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Forms in English

TitleCategoriesTypeFormatSizeLinkhf:doc_categorieshf:doc_tagshf:file_type
Appendix G SAIH Slot Request Form, , pdf15 KBsocial-services special-assistance special-assistance-in-home-programformpdf
APS Brochure, pdf2 MBadult-protective-services adult-services social-servicesformpdf
DAAS 20201 Special Assistance Second Party Review Form APPLICATIONS, docx34 KBsocial-services special-assistanceformdocx
DAAS 20202 Special Assistance Second Party Review Form RECERTIFICATIONS, docx32 KBsocial-services special-assistanceformdocx
DHHS AS 0008 Initial Notice to DA or LE Elec, docx43 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS_6218 Adult Services Intake Inquiry HW 3 2024, docx35 KBadult-services general-adult-services social-servicesformdocx
DHHS-AS-0001 Adult Protective Services Intake, , docx75 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0002 Notice to Reporter Elec 3.2024, docx30 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0003 Adult Services Notice to Administrator Elec 2024, docx32 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0004 Notice to Reporter of Completion of Evaluation Elec 2024, docx32 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0005 Community Evaluation HW 2024, , docx103 KBadult-protective-services adult-services aps-handwritten social-servicesformdocx
DHHS-AS-0005_Community Evaluation Elec.2024, , , , pdf6 MBadult-protective-services adult-services aps-electronic social-services uncategorizedformpdf
DHHS-AS-0006 Facility Evaluation HW 2024, , pdf375 KBadult-protective-services adult-services aps-handwritten social-servicesformpdf
DHHS-AS-0006_Facility_Evaluation_Elec_2024, docx138 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0007_Diligent_Efforts_Elec_2024, docx44 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0007_Diligent_Efforts_HW_2024, docx32 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0009 Written Report of APS Evaluation Elec 3.2024, pdf187 KBadult-protective-services adult-services social-servicesformpdf
DHHS-AS-0009 Written Report of APS Evaluation HW 3.2024, docx35 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0010 APS Notice to Financial Customer Elec, docx39 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0011 Adult and Family Service Plan HW, , , docx44 KBadult-protective-services adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-0011_Adult_and_Family_Service_Plan _Elec, , , docx48 KBadult-protective-services adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-0013 Determination of Ability to Consent 2024, pdf205 KBadult-protective-services adult-services social-servicesformpdf
DHHS-AS-0013 Determination of Ability to Consent HW 3.2024, docx34 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0014 Notice of Request for Record for Adult Protective Services Eval. Elec, docx25 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0015 Consent for Financial Records HW, docx42 KBadult-protective-services adult-services social-servicesformdocx
DHHS-AS-0016 Consent for Release of Information HW, , , docx38 KBadult-protective-services adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-0020-Guardianship Status Report 8.2024, docx51 KBadult-services guardianship social-servicesformdocx
DHHS-AS-5026 Form, , xlsx70 KBadult-protective-services adult-services social-servicesformxlsx
DHHS-AS-6218 Adult Services Intake Inquiry Elec 3 2024, docx44 KBadult-services general-adult-services social-servicesformdocx
DHHS-AS-6219 Adult Services Face Sheet 3 2024, , , docx25 KBadult-protective-services adult-services general-adult-services guardianship social-servicesformdocx
DHHS-AS-6219 Adult Services Face Sheet Elec 3.2024, , , docx35 KBadult-protective-services adult-services general-adult-services guardianship social-servicesformdocx
DHHS-AS-6220 Annual Services Functional Assessment Elec 2024, , doc310 KBadult-protective-services adult-services guardianship social-servicesformdoc
DHHS-AS-6220-Annual Services Functional Assessment HW, , doc210 KBadult-protective-services adult-services guardianship social-servicesformdoc
