KB | | form | pdf |
| DSS-1402ins: CPS Intake Report Instructions | Form | pdf | 319 KB | | form | pdf |
| DSS-1403: North Carolina Requirement to Notify Child Protective Services (CPS) of Substance Affected Infant | Form | pdf | 274 KB | | form | pdf |
| DSS-1404: Care Management for At Risk Children (CMARC) Referral Form | Form | pdf | 2 MB | | form | pdf |
| DSS-1432: Application For Disaster Food and Nutrition Services | Form | pdf | 188 KB | | form | pdf |
| DSS-1432sp: División de Servicios Sociales de Carolina del Norte Solicitud de Servicios de Alimento y Nutrición por desastre | Form | pdf | 184 KB | | form | pdf |
| DSS-1451: Fire and Building Safety Inspection Report | Form | pdf | 16 KB | | form | pdf |
| DSS-1463: Title VI, Federal Civil Rights Act of 1964 | Form | pdf | 95 KB | | form | pdf |
| DSS-1464: Statement of Assurance of Compliance with Title VI of Civil Rights Act of 1964 | Form | pdf | 23 KB | | form | pdf |
| DSS-1464a: Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 for Other Agencies, Institutions, Organizations or Facilities | Form | pdf | 119 KB | | form | pdf |
| DSS-1473: Request for State Appeal | Form | pdf | 318 KB | | form | pdf |
| DSS-1473a: Request for State Appeal 1473-Addendum for Program Integrity | Form | pdf | 263 KB | | form | pdf |
| DSS-1473b: Request for State Appeal 1473-Addendum for Expedited MAD Medical Determination | Form | pdf | 248 KB | | form | pdf |
| DSS-1514: Fire and Building Safety Inspection Report (Institutional Building) | Form | pdf | 16 KB | | form | pdf |
| DSS-1515: Foster Home Fire Inspection Safety Report | Form | pdf | 38 KB | | form | pdf |
| DSS-1515sp: Reporte De Inspeccion Contra Incendios De Casa Foster | Form | pdf | 38 KB | | form | pdf |
| DSS-1516: Understanding Foster Care – A Handbook for Youth | Form | pdf | 679 KB | | form | pdf |
| DSS-1516sp: Entendiendo el Cuidado Foster–Libro para Jóvenes | Form | pdf | 641 KB | | form | pdf |
| DSS-1630: Application for Appointment of Personal Representative | Form | pdf | 21 KB | | form | pdf |
| DSS-1653: Report of Medical Examination | Form | pdf | 65 KB | | form | pdf |
| DSS-1656: Refund Receipt (Collection of Overpayment) | Form | pdf | 133 KB | | form | pdf |
| DSS-1662: Verification of Change in Situation | Form | pdf | 255 KB | | form | pdf |
| DSS-1662sp: Verificación de Cambio de Situación | Form | pdf | 256 KB | | form | pdf |
| DSS-1664: Report on Aid Needed by Inmate’s Dependents | Form | pdf | 32 KB | | form | pdf |
| DSS-1664sp: NC Departmento De Correccion Programa Work Release Reporte de Necesidad de Ayuda para Dependientes de un Interno | Form | pdf | 57 KB | | form | pdf |
| DSS-1665: Work First Cash Assistance Protective Payee Agreement | Form | pdf | 109 KB | | form | pdf |
| DSS-1665sp: Work First (Trabajar Primero) Asistencia Monetaria Acuerdo de Pago Protegido | Form | pdf | 158 KB | | form | pdf |
| DSS-1678_AR: إقرار خطي مشفوع بالقسم للاستبدال | Form | pdf | 78 KB | | form | pdf |
| DSS-1678_DE: Eidesstattliche Erklarung (Ersatz) | Form | pdf | 30 KB | | form | pdf |
| DSS-1678_FR: Declaration Sous Serment De Remplacement | Form | pdf | 29 KB | | form | pdf |
| DSS-1678_KO: 재지급 진술서 | Form | pdf | 111 KB | | form | pdf |
| DSS-1678_VI: BẢN TUYÊN THỆ THAY THẾ | Form | pdf | 104 KB | | form | pdf |
| DSS-1678: Replacement/Supplement Affidavit | Form | pdf | 122 KB | | form | pdf |
| DSS-1678sp: Declaracion Jurada Para Solicitar Reemplazo De Beneficios | Form | pdf | 149 KB | | form | pdf |
| DSS-1682: Report of Erroneous Issuance | Form | pdf | 219 KB | | form | pdf |
| DSS-1688_AR: قسم الخدمات الاجتماعية تعيين ممثل مفوض | Form | pdf | 70 KB | | form | pdf |
| DSS-1688_DE: Ernennung eines befugten Vertreters | Form | pdf | 50 KB | | form | pdf |
| DSS-1688_FR: Désignation du représentant autorisé | Form | pdf | 68 KB | | form | pdf |
| DSS-1688_KO: 공식 대리인 지정 | Form | pdf | 128 KB | | form | pdf |
| DSS-1688_VI: Chỉ Định Đại Diện Được Ủy Quyền | Form | pdf | 120 KB | | form | pdf |
| DSS-1688: Designation of Authorized Representative | Form | pdf | 43 KB | | form | pdf |
| DSS-1688sp: Designación de un Representante Autorizado | Form | pdf | 102 KB | | form | pdf |
| DSS-1700: Application Worksheet | Form | pdf | 166 KB | | form | pdf |
| DSS-1700sp: Hoja De Trabajo (Application Worksheet) | Form | pdf | 148 KB | | form | pdf |
| DSS-1783: Annual Statistical Report for Residential Child Care Facility | Form | pdf | 58 KB | | form | pdf |
| DSS-1789: Voluntary Placement Agreement | Form | pdf | 46 KB | | form | pdf |
| DSS-1789sp: Acuerdo de Colocacion Voluntario | Form | pdf | 35 KB | | form | pdf |
| DSS-1796: Agency/Foster Parents Agreement | Form | pdf | 86 KB | | form | pdf |
| DSS-1797: Inter-County Agreement on the Placement of Children | Form | pdf | 172 KB | | form | pdf |
| DSS-1798: Inter-Agency Adoption Agreement | Form | pdf | 25 KB | | form | pdf |
| DSS-1800: Petition for Adoption of a Minor Child | Form | pdf | 90 KB | | form | pdf |
| DSS-1800sp: Peticion De Adopcion De Un Menor | Form | pdf | 65 KB | | form | pdf |
| DSS-1801: Agency’s Consent to Adoption | Form | pdf | 48 KB | | form | pdf |
| DSS-1802: Consent to Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Father | Form | pdf | 94 KB | | form | pdf |
| DSS-1802sp: Consentimiento De Adopcion Por Padre, Guardian Ad Litem, O Guardian | Form | pdf | 50 KB | | form | pdf |
| DSS-1803: Consent of Child for Adoption | Form | pdf | 51 KB | | form | pdf |
| DSS-1804: Relinquishment of Minor for Adoption by Parent or Guardian | Form | pdf | 161 KB | | form | pdf |
| DSS-1804sp: Renuncia A Un Menor Para Adopcion Por Padre O Guardian | Form | pdf | 144 KB | | form | pdf |
| DSS-1805: Revocation of Relinquishment for Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Father | Form | pdf | 60 KB | | form | pdf |
| DSS-1805sp: Revocacion De Renuncia Para ADOPCION Por Padre O Guardian | Form | pdf | 156 KB | | form | pdf |
| DSS-1806: Revocation of Consent to Adoption by Parent, Guardian, or Guidian Ad Litem of the Mother/Father | Form | pdf | 29 KB | | form | pdf |
| DSS-1806sp: Revocacion De Consentimiento Para Adopcion Por Madre, Padre O Tutor | Form | pdf | 27 KB | | form | pdf |
| DSS-1807: Order for Report on Proposed Adoption | Form | pdf | 131 KB | | form | pdf |
| DSS-1808: Report on Proposed Adoption | Form | pdf | 298 KB | | form | pdf |
| DSS-1808ins: Instructions for Completing Form DSS-1808 | Form | pdf | 254 KB | | form | pdf |
| DSS-1809: Affidavit of Parentage | Form | pdf | 87 KB | | form | pdf |
| DSS-1809sp: Declaracion De Paternidad | Form | pdf | 40 KB | | form | pdf |
| DSS-1810: Guardianship Assistance Agreement | Form | pdf | 65 KB | | form | pdf |
| DSS-1811: Medical Examination | Form | pdf | 16 KB | | form | pdf |
| DSS-1811sp: Examen Medico Como Parte Del Informe A La Corte | Form | pdf | 16 KB | | form | pdf |
| DSS-1812 Autorización General Para El Tratamiento Y Los Medicamentos | Form | pdf | 158 KB | | form | pdf |
| DSS-1812: General Authorization for Treatment and Medication | Form | pdf | 238 KB | | form | pdf |
| DSS-1812ins: General Authorization for Treatment and Medication Instructions | Form | pdf | 225 KB | | form | pdf |
| DSS-1813: Guardianship Assistance Eligibility Checklist | Form | pdf | 182 KB | | form | pdf |
| DSS-1814: Decree of Adoption | Form | pdf | 55 KB | | form | pdf |
| DSS-1815: Report to Vital Records (Not Stepparent or Adult) | Form | pdf | 39 KB | | form | pdf |
| DSS-1815sp: Informe Para El Registro Civil | Form | pdf | 82 KB | | form | pdf |
| DSS-1816: Dismissal of Adoption | Form | pdf | 105 KB | | form | pdf |
| DSS-1820: NC Kids Child Registration Form | Form | pdf | 383 KB | | form | pdf |
| DSS-1820ins: NC Kids Child Registration Form Instructions | Form | pdf | 141 KB | | form | pdf |
| DSS-1821: NC Kids Family Registration Form | Form | pdf | 327 KB | | form | pdf |
| DSS-1821ins: NC Kids Family Registration Form Instructions | Form | pdf | 140 KB | | form | pdf |
| DSS-1837: Interstate Compact on the Placement of Children Request (ICPC 100A) | Form | pdf | 166 KB | | form | pdf |
| DSS-1837I: Instructions for Completing Form ICPC-100A Interstate Compact on the Placement of Children Request | Form | pdf | 125 KB | | form | pdf |
| DSS-1838: Interstate Compact Report on Child’s Placement Status (ICPC 100B) | Form | pdf | 127 KB | | form | pdf |
| DSS-1838I: Instructions for Completing Form ICPC-100B Interstate Compact Report on Child’s Placement Status | Form | pdf | 79 KB | | form | pdf |
| DSS-1839: Regulation 7 Form Order for Expedited Placement Decision Pursuant to the ICPC | Form | pdf | 112 KB | | form | pdf |
| DSS-1841: Regulation # 2 Case Manager Statement of Interest | Form | pdf | 181 KB | | form | pdf |
| DSS-2141: Monthly Requisition For Forms | Form | pdf | 177 KB | | form | pdf |
| DSS-2203: Daysheet | Form | pdf | 31 KB | | form | pdf |
| DSS-2204: Day Summary Sheet | Form | pdf | 25 KB | | form | pdf |
| DSS-2216: Request for Record | Form | pdf | 44 KB | | form | pdf |
| DSS-2239: IV-D Legal Services Bill | Form | pdf | 9 KB | | form | pdf |
| DSS-2249: Affidavit Of Adoption Expenditures | Form | pdf | 23 KB | | form | pdf |
| DSS-2250: Adoption Assistance Payment Authorization Notice | Form | pdf | 40 KB | | form | pdf |