DHHS-AS-6222 Adult Service Contact Activity Log HW 2024, , , , docx17 KBadult-protective-services adult-services general-adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-6222 Adult Services Contact Activity Log Elec 2024, , , , docx26 KBadult-protective-services adult-services general-adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-6223 Interim or Quarterly Review Elec 2024, , , pdf110 KBadult-protective-services adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformpdf
DHHS-AS-6223 Interim or Quarterly Review HW 2024, , , docx26 KBadult-protective-services adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-6224 Adult Services Annual Assessment Elec 3 2024, , docx67 KBadult-protective-services adult-services guardianship social-servicesformdocx
DHHS-AS-6224 Adult Services Annual Assessment_HW_3_2024, , docx56 KBadult-protective-services adult-services guardianship social-servicesformdocx
DHHS-AS-6225: SAIH Program Assessment Electronic, docx140 KBsocial-services special-assistanceformdocx
DHHS-AS-6226 Case Closing Summary Elec 3.2024, , , , docx26 KBadult-protective-services adult-services general-adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-6226 Case Closing Summary HW 3 2024, , , , docx21 KBadult-protective-services adult-services general-adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformdocx
DHHS-AS-7016, pdf417 KBadult-services guardianship social-servicesformpdf
DHHS-AS-Adult and Family Service Plan Elecdocx44 KBadult-services social-servicesformdocx
DHHS-AS-Adult Services Annual Assessment HW 2024docx56 KBadult-services social-servicesformdocx
DHHS-AS-Request 5337 VA Request Template, , pdf183 KBadult-protective-services adult-services social-servicesformpdf
DSS_5027_SIS_Client_Entry_Form, , , , pdf1,014 KBadult-protective-services adult-services general-adult-services guardianship special-assistance-in-home-case-management social-services special-assistanceformpdf
DSS-0031 SAIH Program Interagency Referral Form, pdf230 KBsocial-services special-assistanceformpdf
DSS-0033: Appendix E, Supplement 1, pdf133 KBsocial-services special-assistanceformpdf
DSS-0034: Appendix E, Supplement 2, pdf107 KBsocial-services special-assistanceformpdf
DSS-10001: Language Services Agreementpdf50 KBsocial-servicesformpdf
DSS-10001ins: Instructions for completing the DSS-10001pdf426 KBsocial-servicesformpdf
DSS-1167: Food and Nutrition Services ePass Application Verification Documentpdf401 KBsocial-servicesformpdf
DSS-1168: Locate Data Sheetpdf10 KBsocial-servicesformpdf
DSS-1321: Statement of Admin. Expenditure for Purchased Servicepdf14 KBsocial-servicesformpdf
DSS-1360: Work First Program Purchase of Services: Referral and Authorizationpdf21 KBsocial-servicesformpdf
DSS-1402: CPS Intake Reportpdf428 KBsocial-servicesformpdf
DSS-1402ins: CPS Intake Report Instructionspdf319 KBsocial-servicesformpdf
DSS-1403: North Carolina Requirement to Notify Child Protective Services (CPS) of Substance Affected Infantpdf274 KBsocial-servicesformpdf
DSS-1404: Care Management for At Risk Children (CMARC) Referral Formpdf2 MBsocial-servicesformpdf
DSS-1432: Application For Disaster Food and Nutrition Servicespdf189 KBsocial-servicesformpdf
DSS-1451: Fire and Building Safety Inspection Reportpdf16 KBsocial-servicesformpdf
DSS-1463: Title VI, Federal Civil Rights Act of 1964pdf95 KBsocial-servicesformpdf
DSS-1464: Statement of Assurance of Compliance with Title VI of Civil Rights Act of 1964pdf23 KBsocial-servicesformpdf
DSS-1464a: Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 for Other Agencies, Institutions, Organizations or Facilitiespdf119 KBsocial-servicesformpdf
DSS-1473: Request for State Appealpdf318 KBsocial-servicesformpdf
DSS-1473a: Request for State Appeal 1473-Addendum for Program Integritypdf263 KBsocial-servicesformpdf
DSS-1473b: Request for State Appeal 1473-Addendum for Expedited MAD Medical Determinationpdf248 KBsocial-servicesformpdf
DSS-1514: Fire and Building Safety Inspection Report (Institutional Building)pdf16 KBsocial-servicesformpdf
DSS-1515: Foster Home Fire Inspection Safety Reportpdf38 KBsocial-servicesformpdf
DSS-1516: Understanding Foster Care – A Handbook for Youthpdf679 KBsocial-servicesformpdf
DSS-1630: Application for Appointment of Personal Representativepdf21 KBsocial-servicesformpdf
DSS-1653: Report of Medical Examinationpdf65 KBsocial-servicesformpdf