| DSS-2435I_AR: شعار بانتهاء السريان ونموذج إعادة اعتماد المقابلة لبرنامج خدمات الطعام والتغذية | Form | pdf | 254 KB | | form | pdf |
| DSS-2435I_DE: Mitteilung über Ablauf von Lebensmittelleistungen und Formular für erneute Interviewbestätigung | Form | pdf | 167 KB | | form | pdf |
| DSS-2435I_FR: Services d’alimentation et de nutrition (FNS) Avis d’expiration et formulaire de renouvellement d’attestation | Form | pdf | 334 KB | | form | pdf |
| DSS-2435I_KO: 식품 및 영양 서비스(FNS) 만기 통지 및 면접 재인증 양식 | Form | pdf | 307 KB | | form | pdf |
| 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) | Form | pdf | 368 KB | | form | pdf |
| 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) | Form | pdf | 368 KB | | form | pdf |
| DSS-2435i: Food and Nutrition Services (FNS) Notice of Expiration and Interview Recertification Form | Form | pdf | 348 KB | | form | pdf |
| DSS-2435isp: Servicios de Alimentos y Nutrición (FNS). Aviso de Expiración y Formulario de Entrevista de Re-Certificación | Form | pdf | 396 KB | | form | pdf |
| DSS-2435R_AR: إشعار بانتهاء السريان ونموذج إعادة اعتماد المقابلة لبرنامج خدمات الطعام والتغذية | Form | pdf | 249 KB | | form | pdf |
| DSS-2435R_DE: Mitteilung über Ablauf von Lebensmittelleistungen und Formular für erneute Zertifizierung | Form | pdf | 172 KB | | form | pdf |
| DSS-2435R_FR: Services d’alimentation et de nutrition (FNS) Avis d’expiration et formulaire de renouvellement d’attestation | Form | pdf | 334 KB | | form | pdf |
| DSS-2435R_KO: 식품 및 영양 서비스(FNS) 만기 통지 및 재인증 양식 | Form | pdf | 307 KB | | form | pdf |
| 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) | Form | pdf | 368 KB | | form | pdf |
| DSS-2435r: Food and Nutrition Services (FNS) Notice of Expiration Recertification Form | Form | pdf | 345 KB | | form | pdf |
| DSS-2435rsp: Alimentos y Nutrición (FNS). Aviso de Expiración y Forma de Re-Certificación | Form | pdf | 407 KB | | form | pdf |
| DSS-2435sri_AR: الحقوق والمسؤوليات | Form | pdf | 227 KB | | form | pdf |
| DSS-2435sri_DE: Rechte Und Verantwortungen | Form | pdf | 51 KB | | form | pdf |
| DSS-2435sri_KO: 권리와 의무 | Form | pdf | 169 KB | | form | pdf |
| DSS-2435sri_VI: QUYỀN VÀ TRÁCH NHIỆM | Form | pdf | 194 KB | | form | pdf |
| DSS-2435sri: Rights and Responsibilities | Form | pdf | 166 KB | | form | pdf |
| DSS-2435srisp: Derechos Y Responsabilidades | Form | pdf | 112 KB | | form | pdf |
| DSS-2624: Food and Nutrition Services Referral Form | Form | pdf | 39 KB | | form | pdf |
| DSS-2625: Food and Nutrition Services E&T Information Transmittal | Form | pdf | 127 KB | | form | pdf |
| DSS-2807-II: Part II, Report on Local Hearings | Form | pdf | 99 KB | | form | pdf |
| DSS-2807: Part 1, Report on Local Hearings – Summary | Form | pdf | 13 KB | | form | pdf |
| DSS-2987_ES: Declaración del Propietario | Form | pdf | 316 KB | | form | pdf |
| DSS-2abl: First Notice to Work First Families with Two Adult Recipients Able to Work | Form | pdf | 12 KB | | form | pdf |
| DSS-3000 Appointment Follow-up Letter Regarding SA Assistance Request | Form | pdf | 56 KB | | form | pdf |
| DSS-3001: Notice of County of Residence Reassignment/Transfer | Form | pdf | 30 KB | | form | pdf |
| DSS-3001sp Notificación sobre reasignación o transferencia | Form | pdf | 32 KB | | form | pdf |
| DSS-3002 Agreement to Sell | Form | pdf | 73 KB | | form | pdf |
| DSS-3002sp Compromiso de venta | Form | pdf | 75 KB | | form | pdf |
| DSS-3003 Important Information About Your Special Assistance and Your Resources | Form | pdf | 22 KB | | form | pdf |
| DSS-3004 Referral to SSA for Waiver or Reduction of Overpayment Recoupment | Form | pdf | 57 KB | | form | pdf |
| DSS-3005 Documentation Regarding Continuation of Special Assistance When the LOC Is Upgraded, But No Bed Is Available | Form | pdf | 53 KB | | form | pdf |
| DSS-3006 Medical Care Special / Medical Expense Form | Form | pdf | 57 KB | | form | pdf |
| DSS-3431: Request for Financial Information | Form | pdf | 97 KB | | form | pdf |
| DSS-3449_DE: Genehmigung für vom Landwirtschaftsministerium der Vereinigten Staaten von Amerika gespendete Lebensmittel | Form | pdf | 19 KB | | form | pdf |
| DSS-3449_FR: Autorisation de dons de produits alimentaires du Département de l’agriculture des États-Unis (USDA) | Form | pdf | 18 KB | | form | pdf |
| DSS-3449_KO: 미농무부(USDA)가 기부한 식품에 대한 승인 | Form | pdf | 111 KB | | form | pdf |
| DSS-3449_VI: Uỷ Quyền Nhận Thực Phẩm Được Quyên Góp Của USDA | Form | pdf | 124 KB | | form | pdf |
| DSS-4278: Reunification Referring Agency Referral Form | Form | pdf | 82 KB | | form | pdf |
| DSS-4279: Intensive Family Preservation Referring Agency Referral Form | Form | pdf | 49 KB | | form | pdf |
| DSS-4451: Application for Child Support Services | Form | pdf | 1 MB | | form | pdf |
| DSS-4451sp: Solicitud De Servicios De Sustento De Menores | Form | pdf | 1 MB | | form | pdf |
| DSS-4718: CSE Direct Deposit Authorization | Form | pdf | 47 KB | | form | pdf |
| DSS-4718sp: Autorizacion Para Deposito Directo | Form | pdf | 39 KB | | form | pdf |
| DSS-5002: Child Welfare Services Corrective Action Plan | Form | xlsx | 32 KB | | form | xlsx |
| DSS-5009: Fatality Notification | Form | pdf | 314 KB | | form | pdf |
| DSS-5009A: Instructions for Fatality Notification | Form | pdf | 204 KB | | form | pdf |
| DSS-5010: Structured Documentation Instrument for CPS Assessments | Form | pdf | 1 MB | | form | pdf |
| DSS-5010a: Continuing Need and Safety Requirements | Form | pdf | 103 KB | | form | pdf |
| DSS-5010ins: NC CPS Assessments Documentation Tool (DSS-5010) Instructions | Form | pdf | 244 KB | | form | pdf |
| DSS-5010sp Herramienta De Documentacion De La Evaluatcion De Los CPS De Carolina Del Norte | Form | pdf | 987 KB | | form | pdf |
| DSS-5012: Adoption Assistance Eligibility Checklist | Form | pdf | 252 KB | | form | pdf |
| DSS-5012sp: Lista Para Revisar Eligibilidad De Asistencia Por Adopcion | Form | pdf | 227 KB | | form | pdf |
| DSS-5013: North Carolina Adoption Assistance Agreement | Form | pdf | 235 KB | | form | pdf |
| DSS-5013sp: Acuerdo De Asistencia Por Adopcion De Carolina Del Norte | Form | pdf | 200 KB | | form | pdf |
| DSS-5015: Foster Care Facility Action Request | Form | pdf | 30 KB | | form | pdf |
| DSS-5016: Foster Home License Application | Form | pdf | 538 KB | | form | pdf |
| DSS-5016sp: Solicitud De Licencia Para Casa Foster | Form | pdf | 530 KB | | form | pdf |
| DSS-5017: Medical History Form | Form | pdf | 54 KB | | form | pdf |
| DSS-5017sp: Forma De Historial Medico | Form | pdf | 103 KB | | form | pdf |
| DSS-5018 Autorizacion De Hogares De Acogida Formulario De Evaluacion De Seguridad En Relacion Con El Agua | Form | pdf | 186 KB | | form | pdf |
| DSS-5018: Foster Home Licensing Water Hazard Safety Assessment Form | Form | pdf | 189 KB | | form | pdf |
| DSS-5018a: Foster Home Licensing Individual Water Hazard Safety Plan | Form | pdf | 338 KB | | form | pdf |
| DSS-5022: Refugee Work Registration Certification, Employment/Refusal and Termination/Denial Notice | Form | pdf | 94 KB | | form | pdf |
| DSS-5023: Direct Deposit Enrollment Authorization Form | Form | pdf | 183 KB | | form | pdf |
| DSS-5023sp: Forma de Autorización para Deposito Directo | Form | pdf | 205 KB | | form | pdf |
| DSS-5027: Client Entry Form | Form | pdf | 123 KB | | form | pdf |
| DSS-5027A: Client Entry – Purchase of Service Provider Form | Form | pdf | 72 KB | | form | pdf |
| DSS-5030: Confidential Intermediary Agreement | Form | pdf | 68 KB | | form | pdf |
| DSS-5031: Application for Confidential Intermediary Services | Form | pdf | 129 KB | | form | pdf |
| DSS-5032: Consent to Release of Information and/or Contact | Form | pdf | 68 KB | | form | pdf |
| DSS-5033: Release of Liability and Agreement to Hold Harmless | Form | pdf | 15 KB | | form | pdf |
| DSS-5094: Child Placement and Payment Report | Form | pdf | 132 KB | | form | pdf |
| DSS-5094a: Foster Care Visit Report | Form | pdf | 19 KB | | form | pdf |
| DSS-5094c: Child Placement and Payment Report Continuation Page | Form | pdf | 24 KB | | form | pdf |
| DSS-5095: NC DSS Child Placement and Payment System Adoption Assistance | Form | pdf | 26 KB | | form | pdf |
| DSS-5096A Plan De Hogar Transitorio | Form | pdf | 320 KB | | form | pdf |
| DSS-5096a: Transitional Living Plan For Youth/Young Adults in Foster Care | Form | pdf | 679 KB | | form | pdf |
| DSS-5096B: Plan De Hogar Transitorio | Form | pdf | 319 KB | | form | pdf |
| DSS-5096b: Transitional Living Plan – 90 Day Transition Plan for Youth in Foster Care | Form | pdf | 797 KB | | form | pdf |
| DSS-5096C: Plan De Hogar Transitorio | Form | pdf | 297 KB | | form | pdf |
| DSS-5096c: Transitional Living Plan – 90 Day Transition Plan For Young Adults In Foster Care 18 to 21 | Form | pdf | 299 KB | | form | pdf |
| DSS-5096D: Plan De Hogar Transitorio | Form | pdf | 176 KB | | form | pdf |
| DSS-5096d: Transitional Living Plan – Helpful Resources For Young Adults | Form | pdf | 581 KB | | form | pdf |
| DSS-5097: Voluntary Placement Agreement for Foster Care 18 to 21 | Form | pdf | 362 KB | | form | pdf |
| DSS-5098 Registro Mensual De Contactos | Form | pdf | 287 KB | | form | pdf |
| DSS-5098: North Carolina Monthly Contact Record For Foster Care 18 to 21 | Form | pdf | 421 KB | | form | pdf |