DSS-1656: Refund Receipt (Collection of Overpayment)pdf133 KBsocial-servicesformpdf
DSS-1662: Verification of Change in Situationpdf255 KBsocial-servicesformpdf
DSS-1664: Report on Aid Needed by Inmate’s Dependentspdf32 KBsocial-servicesformpdf
DSS-1665: Work First Cash Assistance Protective Payee Agreementpdf109 KBsocial-servicesformpdf
DSS-1678: Replacement/Supplement Affidavitpdf122 KBsocial-servicesformpdf
DSS-1682: Report of Erroneous Issuancepdf219 KBsocial-servicesformpdf
DSS-1688: Designation of Authorized Representativepdf43 KBsocial-servicesformpdf
DSS-1700: Application Worksheetpdf160 KBsocial-servicesformpdf
DSS-1783: Annual Statistical Report for Residential Child Care Facilitypdf58 KBsocial-servicesformpdf
DSS-1789: Voluntary Placement Agreementpdf46 KBsocial-servicesformpdf
DSS-1796: Agency/Foster Parents Agreementpdf86 KBsocial-servicesformpdf
DSS-1797: Inter-County Agreement on the Placement of Childrenpdf172 KBsocial-servicesformpdf
DSS-1798: Inter-Agency Adoption Agreementpdf25 KBsocial-servicesformpdf
DSS-1800: Petition for Adoption of a Minor Childpdf90 KBsocial-servicesformpdf
DSS-1801: Agency’s Consent to Adoptionpdf48 KBsocial-servicesformpdf
DSS-1802: Consent to Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Fatherpdf94 KBsocial-servicesformpdf
DSS-1803: Consent of Child for Adoptionpdf51 KBsocial-servicesformpdf
DSS-1804: Relinquishment of Minor for Adoption by Parent or Guardianpdf161 KBsocial-servicesformpdf
DSS-1805: Revocation of Relinquishment for Adoption by Parent, Guardian, or Guardian Ad Litem of the Mother/Fatherpdf60 KBsocial-servicesformpdf
DSS-1806: Revocation of Consent to Adoption by Parent, Guardian, or Guidian Ad Litem of the Mother/Fatherpdf29 KBsocial-servicesformpdf
DSS-1807: Order for Report on Proposed Adoptionpdf131 KBsocial-servicesformpdf
DSS-1808: Report on Proposed Adoptionpdf298 KBsocial-servicesformpdf
DSS-1808ins: Instructions for Completing Form DSS-1808pdf254 KBsocial-servicesformpdf
DSS-1809: Affidavit of Parentagepdf87 KBsocial-servicesformpdf
DSS-1810: Guardianship Assistance Agreementpdf65 KBsocial-servicesformpdf
DSS-1811: Medical Examinationpdf16 KBsocial-servicesformpdf
DSS-1812: General Authorization for Treatment and Medicationpdf238 KBsocial-servicesformpdf
DSS-1812ins: General Authorization for Treatment and Medication Instructionspdf225 KBsocial-servicesformpdf
DSS-1813: Guardianship Assistance Eligibility Checklistpdf182 KBsocial-servicesformpdf
DSS-1814: Decree of Adoptionpdf55 KBsocial-servicesformpdf
DSS-1815: Report to Vital Records (Not Stepparent or Adult)pdf39 KBsocial-servicesformpdf
DSS-1816: Dismissal of Adoptionpdf105 KBsocial-servicesformpdf
DSS-1820: NC Kids Child Registration Formpdf383 KBsocial-servicesformpdf
DSS-1820ins: NC Kids Child Registration Form Instructionspdf141 KBsocial-servicesformpdf
DSS-1821: NC Kids Family Registration Formpdf327 KBsocial-servicesformpdf
DSS-1821ins: NC Kids Family Registration Form Instructionspdf140 KBsocial-servicesformpdf
DSS-1837: Interstate Compact on the Placement of Children Request (ICPC 100A)pdf166 KBsocial-servicesformpdf
DSS-1837I: Instructions for Completing Form ICPC-100A Interstate Compact on the Placement of Children Requestpdf125 KBsocial-servicesformpdf
DSS-1838: Interstate Compact Report on Child’s Placement Status (ICPC 100B)pdf127 KBsocial-servicesformpdf
DSS-1838I: Instructions for Completing Form ICPC-100B Interstate Compact Report on Child’s Placement Statuspdf79 KBsocial-servicesformpdf
DSS-1839: Regulation 7 Form Order for Expedited Placement Decision Pursuant to the ICPCpdf112 KBsocial-servicesformpdf
DSS-1841: Regulation # 2 Case Manager Statement of Interestpdf181 KBsocial-servicesformpdf
DSS-20221: SA Recertification Budget Sheet, pdf321 KBsocial-services special-assistanceformpdf
DSS-2141: Monthly Requisition For Formspdf177 KBsocial-servicesformpdf
DSS-2203: Daysheetpdf31 KBsocial-servicesformpdf
DSS-2204: Day Summary Sheetpdf25 KBsocial-servicesformpdf
DSS-2216: Request for Recordpdf44 KBsocial-servicesformpdf
DSS-2239: IV-D Legal Services Billpdf9 KBsocial-servicesformpdf
DSS-2249: Affidavit Of Adoption Expenditurespdf23 KBsocial-servicesformpdf
DSS-2250: Adoption Assistance Payment Authorization Noticepdf40 KBsocial-servicesformpdf