| DSS-5099: Placement Agreement For Foster Care 18 to 21 | Form | pdf | 458 KB | | form | pdf |
| DSS-5100: Semi-Supervised Independent Living Assessment Tool | Form | pdf | 378 KB | | form | pdf |
| DSS-5102: NC DSS Non-Identifying Background Information | Form | pdf | 188 KB | | form | pdf |
| DSS-5102sp: Historial, Sin Proporcionar Informacion Paraidentificar A Alguna Persona Especifica | Form | pdf | 128 KB | | form | pdf |
| DSS-5103: Adoption Health History | Form | pdf | 285 KB | | form | pdf |
| DSS-5103sp: Historial Clínico para Adopción, Parte I | Form | pdf | 38 KB | | form | pdf |
| DSS-5104: Report to Central Registry/CPS Application | Form | pdf | 152 KB | | form | pdf |
| DSS-5104a: Responsible Individuals List Form | Form | pdf | 285 KB | | form | pdf |
| DSS-5104c: Central Registry Report Continuation Page-Children | Form | pdf | 176 KB | | form | pdf |
| DSS-5104d: Modification/Deletion Request Form | Form | pdf | 73 KB | | form | pdf |
| DSS-5104p: Central Registry Report Continuation Page – Perpetrator | Form | pdf | 42 KB | | form | pdf |
| DSS-5105: North Carolina Diligent Efforts to Identify and/or Locate | Form | docx | 36 KB | | form | docx |
| DSS-5106: North Carolina Multiple Response System Case Tracking Form | Form | pdf | 37 KB | | form | pdf |
| DSS-5108A: DSS/Student Contractual Agreement for Continuing Residential Support CARS – Six Month Review | Form | pdf | 52 KB | | form | pdf |
| DSS-5108asp: Contrato de Estudiante/DSS para Apoyo residencial permanente (CARS) Revisión a los seis meses | Form | pdf | 45 KB | | form | pdf |
| DSS-5112: Adoption Assistance Vendor Payment Request Form | Form | pdf | 37 KB | | form | pdf |
| DSS-5113: Adoption Services Agreement | Form | pdf | 279 KB | | form | pdf |
| DSS-5115: Adoption Assistance Vendor Payment Instructions for Providers | Form | pdf | 58 KB | | form | pdf |
| DSS-5115sp: Programa De Asistencia Para Adopcion Instrucciones De Pago | Form | pdf | 44 KB | | form | pdf |
| DSS-5118: Denial of Paternity | Form | pdf | 31 KB | | form | pdf |
| DSS-5118sp: Negacion De Paternidad | Form | pdf | 29 KB | | form | pdf |
| DSS-5120: Determination of Foster Care Assistance Benefits and/or Medical Assistance Only | Form | pdf | 439 KB | | form | pdf |
| DSS-5120A: Re-determination of Foster Care Assistance Benefits and/or Medical Assistance Only | Form | pdf | 110 KB | | form | pdf |
| DSS-5120B: Additional Siblings in Removal Home | Form | pdf | 111 KB | | form | pdf |
| DSS-5120C: Additional Members of the Family Assistance Unit | Form | pdf | 87 KB | | form | pdf |
| DSS-5120E: Determination Of Foster Care 18 to 21 Assistance Benefits and/or Medical Assistance Only | Form | pdf | 315 KB | | form | pdf |
| DSS-5133: Foster Child Notification of Placement (Change) Form | Form | pdf | 169 KB | | form | pdf |
| DSS-5133ins: Foster Child Notification of Placement (Change) Form Instructions | Form | pdf | 140 KB | | form | pdf |
| DSS-5135: Foster Child Immediate Enrollment Form | Form | pdf | 137 KB | | form | pdf |
| DSS-5137: Best Interest Determination Form | Form | pdf | 469 KB | | form | pdf |
| DSS-5137a: North Carolina Best Interest Determination Meeting Override | Form | pdf | 208 KB | | form | pdf |
| DSS-5137sp: Formulario De Determinación De Mejor Interés | Form | pdf | 180 KB | | form | pdf |
| DSS-5143: Consent/Authorization For Medical/Mental Health Evaluation | Form | pdf | 233 KB | | form | pdf |
| DSS-5143sp: Consentimiento/Autorizacion Para Evaluacion De La Salud Medica/Mental Programa De Evaluacion Medica Del | Form | pdf | 212 KB | | form | pdf |
| DSS-5145: State of North Carolina Application for Reimbursement of Non-Recurring Adoption Costs | Form | pdf | 200 KB | | form | pdf |
| DSS-5145sp: Estado De Carolina Del Norte Solicitud Para REEMBOLSO De Costos No Repetitivos De Adopcion | Form | pdf | 169 KB | | form | pdf |
| DSS-5146: Agreement for Reimbursement of Non-Recurring Adoption Costs | Form | pdf | 50 KB | | form | pdf |
| DSS-5146sp: Estado De Carolina Del Norte Convenio Por Reembolso De Costo Costos No Repetitivos De Adopcion | Form | pdf | 55 KB | | form | pdf |
| DSS-5150: Foster Home Environmental Conditions Report | Form | pdf | 54 KB | | form | pdf |
| DSS-5150sp: Reporte De Condiciones De Casa Foster | Form | pdf | 40 KB | | form | pdf |
| DSS-5152-iisp: Componente Del Estado De Salud Del Nino(a) | Form | pdf | 23 KB | | form | pdf |
| DSS-5156: Medical Evaluation | Form | pdf | 65 KB | | form | pdf |
| DSS-5156sp: Evaluacion Medica | Form | pdf | 61 KB | | form | pdf |
| DSS-5157: Foster Home Relicense, Termination and Change Request Application | Form | pdf | 182 KB | | form | pdf |
| DSS-5157sp: Solicitud de Renovacion de Licencia de Casa Foster | Form | pdf | 203 KB | | form | pdf |
| DSS-5158: Foster Home Transfer Request Application | Form | pdf | 134 KB | | form | pdf |
| DSS-5158sp: Solicitud De Transferencia De Casa Foster | Form | pdf | 140 KB | | form | pdf |
| DSS-5159: Foster Home Change Request Application | Form | pdf | 247 KB | | form | pdf |
| DSS-5159sp: Solicitud De Cambio | Form | pdf | 252 KB | | form | pdf |
| DSS-5160 Solicitud De Cese Del Hogar De Acogida | Form | pdf | 142 KB | | form | pdf |
| DSS-5160: Foster Home Termination Application | Form | pdf | 102 KB | | form | pdf |
| DSS-5162: Petition for Adoption of a Minor Child (Step-parent) | Form | pdf | 51 KB | | form | pdf |
| DSS-5162sp: Solicitud Para ADOPCIÓN De Un(a) Nino(a) Menor | Form | pdf | 31 KB | | form | pdf |
| DSS-5163: Petition for Adult Adoption | Form | pdf | 185 KB | | form | pdf |
| DSS-5163sp: Solicitud Para Adopcion De Adulto | Form | pdf | 22 KB | | form | pdf |
| DSS-5164: Consent to Adoption by Adult Adoptee | Form | pdf | 27 KB | | form | pdf |
| DSS-5164sp: Consentimiento De Adopcion Por Adulto Adoptado | Form | pdf | 18 KB | | form | pdf |
| DSS-5165: Consent to Adult Adoption by Spouse of Petitioner | Form | pdf | 125 KB | | form | pdf |
| DSS-5165sp: Consentimiento Para Adopcion De Adulto Por Conyuge De Solicitante | Form | pdf | 18 KB | | form | pdf |
| DSS-5166: Decree of Adult Adoption | Form | pdf | 108 KB | | form | pdf |
| DSS-5167: Report to Vital Records for Adult Adoption | Form | pdf | 37 KB | | form | pdf |
| DSS-5167sp: Informe Al Registro Civil Para Adopcion De Adulto | Form | pdf | 59 KB | | form | pdf |
| DSS-5168: Revocation of Child’s Consent to Adoption | Form | pdf | 19 KB | | form | pdf |
| DSS-5168sp: Revocacion Del Consentimiento Para Adopcion Del Nino(a) | Form | pdf | 21 KB | | form | pdf |
| DSS-5169: Consent of Child for Adoption (Step-parent Adoption) | Form | pdf | 91 KB | | form | pdf |
| DSS-5169sp: Consentimiento Del Nino(a) Para Adopcion | Form | pdf | 22 KB | | form | pdf |
| DSS-5170: Report to Vital Records (Stepparent Adoption) | Form | pdf | 128 KB | | form | pdf |
| DSS-5189-iiisp: Departamento de Servicios Sociales ha programado una reunión del Equipo de Acción de Planeamiento de Permanencia | Form | pdf | 96 KB | | form | pdf |
| DSS-5189-iisp: Notice to Parent Regarding a Change in Placement of Children-Spanish | Form | pdf | 88 KB | | form | pdf |
| DSS-5189-isp: Notice to Parent Regarding Proposed Change in the Placement of Children-Spanish | Form | pdf | 86 KB | | form | pdf |
| DSS-5189-ivsp: Notice to Parent Regarding Permanency Planning Review Outcome | Form | pdf | 44 KB | | form | pdf |
| DSS-5189: Consent to Adoption by Parent Who is Spouse of Stepparent | Form | pdf | 53 KB | | form | pdf |
| DSS-5189I: Notice to Parent of Proposed Change in Placement of Child(ren) | Form | pdf | 40 KB | | form | pdf |
| DSS-5189II: Notice to Parent Regarding Proposed Change in the Placement of Child(ren) | Form | pdf | 39 KB | | form | pdf |
| DSS-5189III: Notice to Permanency Planning Review | Form | pdf | 83 KB | | form | pdf |
| DSS-5189IV: Notice to Parent Regarding Permanency Planning Review Outcome | Form | pdf | 41 KB | | form | pdf |
| DSS-5189sp: Consentimiento De Adopcion Otorgado Por Padre/Madre Que Es Conyuge De Madrastra/Padrastro | Form | pdf | 25 KB | | form | pdf |
| DSS-5190: Consent to Adoption by Parent Who Is Not the Stepparent’s Spouse | Form | pdf | 52 KB | | form | pdf |
| DSS-5190sp: Consent of Adoption by Parent who is not the Stepparent’s Spouse-Spanish | Form | pdf | 49 KB | | form | pdf |
| DSS-5191: Affidavit – Disclosure of Fees & Expenses | Form | pdf | 41 KB | | form | pdf |
| DSS-5191sp: Declaracion Jurada Divulgacion De Honorarios Y Gastos | Form | pdf | 15 KB | | form | pdf |
| DSS-5199: Foster Home Request for Waiver | Form | pdf | 40 KB | | form | pdf |
| DSS-5201: Understanding Foster Care – A Handbook for Parents | Form | pdf | 171 KB | | form | pdf |
| DSS-5203: Initial Provider Assessment | Form | pdf | 258 KB | | form | pdf |
| DSS-5203ins: Initial Provider Assessment Instructions | Form | pdf | 164 KB | | form | pdf |
| DSS-5203sp: Evaluación inicial del cuidado por parientes | Form | pdf | 333 KB | | form | pdf |
| DSS-5204: Comprehensive Provider Assessment | Form | pdf | 288 KB | | form | pdf |
| DSS-5204ins: Instructions for Comprehensive Provider Assessment | Form | pdf | 180 KB | | form | pdf |
| DSS-5204sp: Evaluación completa del cuidado por parientes | Form | pdf | 39 KB | | form | pdf |