DSS-2435i: Food and Nutrition Services (FNS) Notice of Expiration and Interview Recertification Formpdf347 KBsocial-servicesformpdf
DSS-2435r: Food and Nutrition Services (FNS) Notice of Expiration Recertification Formpdf346 KBsocial-servicesformpdf
DSS-2435sri: Rights and Responsibilitiespdf166 KBsocial-servicesformpdf
DSS-2624: Food and Nutrition Services Referral Formpdf39 KBsocial-servicesformpdf
DSS-2625: Food and Nutrition Services E&T Information Transmittalpdf127 KBsocial-servicesformpdf
DSS-2807-II: Part II, Report on Local Hearingspdf99 KBsocial-servicesformpdf
DSS-2807: Part 1, Report on Local Hearings – Summarypdf13 KBsocial-servicesformpdf
DSS-2abl: First Notice to Work First Families with Two Adult Recipients Able to Workpdf12 KBsocial-servicesformpdf
DSS-3000 Appointment Follow-up Letter Regarding SA Assistance Request, pdf56 KBsocial-services special-assistanceformpdf
DSS-3001: Notice of County of Residence Reassignment/Transfer, pdf30 KBsocial-services special-assistanceformpdf
DSS-3002 Agreement to Sell, pdf73 KBsocial-services special-assistanceformpdf
DSS-3003 Important Information About Your Special Assistance and Your Resources, pdf22 KBsocial-services special-assistanceformpdf
DSS-3004 Referral to SSA for Waiver or Reduction of Overpayment Recoupment, pdf57 KBsocial-services special-assistanceformpdf
DSS-3005 Documentation Regarding Continuation of Special Assistance When the LOC Is Upgraded, But No Bed Is Available, pdf53 KBsocial-services special-assistanceformpdf
DSS-3006 Medical Care Special / Medical Expense Form, pdf57 KBsocial-services special-assistanceformpdf
DSS-3431: Request for Financial Informationpdf97 KBsocial-servicesformpdf
DSS-4278: Reunification Referring Agency Referral Formpdf82 KBsocial-servicesformpdf
DSS-4279: Intensive Family Preservation Referring Agency Referral Formpdf49 KBsocial-servicesformpdf
DSS-4451: Application for Child Support Servicespdf1 MBsocial-servicesformpdf
DSS-4718: CSE Direct Deposit Authorizationpdf47 KBsocial-servicesformpdf
DSS-5002: Child Welfare Services Corrective Action Planxlsx32 KBsocial-servicesformxlsx
DSS-5009: Fatality Notificationpdf314 KBsocial-servicesformpdf
DSS-5009A: Instructions for Fatality Notificationpdf204 KBsocial-servicesformpdf
DSS-5010: Structured Documentation Instrument for CPS Assessmentspdf1 MBsocial-servicesformpdf
DSS-5010a: Continuing Need and Safety Requirementspdf103 KBsocial-servicesformpdf
DSS-5010ins: NC CPS Assessments Documentation Tool (DSS-5010) Instructionspdf244 KBsocial-servicesformpdf
DSS-5012: Adoption Assistance Eligibility Checklistpdf252 KBsocial-servicesformpdf
DSS-5013: North Carolina Adoption Assistance Agreementpdf235 KBsocial-servicesformpdf
DSS-5015: Foster Care Facility Action Requestpdf30 KBsocial-servicesformpdf
DSS-5016: Foster Home License Applicationpdf538 KBsocial-servicesformpdf
DSS-5017: Medical History Formpdf54 KBsocial-servicesformpdf
DSS-5018: Foster Home Licensing Water Hazard Safety Assessment Formpdf189 KBsocial-servicesformpdf
DSS-5018a: Foster Home Licensing Individual Water Hazard Safety Planpdf338 KBsocial-servicesformpdf
DSS-5022: Refugee Work Registration Certification, Employment/Refusal and Termination/Denial Noticepdf94 KBsocial-servicesformpdf
DSS-5023: Direct Deposit Enrollment Authorization Formpdf183 KBsocial-servicesformpdf
DSS-5027: Client Entry Formpdf123 KBsocial-servicesformpdf
DSS-5027A: Client Entry – Purchase of Service Provider Formpdf72 KBsocial-servicesformpdf
DSS-5030: Confidential Intermediary Agreementpdf68 KBsocial-servicesformpdf
DSS-5031: Application for Confidential Intermediary Servicespdf129 KBsocial-servicesformpdf
DSS-5032: Consent to Release of Information and/or Contactpdf68 KBsocial-servicesformpdf
DSS-5033: Release of Liability and Agreement to Hold Harmlesspdf15 KBsocial-servicesformpdf
DSS-5094: Child Placement and Payment Reportpdf132 KBsocial-servicesformpdf
DSS-5094a: Foster Care Visit Reportpdf19 KBsocial-servicesformpdf
DSS-5094c: Child Placement and Payment Report Continuation Pagepdf24 KBsocial-servicesformpdf
DSS-5095: NC DSS Child Placement and Payment System Adoption Assistancepdf26 KBsocial-servicesformpdf