| DSS-5206: Health Summary Form – Initial Visit | Form | pdf | 46 KB | | form | pdf |
| DSS-5207: Health History Form | Form | pdf | 188 KB | | form | pdf |
| DSS-5207ins: Health History Form Instructions | Form | pdf | 43 KB | | form | pdf |
| DSS-5208: Health Summary Form – 30-day Comprehensive Visit | Form | pdf | 162 KB | | form | pdf |
| DSS-5209: Health Summary Form – Well-Visit | Form | pdf | 62 KB | | form | pdf |
| DSS-5211: Special Children’s Adoption Incentive Fund – Request for Payment | Form | pdf | 44 KB | | form | pdf |
| DSS-5212: Supplemental Adoption Assistance Agreement | Form | pdf | 87 KB | | form | pdf |
| DSS-5212sp: Fondo De Incentivos Para La Adopcion De Ninos Especiales Convenio Complementario De Asistencia Para Adopcion | Form | pdf | 38 KB | | form | pdf |
| DSS-5213: Verification of Child’s Need for Daily Supervision | Form | pdf | 19 KB | | form | pdf |
| DSS-5214: Agency Verification of Legal Custody and Child’s Living Arrangement for Past Six Months | Form | pdf | 24 KB | | form | pdf |
| DSS-5215: Verification of Child’s Health Condition | Form | pdf | 17 KB | | form | pdf |
| DSS-5217: Request for Reimbursement Of Links Special Funds | Form | pdf | 27 KB | | form | pdf |
| DSS-5218: Consent to Release of Identifying Information | Form | pdf | 28 KB | | form | pdf |
| DSS-5219: Certificate of Delivery of Preplacement Assessment | Form | pdf | 130 KB | | form | pdf |
| DSS-5219sp: Certificado de entrega de la evaluación previa a la colocación | Form | pdf | 37 KB | | form | pdf |
| DSS-5225: Request for NC KIDS Legal Risk Search | Form | pdf | 438 KB | | form | pdf |
| DSS-5225sp: Peticion Para Investigacion De Riesgo De NC KIDS | Form | pdf | 249 KB | | form | pdf |
| DSS-5226: NC SDM Family Risk ReAssessment | Form | pdf | 99 KB | | form | pdf |
| DSS-5226sp: Carolina Del Norte Reevaluacion Del Riesgo Familiar De Abuso / Desciodo | Form | pdf | 227 KB | | form | pdf |
| DSS-5227: NC SDM Family Reunification Assessment | Form | pdf | 204 KB | | form | pdf |
| DSS-5227sp: SDM ® Evaluacion De Reunificacion Familiar | Form | pdf | 267 KB | | form | pdf |
| DSS-5229_ZH-CN: 北卡罗来纳州 家庭能力和需求评估 | Form | pdf | 309 KB | | form | pdf |
| DSS-5229: North Carolina Family Assessment of Strengths and Needs | Form | pdf | 155 KB | | form | pdf |
| DSS-5229sp: Evaluacion De Los Aspectos Fuertes Y Necesidades De La Familia | Form | pdf | 181 KB | | form | pdf |
| DSS-5230: NC SDM Family Risk Assessment of Child Abuse/Neglect | Form | pdf | 215 KB | | form | pdf |
| DSS-5230sp: SDM ®Evaluacion De Riesgo Familiar De Abuso/Negligencia | Form | pdf | 126 KB | | form | pdf |
| DSS-5231 ia: Évaluation de la sécurité en Caroline du Nord | Form | pdf | 360 KB | | form | pdf |
| DSS-5231: North Carolina Safety Assessment | Form | pdf | 408 KB | | form | pdf |
| DSS-5231ins: North Carolina Safety Assessment Instructions | Form | pdf | 129 KB | | form | pdf |
| DSS-5231sp: Carolina Del Norte Evaluacion De Seguridad | Form | pdf | 437 KB | | form | pdf |
| DSS-5233: Personalized Domestic Violence Safety Plan | Form | pdf | 32 KB | | form | pdf |
| DSS-5234: Domestic Violence Perpetrator Assessment Tool | Form | pdf | 91 KB | | form | pdf |
| DSS-5235 – Non-Offending Parent/Adult Victim Domestic Violence Assessment Tool | Form | pdf | 154 KB | | form | pdf |
| DSS-5236: North Carolina Monthly In-Home Contact Record | Form | pdf | 218 KB | | form | pdf |
| DSS-5236ins – North Carolina Monthly In-Home Contact Record Instructions | Form | pdf | 94 KB | | form | pdf |
| DSS-5237: Children’s Domestic Violence Assessment Tool | Form | pdf | 78 KB | | form | pdf |
| DSS-5238: DSS Referral Form for Early Intervention Services (CDSA) | Form | pdf | 180 KB | | form | pdf |
| DSS-5239: In Home Family Services Agreement | Form | pdf | 318 KB | | form | pdf |
| DSS-5239ins: In-Home family Services Agreement Completion Instructions | Form | pdf | 214 KB | | form | pdf |
| DSS-5239sp: Acuerdo De Servicios De Familia En Casa De Carolina Del Norte | Form | pdf | 341 KB | | form | pdf |
| DSS-5239spa: Acuerdo de Servicios para la Familia en el Hogar | Form | pdf | 59 KB | | form | pdf |
| DSS-5240: Permanency Planning Family Services Agreement | Form | pdf | 439 KB | | form | pdf |
| DSS-5240ins: Permanency Planning Family Services Agreement Instructions | Form | pdf | 211 KB | | form | pdf |
| DSS-5240sp: Acuerdo De Servicios Familiares De Planificación De Permanencia En Carolina Del Norte | Form | pdf | 826 KB | | form | pdf |
| DSS-5241: Permanency Planning Review | Form | pdf | 452 KB | | form | pdf |
| DSS-5241ins: Permanency Planning Review Instructions | Form | pdf | 160 KB | | form | pdf |
| DSS-5241sp: Reviso de la Evaluación de Acuerdo de Servicios Familiares | Form | pdf | 425 KB | | form | pdf |
| DSS-5242: Family Time and Contact Plan (Visitation) | Form | pdf | 117 KB | | form | pdf |
| DSS-5242sp: Regimen De Visitas y Contacto | Form | pdf | 356 KB | | form | pdf |
| DSS-5245: Child Education Status | Form | pdf | 148 KB | | form | pdf |
| DSS-5245ins: Child Education Status Instructions | Form | pdf | 112 KB | | form | pdf |
| DSS-5246: Information Sharing Achnowledgement | Form | pdf | 131 KB | | form | pdf |
| DSS-5246sp: Acuse De Recibo De Informacion Compartida | Form | pdf | 49 KB | | form | pdf |
| DSS-5247: Information Sharing Partnership Agreement | Form | pdf | 69 KB | | form | pdf |
| DSS-5248: ICAMA Form 6.02, Notice of Action | Form | pdf | 63 KB | | form | pdf |
| DSS-5249: Icama Form 6.01, Notice of Medicaid Eligibility/Case Activation | Form | pdf | 162 KB | | form | pdf |
| DSS-5250: ICAMA Form 6.03, Report of Change in Child(ren) Family Status | Form | pdf | 116 KB | | form | pdf |
| DSS-5251: ICPC Financial-Medical Plan | Form | pdf | 66 KB | | form | pdf |
| DSS-5252: ICPC Sending State Priority Home Study Request | Form | pdf | 206 KB | | form | pdf |
| DSS-5253: ICPC Receiving State Priority Home Study Request | Form | pdf | 231 KB | | form | pdf |
| DSS-5255: ICPC Checklist for Interstate Placement Requests | Form | pdf | 32 KB | | form | pdf |
| DSS-5256: Drug Endangered Children Protocol: Initial Medical Assessment | Form | pdf | 32 KB | | form | pdf |
| DSS-5257: Drug Endangered Children Protocol – Placement Guidelines | Form | pdf | 151 KB | | form | pdf |
| DSS-5257: Protocolo para niños en peligro a la exposición de drogas: pautas de colocación | Form | pdf | 145 KB | | form | pdf |
| DSS-5258: Protocol for Field Assessment to Determine Need for On-Scene Decontamination Prior to Transport | Form | pdf | 383 KB | | form | pdf |
| DSS-5259: Drug Endangered Children Protocol: Exposure Record | Form | pdf | 38 KB | | form | pdf |
| DSS-5260: Drug Endangered Children Protocol Feedback Form: Law Enforcement | Form | pdf | 13 KB | | form | pdf |
| DSS-5261: Drug Endangered Children Protocol Feedback Form: Social Worker | Form | pdf | 15 KB | | form | pdf |
| DSS-5262: Drug Endangered Children Protocol Feedback Form: Health Care Provider | Form | pdf | 17 KB | | form | pdf |
| DSS-5263: Drug Endangered Children Protocol Feedback Form: Foster Care Provider | Form | pdf | 13 KB | | form | pdf |
| DSS-5264: Family Support Parent and Family Questionnaire – Client Satisfaction Survey | Form | pdf | 312 KB | | form | pdf |
| DSS-5264sp: Encuesta Sobre Servicios al Cliente – Programa de Ayuda a la Familia y Bienestar del Niño | Form | pdf | 49 KB | | form | pdf |
| DSS-5266: 24 Month Time Limit | Form | pdf | 32 KB | | form | pdf |
| DSS-5266sp: Estimada familia del programa Work First | Form | pdf | 23 KB | | form | pdf |
| DSS-5267: 60 Month Lifetime Limit | Form | pdf | 15 KB | | form | pdf |
| DSS-5267sp: Estimada familia del programa Work First Período de por vida de 60 meses | Form | pdf | 22 KB | | form | pdf |
| DSS-5268: Responsible Individuals List (RIL) Information Request | Form | pdf | 213 KB | | form | pdf |
| DSS-5268sp: Solicitud de Información: Lista de Individuos Responsables (RIL) | Form | pdf | 171 KB | | form | pdf |
| DSS-5271: Individual Criminal Violations Declaration Statement | Form | pdf | 30 KB | | form | pdf |
| DSS-5271sp: Declaración de Delitos Penales Individuales | Form | pdf | 23 KB | | form | pdf |
| DSS-5272: Facility ID Number Application | Form | pdf | 115 KB | | form | pdf |
| DSS-5273: Verification of Participation | Form | pdf | 35 KB | | form | pdf |
| DSS-5274: Request for Adjustment to Foster Care Assistance Payment | Form | pdf | 76 KB | | form | pdf |
| DSS-5275: North Carolina Residency Declaration | Form | pdf | 24 KB | | form | pdf |
| DSS-5275sp: Declaración de Residencia en Carolina del Norte | Form | pdf | 23 KB | | form | pdf |
| DSS-5276: North Carolina Residency Applicant Statement | Form | pdf | 17 KB | | form | pdf |
| DSS-5276sp: Declaración del solicitante de residencia en Carolina del Norte | Form | pdf | 19 KB | | form | pdf |
| DSS-5277: Request for Confidential Information Regarding Child Abuse, Neglect and/or Dependency | Form | pdf | 95 KB | | form | pdf |
| DSS-5278: Request for Placement Evaluation for Infant Born to an Incarcerated Mother | Form | pdf | 88 KB | | form | pdf |
| DSS-5279: Request for Revocation of a Foster Home License | Form | pdf | 161 KB | | form | pdf |
| DSS-5280: Notice Foster Home Mandatory Criminal History Check | Form | pdf | 14 KB | | form | pdf |
| DSS-5281 Critical Incident Reporting Form | Form | pdf | 98 KB | | form | pdf |
| DSS-5282: Notification of CPS Involvement | Form | pdf | 125 KB | | form | pdf |
| DSS-5283: Regulatory and Licensing Services Complaint Form | Form | pdf | 22 KB | | form | pdf |
| DSS-5283sp: División de Servicios Sociales de Carolina del NorteForma de Queja de Servicios de Regulaciones y Licencias | Form | pdf | 74 KB | | form | pdf |
| DSS-5285: Child and Family Services Review Protocol for Pilot Counties | Form | pdf | 31 KB | | form | pdf |
| DSS-5286: Stakeholder Questionnaire | Form | pdf | 16 KB | | form | pdf |
| DSS-5287: NC DSS Child and Family Services Review Protocol | Form | pdf | 72 KB | | form | pdf |
| DSS-5288: Notice of Extension Hearing | Form | pdf | 21 KB | | form | pdf |
| DSS-5288sp: Aviso De Audiencia De Extension | Form | pdf | 26 KB | | form | pdf |
| DSS-5288sp: Aviso De Audiencia De Extension | Form | pdf | 26 KB | | form | pdf |
| DSS-5290-B: Notice of Work First 60-Month State Time Clock Starting | Form | pdf | 62 KB | | form | pdf |
| DSS-5290-Bsp: Aviso de los 60 meses iniciales de su participación en el Programa Work First (Trabajar Primero) | Form | pdf | 64 KB | | form | pdf |
| DSS-5290: Notice of Work First 24-Month State Time Clock Starting | Form | pdf | 20 KB | | form | pdf |
| DSS-5291: Indian Child Welfare Act Compliance Checklist | Form | pdf | 257 KB | | form | pdf |
| DSS-5292: Work First Participation Summary | Form | pdf | 93 KB | | form | pdf |
| DSS-5292sp: Resumen De Participacion En El Programa Work First | Form | pdf | 26 KB | | form | pdf |
| DSS-5293: Notice of Hardship Exemption Hearing | Form | pdf | 22 KB | | form | pdf |
| DSS-5293sp: Aviso De Audiencia De Exencion Por Penuria | Form | pdf | 32 KB | | form | pdf |
| DSS-5294: Notice of Decision on Hardship Exemption Request | Form | pdf | 22 KB | | form | pdf |
| DSS-5294sp: Aviso De Decision Sobre Solicitud De Exencion | Form | pdf | 28 KB | | form | pdf |
| DSS-5295: Monthly Permanency Planning Contact Record | Form | pdf | 171 KB | | form | pdf |
| DSS-5295ins: Monthly Permanency Planning Contact Record Instructions | Form | pdf | 114 KB | | form | pdf |
| DSS-5295sp: Registro De Contacto Mensual De Padres Foster En Carolina Del Norte | Form | pdf | 233 KB | | form | pdf |
| DSS-5297: Consent for Release of Confidential Information | Form | pdf | 52 KB | | form | pdf |
| DSS-5297sp: Consentimiento para Divulgar Información Confidencial | Form | pdf | 53 KB | | form | pdf |
| DSS-5298: North Carolina’s Work First Family Assessment of Strengths and Needs | Form | pdf | 76 KB | | form | pdf |
| DSS-5298sp: Porgrama Work First de Carolina del Norte Evaluación de fortalezas y necesidades de la familia | Form | pdf | 90 KB | | form | pdf |
| DSS-5299: 24-Month Time Limit Checklist | Form | pdf | 41 KB | | form | pdf |
| DSS-5300: Notice of Decision on Extension Request | Form | pdf | 22 KB | | form | pdf |
| DSS-5300sp: Aviso De Decision Sobre Solicitud De Extension | Form | pdf | 57 KB | | form | pdf |
| DSS-5301: Extension Hearing Request | Form | pdf | 19 KB | | form | pdf |
| DSS-5301sp: Solicitud De Audiencia De Extension | Form | pdf | 23 KB | | form | pdf |
| DSS-5302: Work First Extension/Exemption Monthly Report | Form | pdf | 68 KB | | form | pdf |
| DSS-5303: Request for NC Kids Child Registration Exemption | Form | pdf | 252 KB | | form | pdf |
| DSS-5303sp: Peticion De Excepcion De Registro Para Un Nino Del Programa NC KIDS | Form | pdf | 52 KB | | form | pdf |
| DSS-5304: Legal Risk Placement Agreement | Form | pdf | 40 KB | | form | pdf |
| DSS-5305: Purchase of Adoption Services Agreement | Form | pdf | 33 KB | | form | pdf |
| DSS-5306: Adoption Assistance Suspension Notice | Form | pdf | 53 KB | | form | pdf |
| DSS-5307: Adoption Assistance Agreement Amendment | Form | pdf | 46 KB | | form | pdf |
| DSS-5308: Adoption Assistance Termination Notice | Form | pdf | 63 KB | | form | pdf |
| DSS-5309: Excused Absence Log (For Unpaid Activities) | Form | pdf | 85 KB | | form | pdf |
| DSS-5310: Model Court Report for Dispositional and Review Hearings | Form | pdf | 224 KB | | form | pdf |
| DSS-5311: Model Court Report for Permanency Planning Hearings | Form | pdf | 290 KB | | form | pdf |
| DSS-5312: Model Court Report for Post Termination of Parental Rights Hearings | Form | pdf | 68 KB | | form | pdf |
| DSS-5313: Work Registration Indicator | Form | pdf | 112 KB | | form | pdf |
| DSS-5313sp: Registro para Trabajar | Form | pdf | 16 KB | | form | pdf |
| DSS-5314: Sample Letter for Annual Adoptions Assistance Eligibility Review | Form | pdf | 37 KB | | form | pdf |
| DSS-5315sp: Plan de Emancipación de Custodia en Cuidado Foster | Form | pdf | 160 KB | | form | pdf |
| DSS-5316: Relative Interest Form | Form | pdf | 145 KB | | form | pdf |
| DSS-5317: Relative Notification Letter | Form | pdf | 25 KB | | form | pdf |
| DSS-5318: Relative Search Information | Form | pdf | 88 KB | | form | pdf |
| DSS-5320: DSS – Monthly Adoption Reporting Form | Form | xlsx | 75 KB | | form | xlsx |
| DSS-5320a: Contract Agency – Monthly Adoption Reporting & Payment Form | Form | xlsx | 82 KB | | form | xlsx |
| DSS-5321: Workers Compensation Fraud in North Carolina | Form | pdf | 32 KB | | form | pdf |
| DSS-5321sp: Compensacion De Trabajadores en Carolina Del Norte | Form | pdf | 46 KB | | form | pdf |
| DSS-5322: Report of Injuries to Work First Participants in Work Experience/Community Service | Form | pdf | 29 KB | | form | pdf |
| DSS-5324: Adoptive Placement Agreement | Form | pdf | 32 KB | | form | pdf |
| DSS-5325: Substance Use Behavioral Indicator Checklist II | Form | pdf | 154 KB | | form | pdf |
| DSS-5325sp: Lista II De Indicadores De Conducta Por Abuso De Sustancias | Form | pdf | 102 KB | | form | pdf |
| DSS-5326: Teen Pregnancy Prevention and Healthy Marriage Initiatives Fact Sheet | Form | pdf | 23 KB | | form | pdf |
| DSS-5326sp: Volante Informativo Iniciativas Para La Prevencion Del Embarazo En Adolescentes Y Matrimonios Saludables | Form | pdf | 67 KB | | form | pdf |
| DSS-5327: Learning Needs Screening Tool | Form | pdf | 28 KB | | form | pdf |
| DSS-5328: Request to Cancel Direct Deposit | Form | pdf | 75 KB | | form | pdf |
| DSS-5328sp: Solicitud de Cancelación de Depósito Directo | Form | pdf | 377 KB | | form | pdf |
| DSS-5329: Complaint Procedures for the Work First Program | Form | pdf | 13 KB | | form | pdf |
| DSS-5329sp: Procedimiento de Queja del Programa Work First | Form | pdf | 13 KB | | form | pdf |
| DSS-5330: Learning Needs Screening Tool Waiver & Consent Agreement | Form | pdf | 18 KB | | form | pdf |
| DSS-5330sp: Rechazo al Uso de la Herramienta de Detección de Necesidades en el Aprendizaje y Forma de Consentimiento | Form | pdf | 26 KB | | form | pdf |
| DSS-5331: ICPC Supervision Report – 30 Days | Form | pdf | 30 KB | | form | pdf |
| DSS-5332: ICPC Supervision Report – 90 Days | Form | pdf | 34 KB | | form | pdf |
| DSS-5333: Americans with Disabilities Act – Did you know? | Form | pdf | 65 KB | | form | pdf |
| DSS-5333sp: ¿Sabía usted? | Form | pdf | 49 KB | | form | pdf |
| DSS-5334: Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement | Form | pdf | 17 KB | | form | pdf |
| 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) | Form | pdf | 30 KB | | form | pdf |
| DSS-5335: Consent to Explore American Indian Heritage | Form | pdf | 51 KB | | form | pdf |
| DSS-5336: Fostering Connections/Tribal Relative Search (DSS-5336) Instructions | Form | pdf | 45 KB | | form | pdf |
| DSS-5339: CPS Expansion (TANF Transfer to SSBG) Eligibility Documentation Form | Form | pdf | 30 KB | | form | pdf |
| DSS-5340: TANF Federal Time Clock Verification Request | Form | pdf | 34 KB | | form | pdf |
| DSS-5340sp: Peticion De Verificacion Del Reloj Federal Del Programa TANF | Form | pdf | 40 KB | | form | pdf |
| DSS-5401 Consent Form for a Clinical Assessment of Protective Parenting (CAPP) | Form | pdf | 162 KB | | form | pdf |
| DSS-5402: Child Welfare Human Trafficking Screening Tool | Form | pdf | 305 KB | | form | pdf |
| DSS-5758: Supplemental Board Payment for HIV Positive Foster Children Request for Reimbursement | Form | pdf | 71 KB | | form | pdf |
| DSS-5759: Request for Supplemental Adoption Assistance for HIV Positive Adopted Children | Form | pdf | 36 KB | | form | pdf |
| DSS-5760 Verification of Custody Letter | Form | pdf | 119 KB | | form | pdf |
| DSS-5800: Unlicensed Kinship Payment Eligibility Checklist | Form | pdf | 272 KB | | form | pdf |
| DSS-5801: Unlicensed Kinship Form-Facility ID Request | Form | pdf | 240 KB | | form | pdf |
| DSS-5802: Unlicensed Kinship Acknowledgment | Form | pdf | 154 KB | | form | pdf |
| DSS-5960: Law Enforcement and District Attorney Notification | Form | pdf | 180 KB | | form | pdf |
| DSS-6187: Application for State Maternity Funds (Voucher, Social History & Service Plan) Problem Pregnancy Services | Form | pdf | 88 KB | | form | pdf |
| DSS-6187I: Instructions for Completing Application for State Maternity Fund DSS-6187 | Form | pdf | 33 KB | | form | pdf |
| DSS-6187sp: Solicitud Para Fondos Estatales Para Maternidad | Form | pdf | 124 KB | | form | pdf |