DSS-5096a: Transitional Living Plan For Youth/Young Adults in Foster Carepdf679 KBsocial-servicesformpdf
DSS-5096b: Transitional Living Plan – 90 Day Transition Plan for Youth in Foster Carepdf797 KBsocial-servicesformpdf
DSS-5096c: Transitional Living Plan – 90 Day Transition Plan For Young Adults In Foster Care 18 to 21pdf299 KBsocial-servicesformpdf
DSS-5096d: Transitional Living Plan – Helpful Resources For Young Adultspdf581 KBsocial-servicesformpdf
DSS-5097: Voluntary Placement Agreement for Foster Care 18 to 21pdf362 KBsocial-servicesformpdf
DSS-5098: North Carolina Monthly Contact Record For Foster Care 18 to 21pdf421 KBsocial-servicesformpdf
DSS-5099: Placement Agreement For Foster Care 18 to 21pdf458 KBsocial-servicesformpdf
DSS-5100: Semi-Supervised Independent Living Assessment Toolpdf378 KBsocial-servicesformpdf
DSS-5102: NC DSS Non-Identifying Background Informationpdf188 KBsocial-servicesformpdf
DSS-5103: Adoption Health Historypdf285 KBsocial-servicesformpdf
DSS-5104: Report to Central Registry/CPS Applicationpdf152 KBsocial-servicesformpdf
DSS-5104a: Responsible Individuals List Formpdf285 KBsocial-servicesformpdf
DSS-5104c: Central Registry Report Continuation Page-Childrenpdf176 KBsocial-servicesformpdf
DSS-5104d: Modification/Deletion Request Formpdf73 KBsocial-servicesformpdf
DSS-5104p: Central Registry Report Continuation Page – Perpetratorpdf42 KBsocial-servicesformpdf
DSS-5105: North Carolina Diligent Efforts to Identify and/or Locatedocx36 KBsocial-servicesformdocx
DSS-5106: North Carolina Multiple Response System Case Tracking Formpdf37 KBsocial-servicesformpdf
DSS-5108A: DSS/Student Contractual Agreement for Continuing Residential Support CARS – Six Month Reviewpdf52 KBsocial-servicesformpdf
DSS-5112: Adoption Assistance Vendor Payment Request Formpdf37 KBsocial-servicesformpdf
DSS-5113: Adoption Services Agreementpdf279 KBsocial-servicesformpdf
DSS-5115: Adoption Assistance Vendor Payment Instructions for Providerspdf58 KBsocial-servicesformpdf
DSS-5118: Denial of Paternitypdf31 KBsocial-servicesformpdf
DSS-5120: Determination of Foster Care Assistance Benefits and/or Medical Assistance Onlypdf439 KBsocial-servicesformpdf
DSS-5120A: Re-determination of Foster Care Assistance Benefits and/or Medical Assistance Onlypdf110 KBsocial-servicesformpdf
DSS-5120B: Additional Siblings in Removal Homepdf111 KBsocial-servicesformpdf
DSS-5120C: Additional Members of the Family Assistance Unitpdf87 KBsocial-servicesformpdf
DSS-5120E: Determination Of Foster Care 18 to 21 Assistance Benefits and/or Medical Assistance Onlypdf315 KBsocial-servicesformpdf
DSS-5133: Foster Child Notification of Placement (Change) Formpdf169 KBsocial-servicesformpdf
DSS-5133ins: Foster Child Notification of Placement (Change) Form Instructionspdf140 KBsocial-servicesformpdf
DSS-5135: Foster Child Immediate Enrollment Formpdf137 KBsocial-servicesformpdf
DSS-5137: Best Interest Determination Formpdf469 KBsocial-servicesformpdf
DSS-5137a: North Carolina Best Interest Determination Meeting Overridepdf208 KBsocial-servicesformpdf
DSS-5143 Consent Form for Child Medical Evaluations Instructionspdf123 KBsocial-servicesformpdf
DSS-5143: Consent/Authorization For Medical/Mental Health Evaluationpdf176 KBsocial-servicesformpdf
DSS-5145: State of North Carolina Application for Reimbursement of Non-Recurring Adoption Costspdf200 KBsocial-servicesformpdf
DSS-5146: Agreement for Reimbursement of Non-Recurring Adoption Costspdf50 KBsocial-servicesformpdf
DSS-5150: Foster Home Environmental Conditions Reportpdf54 KBsocial-servicesformpdf
DSS-5156: Medical Evaluationpdf65 KBsocial-servicesformpdf
DSS-5157: Foster Home Relicense, Termination and Change Request Applicationpdf182 KBsocial-servicesformpdf
DSS-5158: Foster Home Transfer Request Applicationpdf134 KBsocial-servicesformpdf
DSS-5159: Foster Home Change Request Applicationpdf247 KBsocial-servicesformpdf
DSS-5160: Foster Home Termination Applicationpdf102 KBsocial-servicesformpdf
DSS-5162: Petition for Adoption of a Minor Child (Step-parent)pdf51 KBsocial-servicesformpdf
DSS-5163: Petition for Adult Adoptionpdf185 KBsocial-servicesformpdf
DSS-5164: Consent to Adoption by Adult Adopteepdf27 KBsocial-servicesformpdf
DSS-5165: Consent to Adult Adoption by Spouse of Petitionerpdf125 KBsocial-servicesformpdf
DSS-5166: Decree of Adult Adoptionpdf108 KBsocial-servicesformpdf
DSS-5167: Report to Vital Records for Adult Adoptionpdf37 KBsocial-servicesformpdf
DSS-5168: Revocation of Child’s Consent to Adoptionpdf19 KBsocial-servicesformpdf
DSS-5169: Consent of Child for Adoption (Step-parent Adoption)pdf91 KBsocial-servicesformpdf
DSS-5170: Report to Vital Records (Stepparent Adoption)pdf128 KBsocial-servicesformpdf
DSS-5189: Consent to Adoption by Parent Who is Spouse of Stepparentpdf53 KBsocial-servicesformpdf
DSS-5189I: Notice to Parent of Proposed Change in Placement of Child(ren)pdf40 KBsocial-servicesformpdf
DSS-5189II: Notice to Parent Regarding Proposed Change in the Placement of Child(ren)pdf39 KBsocial-servicesformpdf
DSS-5189III: Notice to Permanency Planning Reviewpdf83 KBsocial-servicesformpdf
DSS-5189IV: Notice to Parent Regarding Permanency Planning Review Outcomepdf41 KBsocial-servicesformpdf
DSS-5190: Consent to Adoption by Parent Who Is Not the Stepparent’s Spousepdf52 KBsocial-servicesformpdf
DSS-5191: Affidavit – Disclosure of Fees & Expensespdf41 KBsocial-servicesformpdf
DSS-5199: Foster Home Request for Waiverpdf40 KBsocial-servicesformpdf
DSS-5201: Understanding Foster Care – A Handbook for Parentspdf171 KBsocial-servicesformpdf
DSS-5203: Initial Provider Assessmentpdf258 KBsocial-servicesformpdf
DSS-5203ins: Initial Provider Assessment Instructionspdf164 KBsocial-servicesformpdf
DSS-5204: Comprehensive Provider Assessmentpdf288 KBsocial-servicesformpdf
DSS-5204ins: Instructions for Comprehensive Provider Assessmentpdf180 KBsocial-servicesformpdf
DSS-5206: Health Summary Form – Initial Visitpdf46 KBsocial-servicesformpdf
DSS-5207: Health History Formpdf188 KBsocial-servicesformpdf
DSS-5207ins: Health History Form Instructionspdf43 KBsocial-servicesformpdf
DSS-5208: Health Summary Form – 30-day Comprehensive Visitpdf162 KBsocial-servicesformpdf
DSS-5209: Health Summary Form – Well-Visitpdf62 KBsocial-servicesformpdf
DSS-5211: Special Children’s Adoption Incentive Fund – Request for Paymentpdf44 KBsocial-servicesformpdf
DSS-5212: Supplemental Adoption Assistance Agreementpdf87 KBsocial-servicesformpdf
DSS-5213: Verification of Child’s Need for Daily Supervisionpdf19 KBsocial-servicesformpdf
DSS-5214: Agency Verification of Legal Custody and Child’s Living Arrangement for Past Six Monthspdf24 KBsocial-servicesformpdf
DSS-5215: Verification of Child’s Health Conditionpdf17 KBsocial-servicesformpdf
DSS-5217: Request for Reimbursement Of Links Special Fundspdf27 KBsocial-servicesformpdf
DSS-5218: Consent to Release of Identifying Informationpdf28 KBsocial-servicesformpdf
DSS-5219: Certificate of Delivery of Preplacement Assessmentpdf130 KBsocial-servicesformpdf
DSS-5225: Request for NC KIDS Legal Risk Searchpdf438 KBsocial-servicesformpdf
DSS-5226: NC SDM Family Risk ReAssessmentpdf99 KBsocial-servicesformpdf
DSS-5227: NC SDM Family Reunification Assessmentpdf204 KBsocial-servicesformpdf
DSS-5229: North Carolina Family Assessment of Strengths and Needspdf155 KBsocial-servicesformpdf
DSS-5230: NC SDM Family Risk Assessment of Child Abuse/Neglectpdf215 KBsocial-servicesformpdf
DSS-5231: North Carolina Safety Assessmentpdf408 KBsocial-servicesformpdf
DSS-5231ins: North Carolina Safety Assessment Instructionspdf129 KBsocial-servicesformpdf
DSS-5233: Personalized Domestic Violence Safety Planpdf32 KBsocial-servicesformpdf
DSS-5234: Domestic Violence Perpetrator Assessment Toolpdf91 KBsocial-servicesformpdf
DSS-5235 – Non-Offending Parent/Adult Victim Domestic Violence Assessment Toolpdf154 KBsocial-servicesformpdf
DSS-5236: North Carolina Monthly In-Home Contact Recordpdf218 KBsocial-servicesformpdf
DSS-5236ins – North Carolina Monthly In-Home Contact Record Instructionspdf94 KBsocial-servicesformpdf
DSS-5237: Children’s Domestic Violence Assessment Toolpdf78 KBsocial-servicesformpdf
DSS-5238: DSS Referral Form for Early Intervention Services (CDSA)pdf180 KBsocial-servicesformpdf
DSS-5239: In Home Family Services Agreementpdf318 KBsocial-servicesformpdf
DSS-5239ins: In-Home family Services Agreement Completion Instructionspdf214 KBsocial-servicesformpdf
DSS-5240: Permanency Planning Family Services Agreementpdf439 KBsocial-servicesformpdf