| DSS-6188: Notice of Action on Request for State Maternity Home Funds | Form | pdf | 60 KB | | form | pdf |
| DSS-6189: State Maternity Fund Residential Care Provider Agreement | Form | pdf | 32 KB | | form | pdf |
| DSS-6190 Rapid Response Team Referral Form | Form | pdf | 128 KB | | form | pdf |
| DSS-6191 Plan of Safe Care State Form | Form | pdf | 208 KB | | form | pdf |
| DSS-6191sp Formulario de plan de cuidado seguro | Form | pdf | 168 KB | | form | pdf |
| DSS-6192: Safe Surrender Health and Information Form | Form | pdf | 226 KB | | form | pdf |
| DSS-6195A: Trauma Screening Tool 0-5 | Form | pdf | 199 KB | | form | pdf |
| DSS-6195B: Trauma Screening Tool 6-21 | Form | pdf | 210 KB | | form | pdf |
| DSS-6211: State Abortion Fund Eligibility Certification | Form | pdf | 32 KB | | form | pdf |
| DSS-6226: NC Division of Vocational Rehabilitation Services and County Social Services Agency/Department Referral | Form | pdf | 234 KB | | form | pdf |
| DSS-6226sp: División de Servicios de Rehabilitación Vocacional y Agencia de Servicios Sociales del Condado/ Referencia Departamental | Form | pdf | 237 KB | | form | pdf |
| DSS-6228: د مسلکي مهارتونو روزنه او د مهارتونو د بیا تصدیق پلان | Form | pdf | 316 KB | | form | pdf |
| DSS-6228: MPANGO WA MAFUNZO YA UJUZI WA UFUNDI NA UTHIBITISHAJI WA UJUZI | Form | pdf | 275 KB | | form | pdf |
| DSS-6228: NC Amahugurwa yimyuga nubumenyi Gahunda yo Kwemeza | Form | pdf | 286 KB | | form | pdf |
| DSS-6228: NC Vocational Skills Training and Skills Recertifiation Plan (DSS-6228) | Form | pdf | 283 KB | | form | pdf |
| DSS-6228: NC የሙያ ክህሎት ስልጠና እና ክህሎት ዳግም ማረጋገጫ እቅድ | Form | pdf | 269 KB | | form | pdf |
| DSS-6228: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ПРОФЕСІЙНО-ТЕХНІЧНОЇ ПІДГОТОВКИ ТА ПЕРЕАТЕСТАЦІЇ | Form | pdf | 348 KB | | form | pdf |
| DSS-6228: آموزش مهارت های حرفه ای NC و طرح تایید مجدد مهارت ها | Form | pdf | 325 KB | | form | pdf |
| DSS-6228sp: Plan De Recertification Vocacional De Destrezas Y Capacitacion De Destrezas De NC | Form | pdf | 211 KB | | form | pdf |
| DSS-6229: MAFUNZO YA UJUZI WA UFUNDI NA UTHIBITISHAJI UPYA WA UJUZI MASHRTI YA MPANGO WA UTEKELEZAJI | Form | pdf | 146 KB | | form | pdf |
| DSS-6229: NC Amahugurwa Yimyuga Yumwuga Nubuhanga bwo Kwemeza Amasezerano Yibisabwa | Form | pdf | 142 KB | | form | pdf |
| DSS-6229: NC Vocational Skills Training And Skills Recertification Agreement Plan of Action Requirements (DSS-6229) | Form | pdf | 143 KB | | form | pdf |
| DSS-6229: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА ПРО ПРОФЕСІЙНО-ТЕХНІЧНУ ПІДГОТОВКУ ТА ПЕРЕАТЕСТАЦІЮ ВИМОГИ ДО ПЛАНУ ДІЙ | Form | pdf | 194 KB | | form | pdf |
| DSS-6229: الزامات برنامه اقدام برای آموزش مهارت های حرفه ای NC و گواهینامه مجدد مهارت ها | Form | pdf | 166 KB | | form | pdf |
| DSS-6229: د مسلکي مهارتونو روزنه او د مهارتونو د بیا تصدیقولو هوکړه لیکد عمل د پلان شراېط | Form | pdf | 163 KB | | form | pdf |
| DSS-6229: የኤንሲ የሙያ ክህሎት ስልጠና እና የችሎታ ማረጋገጫ ስምምነት የድርጊት መስፈርቶች እቅድ | Form | pdf | 119 KB | | form | pdf |
| dss-6229sp: Acuerdo De Los Requerimientos Del Plan De Accion Del Programa De Evaluacion Y Rercertificacion De Destrezas De NC | Form | pdf | 41 KB | | form | pdf |
| DSS-6230 (pt. A): Gahunda yo Kwihaza mu Muryango | Form | pdf | 175 KB | | form | pdf |
| DSS-6230 (pt. A): طرح خودکفایی خانواده | Form | pdf | 184 KB | | form | pdf |
| DSS-6230 (pt. A): የቤተሰብ ራስን መቻል እቅድ | Form | pdf | 205 KB | | form | pdf |
| DSS-6230 (pt. B): Gahunda yo Kwihaza mu Muryango | Form | pdf | 186 KB | | form | pdf |
| DSS-6230 (pt. B): طرح خودکفایی خانواده | Form | pdf | 204 KB | | form | pdf |
| DSS-6230 (pt. B): የቤተሰብ ራስን መቻል እቅድ | Form | pdf | 191 KB | | form | pdf |
| DSS-6230 Part A: MPANGO WA KUJITOSHELEZA KWA FAMILIA SEHEMU A | Form | pdf | 181 KB | | form | pdf |
| DSS-6230 Part A: План сімейного самозабезпечення | Form | pdf | 216 KB | | form | pdf |
| DSS-6230 Part A: د کورنۍ په ځان بساېنې پلان | Form | pdf | 191 KB | | form | pdf |
| DSS-6230 Part B: MPANGO WA KUJITOSHELEZA KWA FAMILIA SEHEMU B | Form | pdf | 187 KB | | form | pdf |
| DSS-6230 Part B: План сімейного самозабезпечення | Form | pdf | 233 KB | | form | pdf |
| DSS-6230 Part B: کورنۍ په ځان بساېنې پلان | Form | pdf | 208 KB | | form | pdf |
| DSS-6230A: Family Self-Sufficiency Plan | Form | pdf | 172 KB | | form | pdf |
| DSS-6230B: Family Self Sufficiency Plan | Form | pdf | 186 KB | | form | pdf |
| DSS-6230sp: Plan De Autosuficiencia Familiar | Form | pdf | 11 KB | | form | pdf |
| DSS-6231: Gahunda ya serivisi ya Leta ishinzwe impunzi | Form | pdf | 262 KB | | form | pdf |
| DSS-6231: MPANGO WA HUDUMA | Form | pdf | 254 KB | | form | pdf |
| DSS-6231: NC State Refugee Office Service Plan | Form | pdf | 257 KB | | form | pdf |
| DSS-6231: NC የስቴት የስደተኞች ቢሮ አገልግሎት እቅድ | Form | pdf | 248 KB | | form | pdf |
| DSS-6231: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН НАДАННЯ ПОСЛУГ | Form | pdf | 324 KB | | form | pdf |
| DSS-6231: د کډوالو د دفتر د خدمتونو پلان | Form | pdf | 303 KB | | form | pdf |
| DSS-6231: طرح خدمات اداره پناهندگان ایالتی NC | Form | pdf | 300 KB | | form | pdf |
| DSS-6231sp: Plan Para Establecer Metas | Form | pdf | 15 KB | | form | pdf |
| DSS-6232: MPANGO WA UWEZO WA KUAJIRIWA | Form | pdf | 315 KB | | form | pdf |
| DSS-6232: NC Gahunda yo Guha akazi Ibiro bya Leta | Form | pdf | 335 KB | | form | pdf |
| DSS-6232: NC State Refugee Office Employability Plan | Form | pdf | 317 KB | | form | pdf |
| DSS-6232: NC የስቴት የስደተኞች ቢሮ የቅጥር እቅድ | Form | pdf | 367 KB | | form | pdf |
| DSS-6232: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ПРАЦЕВЛАШТУВАННЯ | Form | pdf | 427 KB | | form | pdf |
| DSS-6232: د استخدام د وړتیا پلان | Form | pdf | 370 KB | | form | pdf |
| DSS-6232: طرح استخدامی اداره پناهندگان ایالتی NC | Form | pdf | 363 KB | | form | pdf |
| DSS-6232sp: Programa De Carolina Del Norte Para Asistencia A Refugiados Plan Para Determinar Si La Persona Esta En Condiciones Para Ser Empleada | Form | pdf | 184 KB | | form | pdf |
| DSS-6233: Client (ELT) Service Plan | Form | pdf | 191 KB | | form | pdf |
| DSS-6233: Gahunda ya serivisi y’abakiriya (ELT) | Form | pdf | 197 KB | | form | pdf |
| DSS-6233: MAFUNZO YA LUGHA YA KIINGEREZA | Form | pdf | 196 KB | | form | pdf |
| DSS-6233: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН ВИВЧЕННЯ АНГЛІЙСЬКОЇ МОВИ | Form | pdf | 267 KB | | form | pdf |
| DSS-6233: د پیرودونکي (ELT) خدمت پلان | Form | pdf | 209 KB | | form | pdf |
| DSS-6233: طرح خدمات مشتری (ELT). | Form | pdf | 203 KB | | form | pdf |
| DSS-6233: የደንበኛ (ELT) የአገልግሎት እቅድ | Form | pdf | 213 KB | | form | pdf |
| DSS-6233sp: Plan De Servicio (ELT) Al Cliente | Form | pdf | 8 KB | | form | pdf |
| DSS-6234: ELT Learner Initial Assessment Form | Form | pdf | 257 KB | | form | pdf |
| DSS-6234: ELT Yiga Ifishi Yambere Yisuzuma | Form | pdf | 422 KB | | form | pdf |
| DSS-6234: MAFUNZO YA LUGHA YA KIINGEREZA FOMU YA MTIHANI WA KWANZA | Form | pdf | 420 KB | | form | pdf |
| DSS-6234: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА НАВЧАННЯ АНГЛІЙСЬКОЇ МОВИ ФОРМА ПОЧАТКОВОГО ОЦІНЮВАННЯ | Form | pdf | 502 KB | | form | pdf |
| DSS-6234: د لومړنۍ ارزونې فورمه | Form | pdf | 445 KB | | form | pdf |
| DSS-6234: فرم ارزیابی اولیه زبان آموزان ELT | Form | pdf | 450 KB | | form | pdf |
| DSS-6234: የELT ተማሪ የመጀመሪያ ግምገማ ቅጽ | Form | pdf | 939 KB | | form | pdf |
| DSS-6234sp: Formulario De Evaluacion Inicial Del Estudiante ELT | Form | pdf | 25 KB | | form | pdf |
| DSS-6235: Case Review Form | Form | pdf | 162 KB | | form | pdf |
| DSS-6235: FOMU YA UKAGUZI WA MPANGO | Form | pdf | 163 KB | | form | pdf |
| DSS-6235: Ifishi yo gusuzuma | Form | pdf | 163 KB | | form | pdf |
| DSS-6235: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ФОРМА ПЕРЕГЛЯДУ СПРАВИ | Form | pdf | 219 KB | | form | pdf |
| DSS-6235: د قضیې د بیاکتنې فورمه | Form | pdf | 185 KB | | form | pdf |
| DSS-6235: فرم بررسی پرونده | Form | pdf | 186 KB | | form | pdf |
| DSS-6235: የጉዳይ ግምገማ ቅጽ | Form | pdf | 189 KB | | form | pdf |
| DSS-6235sp: Revision Trimestral | Form | pdf | 13 KB | | form | pdf |
| DSS-6236: Idhini ya Ufahamu ya Kutolewa kwa Maelezo | Form | pdf | 181 KB | | form | pdf |
| DSS-6236: Informed Consent For Release Of Information | Form | pdf | 175 KB | | form | pdf |
| DSS-6236: Kumenyeshwa Kumenyekanisha Kurekura Amakuru | Form | pdf | 178 KB | | form | pdf |
| DSS-6236: управління у справах біженців штату північна кароліна Інформована згода на розкриття інформації | Form | pdf | 227 KB | | form | pdf |
| DSS-6236: د مالوماتو خپرولو لپاره آګاهانه رضایت | Form | pdf | 202 KB | | form | pdf |
| DSS-6236: رضایت آگاهانه برای انتشار اطلاعات | Form | pdf | 202 KB | | form | pdf |
| DSS-6236: መረጃን ለመልቀቅ በመረጃ የተደገፈ ስምምነት | Form | pdf | 204 KB | | form | pdf |
| DSS-6236sp: Consentimiento Con Conocimiento De Causa Para Divulgación De Información | Form | pdf | 14 KB | | form | pdf |
| DSS-6237: DSS Refugee Client Rights Form | Form | pdf | 132 KB | | form | pdf |
| DSS-6237: FOMU IKUBIYEMO UBURENGANZIRA BW’UMUKIRIYA | Form | pdf | 153 KB | | form | pdf |
| DSS-6237: FOMU YA HAKI ZA MTEJA | Form | pdf | 132 KB | | form | pdf |
| DSS-6237: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ФОРМА ПРАВ КЛІЄНТА | Form | pdf | 184 KB | | form | pdf |
| DSS-6237: د مهاجرینو د مراجعینو د حقونو فورمه | Form | pdf | 149 KB | | form | pdf |