DSS-5240ins: Permanency Planning Family Services Agreement Instructionspdf211 KBsocial-servicesformpdf
DSS-5241: Permanency Planning Reviewpdf452 KBsocial-servicesformpdf
DSS-5241ins: Permanency Planning Review Instructionspdf160 KBsocial-servicesformpdf
DSS-5242: Family Time and Contact Plan (Visitation)pdf117 KBsocial-servicesformpdf
DSS-5245: Child Education Statuspdf148 KBsocial-servicesformpdf
DSS-5245ins: Child Education Status Instructionspdf112 KBsocial-servicesformpdf
DSS-5246: Information Sharing Achnowledgementpdf131 KBsocial-servicesformpdf
DSS-5247: Information Sharing Partnership Agreementpdf69 KBsocial-servicesformpdf
DSS-5248: ICAMA Form 6.02, Notice of Actionpdf63 KBsocial-servicesformpdf
DSS-5249: Icama Form 6.01, Notice of Medicaid Eligibility/Case Activationpdf162 KBsocial-servicesformpdf
DSS-5250: ICAMA Form 6.03, Report of Change in Child(ren) Family Statuspdf116 KBsocial-servicesformpdf
DSS-5251: ICPC Financial-Medical Planpdf66 KBsocial-servicesformpdf
DSS-5252: ICPC Sending State Priority Home Study Requestpdf236 KBsocial-servicesformpdf
DSS-5253: ICPC Receiving State Priority Home Study Requestpdf231 KBsocial-servicesformpdf
DSS-5255: ICPC Checklist for Interstate Placement Requestspdf32 KBsocial-servicesformpdf
DSS-5256: Drug Endangered Children Protocol: Initial Medical Assessmentpdf32 KBsocial-servicesformpdf
DSS-5257: Drug Endangered Children Protocol – Placement Guidelinespdf151 KBsocial-servicesformpdf
DSS-5258: Protocol for Field Assessment to Determine Need for On-Scene Decontamination Prior to Transportpdf383 KBsocial-servicesformpdf
DSS-5259: Drug Endangered Children Protocol: Exposure Recordpdf38 KBsocial-servicesformpdf
DSS-5260: Drug Endangered Children Protocol Feedback Form: Law Enforcementpdf13 KBsocial-servicesformpdf
DSS-5261: Drug Endangered Children Protocol Feedback Form: Social Workerpdf15 KBsocial-servicesformpdf
DSS-5262: Drug Endangered Children Protocol Feedback Form: Health Care Providerpdf17 KBsocial-servicesformpdf
DSS-5263: Drug Endangered Children Protocol Feedback Form: Foster Care Providerpdf13 KBsocial-servicesformpdf
DSS-5264: Family Support Parent and Family Questionnaire – Client Satisfaction Surveypdf312 KBsocial-servicesformpdf
DSS-5266: 24 Month Time Limitpdf32 KBsocial-servicesformpdf
DSS-5267: 60 Month Lifetime Limitpdf15 KBsocial-servicesformpdf
DSS-5268: Responsible Individuals List (RIL) Information Requestpdf843 KBsocial-servicesformpdf
DSS-5271: Individual Criminal Violations Declaration Statementpdf30 KBsocial-servicesformpdf
DSS-5272: Facility ID Number Applicationpdf141 KBsocial-servicesformpdf
DSS-5273: Verification of Participationpdf35 KBsocial-servicesformpdf
DSS-5274: Request for Adjustment to Foster Care Assistance Paymentpdf264 KBsocial-servicesformpdf
DSS-5275: North Carolina Residency Declarationpdf24 KBsocial-servicesformpdf
DSS-5276: North Carolina Residency Applicant Statementpdf17 KBsocial-servicesformpdf
DSS-5277: Request for Confidential Information Regarding Child Abuse, Neglect and/or Dependencypdf95 KBsocial-servicesformpdf
DSS-5278: Request for Placement Evaluation for Infant Born to an Incarcerated Motherpdf88 KBsocial-servicesformpdf
DSS-5279: Request for Revocation of a Foster Home Licensepdf161 KBsocial-servicesformpdf
DSS-5280: Notice Foster Home Mandatory Criminal History Checkpdf14 KBsocial-servicesformpdf
DSS-5281 Critical Incident Reporting Formpdf102 KBsocial-servicesformpdf
DSS-5282: Notification of CPS Involvementpdf126 KBsocial-servicesformpdf
DSS-5283: Regulatory and Licensing Services Complaint Formpdf22 KBsocial-servicesformpdf
DSS-5285: Child and Family Services Review Protocol for Pilot Countiespdf31 KBsocial-servicesformpdf
DSS-5286: Stakeholder Questionnairepdf16 KBsocial-servicesformpdf
DSS-5287: NC DSS Child and Family Services Review Protocolpdf72 KBsocial-servicesformpdf
DSS-5288: Notice of Extension Hearingpdf21 KBsocial-servicesformpdf
DSS-5290-B: Notice of Work First 60-Month State Time Clock Startingpdf62 KBsocial-servicesformpdf
DSS-5290: Notice of Work First 24-Month State Time Clock Startingpdf20 KBsocial-servicesformpdf
DSS-5291: Indian Child Welfare Act Compliance Checklistpdf257 KBsocial-servicesformpdf
DSS-5292: Work First Participation Summarypdf93 KBsocial-servicesformpdf