| DSS-6237: فرم حقوق مشتری پناهندگان DSS | Form | pdf | 146 KB | | form | pdf |
| DSS-6237: የDSS የስደተኞች ደንበኛ መብቶች ቅጽ | Form | pdf | 170 KB | | form | pdf |
| DSS-6237sp: Formulario De Derechos Del Cliente De Carolina De Norte | Form | pdf | 15 KB | | form | pdf |
| DSS-6238: Refugee Cash Assistance Eligibility Monitoring Guide | Form | pdf | 304 KB | | form | pdf |
| DSS-6239A: Amasezerano yo Guhana Impunzi | Form | pdf | 170 KB | | form | pdf |
| DSS-6239A: MAKUBALIANO YA UWAJIBIKAJI WA PAMOJA WA WAKIMBIZI | Form | pdf | 170 KB | | form | pdf |
| DSS-6239A: Refugee Mutual Responsibility Agreement | Form | pdf | 172 KB | | form | pdf |
| DSS-6239A: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА З БІЖЕНЦЯМИ ПРО ВЗАЄМНУ ВІДПОВІДАЛЬНІСТЬ | Form | pdf | 187 KB | | form | pdf |
| DSS-6239A: د کډوالو د دوه اړخیز مسؤلیت تړون | Form | pdf | 190 KB | | form | pdf |
| DSS-6239A: موافقتنامه مسئولیت متقابل پناهندگان | Form | pdf | 192 KB | | form | pdf |
| DSS-6239A: የስደተኞች የጋራ ኃላፊነት ስምምነት | Form | pdf | 194 KB | | form | pdf |
| DSS-6239B: Impunzi MRA Gahunda y’ibisabwa | Form | pdf | 143 KB | | form | pdf |
| DSS-6239B: MASHARTI YA MPANGO WA UTEKELEZAJI | Form | pdf | 143 KB | | form | pdf |
| DSS-6239B: Refugee MRA Plan of Action Requirements | Form | pdf | 140 KB | | form | pdf |
| DSS-6239B: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА УГОДА ПРО ВЗАЄМНУ ВІДПОВІДАЛЬНІСТЬ | Form | pdf | 176 KB | | form | pdf |
| DSS-6239B: الزامات برنامه اقدام MRA پناهندگان | Form | pdf | 159 KB | | form | pdf |
| DSS-6239B: د مهاجرینو MRA د عمل اړتیاو پلان | Form | pdf | 160 KB | | form | pdf |
| DSS-6239B: የስደተኛ MRA የድርጊት መስፈርቶች እቅድ | Form | pdf | 154 KB | | form | pdf |
| DSS-6240_AR: (SNAP) طلب الاشتراك في برنامج المعونة الغذائية المُبسط | Form | pdf | 112 KB | | form | pdf |
| DSS-6240_DE: Antrag Auf Vereinfachtes Programm Fur Lebensmittelhilfe (SNAP) | Form | pdf | 74 KB | | form | pdf |
| DSS-6240_KO: 간이 영양 지원 프로그램(SNAP) 신청서 | Form | pdf | 238 KB | | form | pdf |
| DSS-6240: Simplified Nutritional Assistance Program (SNAP) Application | Form | pdf | 173 KB | | form | pdf |
| DSS-6240A_AR: احفظ هذه الصفحة في سجلاتك | Form | pdf | 85 KB | | form | pdf |
| DSS-6240A_DE: Legen Sie diese Seite bitte zu Ihren Unterlagen | Form | pdf | 34 KB | | form | pdf |
| DSS-6240A_FR: Programme Simplifie D’Aide Nutritionnelle (SNAP) | Form | pdf | 31 KB | | form | pdf |
| DSS-6240A_KO: 참조를 위해 이 문서를 보관하십시오 | Form | pdf | 141 KB | | form | pdf |
| DSS-6240A_VI: Thông Tin Chương Trình Và Các Quyền Và Trách Nhiệm Của Bạn | Form | pdf | 118 KB | | form | pdf |
| DSS-6240Asp: Programa Simplificado De Asistencia Nutricional Información sobre el programa. Derechos y Responsabilidades | Form | pdf | 252 KB | | form | pdf |
| DSS-6240sp: Solicitud Del Programa Simplificado De Asistencia Nutricional (Simplified Nutritional Assistance Program, SNAP) | Form | pdf | 251 KB | | form | pdf |
| DSS-6241: Refugee Cash Assistance (RCA) Application | Form | pdf | 164 KB | | form | pdf |
| DSS-6241sp: Solicitud de Asistencia en Efectivo para Refugiados (RCA) | Form | pdf | 365 KB | | form | pdf |
| DSS-6242: Refugee Medical Assistance (RMA) Application | Form | pdf | 159 KB | | form | pdf |
| DSS-6242sp: Solicitud de Asistencia Médica para Refugiados (RMA) | Form | pdf | 146 KB | | form | pdf |
| DSS-6246: Affidavit of Paternity | Form | pdf | 39 KB | | form | pdf |
| DSS-6247: Notification of Refugee Arrival and Intent to Apply for Benefits | Form | pdf | 141 KB | | form | pdf |
| DSS-6250: Gahunda ya Serivisi ishinzwe amategeko | Form | pdf | 220 KB | | form | pdf |
| DSS-6250: Legal Service Plan | Form | pdf | 216 KB | | form | pdf |
| DSS-6250: MPANGO WA HUDUMA YA KISHERIA | Form | pdf | 218 KB | | form | pdf |
| DSS-6250: УПРАВЛІННЯ У СПРАВАХ БІЖЕНЦІВ ШТАТУ ПІВНІЧНА КАРОЛІНА ПЛАН НАДАННЯ ЮРИДИЧНИХ ПОСЛУГ | Form | pdf | 283 KB | | form | pdf |
| DSS-6250: د حقوقي خدماتو پلان | Form | pdf | 259 KB | | form | pdf |
| DSS-6250: طرح خدمات حقوقی | Form | pdf | 252 KB | | form | pdf |
| DSS-6250: የህግ አገልግሎት እቅድ | Form | pdf | 240 KB | | form | pdf |
| DSS-6852: Authorization / Receipt for Direct Payment | Form | pdf | 10 KB | | form | pdf |
| DSS-6901: Work First Employment Services Assessment Form | Form | pdf | 368 KB | | form | pdf |
| DSS-6902: Screening for Child Well Being | Form | pdf | 191 KB | | form | pdf |
| DSS-6902sp: Evaluacion De Bienestar De Menores | Form | pdf | 165 KB | | form | pdf |
| DSS-6904: Work First Information Transmittal | Form | pdf | 37 KB | | form | pdf |
| DSS-6905: Work Experience/Community Service Agreement | Form | pdf | 296 KB | | form | pdf |
| DSS-6905sp: Sericios De Empleo Work First Acuerdo de Experiencia Laboral y Servicio Comunitario | Form | pdf | 381 KB | | form | pdf |
| DSS-6960: Job Search/Verification Log | Form | pdf | 275 KB | | form | pdf |
| DSS-6960sp: Busqueda De Trabajo y Registro De Verificaion | Form | pdf | 632 KB | | form | pdf |
| DSS-6961: Verification of Household Composition | Form | pdf | 43 KB | | form | pdf |
| DSS-6961sp: La Verificacion De La Composicion Del Grupo Familiar | Form | pdf | 49 KB | | form | pdf |
| DSS-6962: Workers Compensation Guide for Work First Participants In Work Experience and Community Service Activities | Form | pdf | 145 KB | | form | pdf |
| DSS-6962sp: Guía de Compensación Para Trabajadores Participantes en los Programas de Work Experience (Experiencia de Trabajo) y Servicio Comunitario | Form | pdf | 146 KB | | form | pdf |
| DSS-6963a_bsp: Acuerdo De Responsbilidad Mutua Requerimientos Basicos | Form | pdf | 124 KB | | form | pdf |
| DSS-6963a: Mutual Responsibility Agreement – Core Requirements | Form | pdf | 22 KB | | form | pdf |
| DSS-6963Asp: Acuerdo De Responsabilidad Mutua – Requerimientos Basicos | Form | pdf | 22 KB | | form | pdf |
| DSS-6963b: Mutual Responsibility Agreement Plan of Action Requirements | Form | pdf | 64 KB | | form | pdf |
| DSS-6963Bsp: Acuerdo De Responsabilidad Mutua Requisitos Del Plan Accion | Form | pdf | 32 KB | | form | pdf |
| DSS-6963c: Mutual Responsibility Agreement Plan of Action Requirements for Work First Services | Form | pdf | 18 KB | | form | pdf |
| DSS-6964: Program Reference Guide | Form | pdf | 404 KB | | form | pdf |
| DSS-6964sp: Informacion de Programas | Form | pdf | 146 KB | | form | pdf |
| DSS-6965: Family Violence Option/Domestic Violence Work First Assessment | Form | pdf | 301 KB | | form | pdf |
| DSS-6965sp: Opcion Respecto a Violencia Familiar/Violencia Domestica Evaluacion Work First | Form | pdf | 193 KB | | form | pdf |
| DSS-6966: Notification of Family Violence Option | Form | pdf | 107 KB | | form | pdf |
| DSS-6966sp: Notificación de opción de violencia familiar | Form | pdf | 104 KB | | form | pdf |
| DSS-6967: Family Violence Option Brochure | Form | pdf | 3 MB | | form | pdf |
| DSS-6968: Screening for Domestic Violence | Form | pdf | 23 KB | | form | pdf |
| DSS-6968sp: Preguntas de Violencia Doméstica | Form | pdf | 490 KB | | form | pdf |
| DSS-6969: Consent for Release of Information | Form | pdf | 55 KB | | form | pdf |
| DSS-6969sp: Consentimiento Para Proporcionar Informacion | Form | pdf | 41 KB | | form | pdf |
| DSS-8104: Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement | Form | pdf | 23 KB | | form | pdf |
| DSS-8104sp: Segundo Aviso De Derecho A Presentar Buena Razon Para Negarse A Cooperar Con El Cumplimiento De La Manutencion Infantil | Form | pdf | 34 KB | | form | pdf |
| DSS-8105A Programa De Asistencia De Agua-Aviso De Aprobacion | Form | pdf | 177 KB | | form | pdf |
| DSS-8105A Water Assistance Program-Notice of Approval | Form | pdf | 179 KB | | form | pdf |
| DSS-8105A СПОВІЩЕННЯ ПРО СХВАЛЕННЯ ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ | Form | pdf | 184 KB | | form | pdf |
| DSS-8105A: СПОВІЩЕННЯ ПРО СХВАЛЕННЯ ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ | Form | pdf | 169 KB | | form | pdf |
| DSS-8105B Programa De Asistencia De Agua-Aviso De Negacion | Form | pdf | 113 KB | | form | pdf |
| DSS-8105B Water Assistance Program-Notice of Denial | Form | pdf | 114 KB | | form | pdf |
| DSS-8105B: ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ – СПОВІЩЕННЯ ПРО ВІДХИЛЕННЯ | Form | pdf | 130 KB | | form | pdf |
| DSS-8105B: ПРОГРАММА ПОМОЩИ В ОПЛАТЕ ВОДОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ ОТКАЗЕ | Form | pdf | 129 KB | | form | pdf |
| DSS-8105C Programa De Asistencia De Agua-Aviso De Solicitud Retirada | Form | pdf | 111 KB | | form | pdf |
| DSS-8105C Water Assistance Program-Notice of Withdrawal | Form | pdf | 113 KB | | form | pdf |
| DSS-8105C: ПРОГРАМИ ДОПОМОГИ З ВОДОПОСТАЧАННЯМ – СПОВІЩЕННЯ ПРО ВІДКЛИКАННЯ | Form | pdf | 130 KB | | form | pdf |
| DSS-8105C: ПРОГРАММА ПОМОЩИ В ОПЛАТЕ ВОДОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ ОТЗЫВЕ | Form | pdf | 130 KB | | form | pdf |
| DSS-8107_AR: إخطار الموافقة/الرفض برامج الطاقة | Form | pdf | 83 KB | | form | pdf |
| DSS-8107_DE: Energie Programme Mitteilung Uber Genehmigung/Ablehnung | Form | pdf | 29 KB | | form | pdf |
| DSS-8107_FR: Programmes Lies A L’Energie Notifcation D’Approbation/De Refus | Form | pdf | 26 KB | | form | pdf |
| DSS-8107_KO: 에너지 프로그램 승인/거부 고지 | Form | pdf | 129 KB | | form | pdf |
| DSS-8107_VI: CHƯƠNG TRÌNH NĂNG LƯỢNG THÔNG BÁO VỀ PHÊ DUYỆT/TỪ CHỐI | Form | pdf | 135 KB | | form | pdf |
| DSS-8107-ia: СПОВІЩЕННЯ ПРО СХВАЛЕННЯ/ВІДХИЛЕННЯ УЧАСТІ В ЕНЕРГЕТИЧНИХ ПРОГРАМАХ | Form | pdf | 126 KB | | form | pdf |
| DSS-8107-ia: УЧАСТИЕ В ПРОГРАММАХ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯ — УВЕДОМЛЕНИЕ ОБ УТВЕРЖДЕНИИ/ОТКАЗЕ | Form | pdf | 157 KB | | form | pdf |
| DSS-8107: Energy Programs Notice of Approval/Denial | Form | pdf | 26 KB | | form | pdf |
| DSS-8107b: Energy Programs Action Notice | Form | pdf | 87 KB | | form | pdf |
| DSS-8107bsp: Programas De Energia Aviso De Accion | Form | pdf | 21 KB | | form | pdf |
| DSS-8107sp: Programas De Asistencia De Energia Aviso De Aprobacion/Denegacion | Form | pdf | 27 KB | | form | pdf |
| DSS-8108: Notice of Benefits | Form | pdf | 110 KB | | form | pdf |
| DSS-8108sp: Aviso De Beneficios | Form | pdf | 109 KB | | form | pdf |
| DSS-8109: Votre demande de prestations est refusée ou retirée | Form | pdf | 235 KB | | form | pdf |
| DSS-8109: Your Application for Benefits is Being Denied or Withdrawn | Form | pdf | 87 KB | | form | pdf |
| DSS-8109sp: Su Solicitud De Beneficios Ha Sido Rechazada O Retirada | Form | pdf | 40 KB | | form | pdf |
| DSS-8110: Notice of Modification, Termination, or Continuation of Public Assistance | Form | pdf | 114 KB | | form | pdf |
| DSS-8110sp: Aviso de Modificación, Terminación, o Continuación de Asistencia Pública | Form | pdf | 153 KB | | form | pdf |
| DSS-8113_DE: Gehaltsbestatigungsformular | Form | pdf | 43 KB | | form | pdf |
| DSS-8113_FR: Formulaire De Verification Des Salaires | Form | pdf | 37 KB | | form | pdf |
| DSS-8113: Wage Verification Form | Form | pdf | 51 KB | | form | pdf |
| DSS-8113sp: Formulario de Verificacin de Sueldo | Form | pdf | 91 KB | | form | pdf |
| DSS-8115: LIEAP Denial Notice | Form | pdf | 13 KB | | form | pdf |
| DSS-8115sp: Programa De Asistencia De Energia Para Personas De Escasos Recursos Aviso De Denegacion | Form | pdf | 20 KB | | form | pdf |
| DSS-8116I: Low Income Energy Assistance Program Eligibility Worksheet | Form | pdf | 147 KB | | form | pdf |
| DSS-8116Isp: Programa De Asistencia De Energia Por Bajos Ingresos Hoja De Trabajo Para Determinar La Elegibidad | Form | pdf | 177 KB | | form | pdf |
| DSS-8117: North Carolina’s Energy Programs Brochure | Form | pdf | 150 KB | | form | pdf |
| DSS-8117: ЕНЕРГЕТИЧНІ ПРОГРАМИ ПІВНІЧНОЇ КАРОЛІНИ | Form | pdf | 169 KB | | form | pdf |
| DSS-8117: ПРОГРАММЫ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯ, NORTH CAROLINA | Form | pdf | 178 KB | | form | pdf |
| DSS-8117sp: Programas De Asistencia De Energia De Carolina Del Norte | Form | pdf | 89 KB | | form | pdf |
| DSS-8118: Certification Utilities Moratorium | Form | pdf | 15 KB | | form | pdf |
| DSS-8118sp: Moratoria De Certificacion De Servicios Publicos | Form | pdf | 29 KB | | form | pdf |
| DSS-8119: Energy Programs Outreach Plan | Form | pdf | 86 KB | | form | pdf |
| DSS-8124: Application for Work First Family Assistance, MA, Refugee, and SA | Form | pdf | 98 KB | | form | pdf |
| DSS-8124a: EIS Application for Work First Family Assistance, MA, Refugee, and SA | Form | pdf | 54 KB | | form | pdf |
| DSS-8124Asp: Application for Work First Family Assistance, MA, Refugee, and SA | Form | pdf | 54 KB | | form | pdf |
| DSS-8124b: Rights and Responsibilities | Form | pdf | 46 KB | | form | pdf |
| DSS-8124Bsp: ¿Cuáles son mis derechos? ¿Cuáles son mis responsabilidades? | Form | pdf | 30 KB | | form | pdf |
| DSS-8127: Work First Family Assistance Report | Form | pdf | 92 KB | | form | pdf |
| DSS-8127sp: Informe De Asistencia Familiar Work First | Form | pdf | 75 KB | | form | pdf |
| DSS-8129: Request for Replacement Check | Form | pdf | 346 KB | | form | pdf |
| DSS-8129sp: Sistema De Informacion Sobre Elegibilidad y Sistema De Seguimiento De Informacion Sobre Acogimiento De Menores | Form | pdf | 83 KB | | form | pdf |
| DSS-8131: Change in Situation Report | Form | pdf | 10 KB | | form | pdf |
| DSS-8137: Notice of Incomplete Work First Family Assistance Report | Form | pdf | 26 KB | | form | pdf |
| DSS-8137sp: Notificacion De Informe Incompleto Del Programa De Asistencia Familiar Work First | Form | pdf | 37 KB | | form | pdf |
| DSS-8146A: Notice of Information Needed to Determine Your Eligibility for Work First Family Assistance | Form | pdf | 61 KB | | form | pdf |
| DSS-8146Asp: Aviso De Informacion Necesaria Para Determinar Su Elegibilidad Para El Programa Work First | Form | pdf | 65 KB | | form | pdf |
| DSS-8162 LIHWAP Agreement | Form | pdf | 45 KB | | form | pdf |
| DSS-8162sp LIHWAP Agreement | Form | pdf | 127 KB | | form | pdf |
| DSS-8163_FR: Accord Sur L’Approvionnement En Energie Domestique | Form | pdf | 29 KB | | form | pdf |
| DSS-8163: Energy Provider Agreement | Form | pdf | 358 KB | | form | pdf |
| DSS-8169: Work First Emergency Assistance Application | Form | pdf | 74 KB | | form | pdf |
| DSS-8169sp: Solicitud Del Programa Work First (Trabajar Primero) De Emergencia | Form | pdf | 74 KB | | form | pdf |
| DSS-8173_AR: بيان إحصاء | Form | pdf | 54 KB | | form | pdf |
| DSS-8173_DE: Freistellungserklärung für Auflistung | Form | pdf | 15 KB | | form | pdf |
| DSS-8173_FR: Communiqué concernant le recensement | Form | pdf | 14 KB | | form | pdf |
| DSS-8173_VI: Công Bố Cho Mục Đích Liệt Kê | Form | pdf | 101 KB | | form | pdf |
| DSS-8173: Release For Enumeration | Form | pdf | 14 KB | | form | pdf |
| DSS-8173sp: Revelación para enumeración | Form | pdf | 17 KB | | form | pdf |
| DSS-8174: Referral for Social Security Number Application | Form | pdf | 12 KB | | form | pdf |
| DSS-8176_AR: نموذج المساهمة | Form | pdf | 67 KB | | form | pdf |
| DSS-8176_DE: Beitragsformular | Form | pdf | 27 KB | | form | pdf |
| DSS-8176_FR: Formulaire De Contribution | Form | pdf | 26 KB | | form | pdf |
| DSS-8176_KO: 기증 양식 | Form | pdf | 102 KB | | form | pdf |
| DSS-8176_VI: MẪU ĐÓNG GÓP | Form | pdf | 97 KB | | form | pdf |
| DSS-8176: Contribution Form | Form | pdf | 88 KB | | form | pdf |
| DSS-8176sp: Contribution Form (Spanish) | Form | pdf | 19 KB | | form | pdf |
| DSS-8178_AR: طلب برامج الطاقة | Form | pdf | 103 KB | | form | pdf |
| DSS-8178-ia: ЗАЯВКА НА УЧАСТИЕ В ПРОГРАММЕ ПОМОЩИ В СФЕРЕ ЭНЕРГОСНАБЖЕНИЯ | Form | pdf | 271 KB | | form | pdf |
| DSS-8178-ia: ЗАЯВКА НА УЧАСТЬ В ЕНЕРГЕТИЧНИХ ПРОГРАМАХ | Form | pdf | 280 KB | | form | pdf |
| DSS-8178: Energy Programs Application | Form | pdf | 249 KB | | form | pdf |
| DSS-8178A: Crisis Intervention Program Worksheet | Form | pdf | 98 KB | | form | pdf |
| DSS-8178Asp: Hoja De Trabajo De Intervencion De Crisis | Form | pdf | 125 KB | | form | pdf |
| DSS-8178L: Low Income Energy Assistance Program Application (LIEAP) | Form | pdf | 225 KB | | form | pdf |
| DSS-8178Lsp: Solicitud Para El Programa De Asistencia De Energia Para Personas De Bajos Ingresos | Form | pdf | 242 KB | | form | pdf |
| DSS-8178sp: Solicitud Para Programas De Ayuda Para Energia | Form | pdf | 163 KB | | form | pdf |
| DSS-8178W: Low Income Household Water Assistance Application (LIHWAP) | Form | pdf | 226 KB | | form | pdf |
| DSS-8178W: Solicitud Del Programa De Asistencia De Agua Para Familias De Bajos Ingresos (LIHWAP) | Form | pdf | 208 KB | | form | pdf |
| DSS-8185-ia: Програма допомоги в енергетичній сфері для сімей із низьким доходом / програма кризового втручання | Form | pdf | 135 KB | | form | pdf |
| DSS-8185-ia: Программа помощи семьям с низким доходом в оплате энергоснабжения Программа кризисного вмешательства | Form | pdf | 146 KB | | form | pdf |
| DSS-8185: Low Income Energy Assistance Program Crisis Intervention Program Information Needed | Form | pdf | 254 KB | | form | pdf |
| DSS-8185A: Prepare for the Energy Program Application Interview | Form | pdf | 90 KB | | form | pdf |
| DSS-8185Asp: Prepárese para la entrevista de la solicitud del Programa de Energía | Form | pdf | 76 KB | | form | pdf |
| DSS-8185sp: Programa de Asistencia de Energía para Personas de Bajos Ingresos Programa de Intervención en Crisis Se Necesita La Siguiente Informacion | Form | pdf | 154 KB | | form | pdf |
| DSS-8189: Appointment Notice | Form | pdf | 89 KB | | form | pdf |
| DSS-8189sp: Aviso De Cita | Form | pdf | 24 KB | | form | pdf |
| DSS-8190 SSI/Non-SSI Application Workbook | Form | pdf | 800 KB | | form | pdf |
| DSS-8190A SSI/Non-SSI Application Workbook Appendix A | Form | pdf | 118 KB | | form | pdf |
| DSS-8191 Special Assistance Re-enrollment Information Notice | Form | pdf | 554 KB | | form | pdf |
| DSS-8191i: Work First / Medicaid Notice of Inquiry | Form | pdf | 44 KB | | form | pdf |
| DSS-8191w: Work First / Medicaid Notice of Withdrawal | Form | pdf | 42 KB | | form | pdf |
| DSS-8191wsp: Aiso De Retiro De Work First / Medicaid | Form | pdf | 18 KB | | form | pdf |
| DSS-8194: Income Maintenance Transmittal Form | Form | pdf | 127 KB | | form | pdf |
| DSS-8196: Special Announcement Letter | Form | pdf | 16 KB | | form | pdf |
| DSS-8197: Change in Caseworker Letter | Form | pdf | 13 KB | | form | pdf |
| DSS-8200: Third Party Query Request | Form | pdf | 16 KB | | form | pdf |
| DSS-8201: County Responsible Overpayment | Form | pdf | 88 KB | | form | pdf |
| DSS-8205_AR: خطاب مصادقة مالك العقار | Form | pdf | 88 KB | |