DSS-5293: Notice of Hardship Exemption Hearingpdf22 KBsocial-servicesformpdf
DSS-5294: Notice of Decision on Hardship Exemption Requestpdf22 KBsocial-servicesformpdf
DSS-5295: Monthly Permanency Planning Contact Recordpdf171 KBsocial-servicesformpdf
DSS-5295ins: Monthly Permanency Planning Contact Record Instructionspdf114 KBsocial-servicesformpdf
DSS-5297: Consent for Release of Confidential Informationpdf52 KBsocial-servicesformpdf
DSS-5298: North Carolina’s Work First Family Assessment of Strengths and Needspdf76 KBsocial-servicesformpdf
DSS-5299: 24-Month Time Limit Checklistpdf41 KBsocial-servicesformpdf
DSS-5300: Notice of Decision on Extension Requestpdf22 KBsocial-servicesformpdf
DSS-5301: Extension Hearing Requestpdf19 KBsocial-servicesformpdf
DSS-5302: Work First Extension/Exemption Monthly Reportpdf68 KBsocial-servicesformpdf
DSS-5303: Request for NC Kids Child Registration Exemptionpdf252 KBsocial-servicesformpdf
DSS-5304: Legal Risk Placement Agreementpdf40 KBsocial-servicesformpdf
DSS-5305: Purchase of Adoption Services Agreementpdf33 KBsocial-servicesformpdf
DSS-5306: Adoption Assistance Suspension Noticepdf53 KBsocial-servicesformpdf
DSS-5307: Adoption Assistance Agreement Amendmentpdf46 KBsocial-servicesformpdf
DSS-5308: Adoption Assistance Termination Noticepdf63 KBsocial-servicesformpdf
DSS-5309: Excused Absence Log (For Unpaid Activities)pdf85 KBsocial-servicesformpdf
DSS-5310: Model Court Report for Dispositional and Review Hearingspdf224 KBsocial-servicesformpdf
DSS-5311: Model Court Report for Permanency Planning Hearingspdf290 KBsocial-servicesformpdf
DSS-5312: Model Court Report for Post Termination of Parental Rights Hearingspdf68 KBsocial-servicesformpdf
DSS-5313: Work Registration Indicatorpdf112 KBsocial-servicesformpdf
DSS-5314: Sample Letter for Annual Adoptions Assistance Eligibility Reviewpdf37 KBsocial-servicesformpdf
DSS-5316: Relative Interest Formpdf145 KBsocial-servicesformpdf
DSS-5317: Relative Notification Letterpdf25 KBsocial-servicesformpdf
DSS-5318: Relative Search Informationpdf88 KBsocial-servicesformpdf
DSS-5320: DSS – Monthly Adoption Reporting Formxlsx75 KBsocial-servicesformxlsx
DSS-5320a: Contract Agency – Monthly Adoption Reporting & Payment Formxlsx82 KBsocial-servicesformxlsx
DSS-5321: Workers Compensation Fraud in North Carolinapdf32 KBsocial-servicesformpdf
DSS-5322: Report of Injuries to Work First Participants in Work Experience/Community Servicepdf29 KBsocial-servicesformpdf
DSS-5324: Adoptive Placement Agreementpdf32 KBsocial-servicesformpdf
DSS-5325: Substance Use Behavioral Indicator Checklist IIpdf154 KBsocial-servicesformpdf
DSS-5326: Teen Pregnancy Prevention and Healthy Marriage Initiatives Fact Sheetpdf23 KBsocial-servicesformpdf
DSS-5327: Learning Needs Screening Toolpdf28 KBsocial-servicesformpdf
DSS-5328: Request to Cancel Direct Depositpdf75 KBsocial-servicesformpdf
DSS-5329: Complaint Procedures for the Work First Programpdf13 KBsocial-servicesformpdf
DSS-5330: Learning Needs Screening Tool Waiver & Consent Agreementpdf18 KBsocial-servicesformpdf
DSS-5331: ICPC Supervision Report – 30 Dayspdf30 KBsocial-servicesformpdf
DSS-5332: ICPC Supervision Report – 90 Dayspdf34 KBsocial-servicesformpdf
DSS-5333: Americans with Disabilities Act – Did you know?pdf65 KBsocial-servicesformpdf
DSS-5334: Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcementpdf17 KBsocial-servicesformpdf
DSS-5335: Consent to Explore American Indian Heritagepdf51 KBsocial-servicesformpdf
DSS-5336: Fostering Connections/Tribal Relative Search (DSS-5336) Instructionspdf45 KBsocial-servicesformpdf
DSS-5339: CPS Expansion (TANF Transfer to SSBG) Eligibility Documentation Formpdf30 KBsocial-servicesformpdf
DSS-5340: TANF Federal Time Clock Verification Requestpdf34 KBsocial-servicesformpdf
DSS-5401 Consent Form for a Clinical Assessment of Protective Parenting (CAPP)pdf162 KBsocial-servicesformpdf
DSS-5402: Child Welfare Human Trafficking Screening Toolpdf305 KBsocial-servicesformpdf
DSS-5758: Supplemental Board Payment for HIV Positive Foster Children Request for Reimbursementpdf71 KBsocial-servicesformpdf
DSS-5759: Request for Supplemental Adoption Assistance for HIV Positive Adopted Childrenpdf36 KBsocial-servicesformpdf
DSS-5760 Verification of Custody Letterpdf119 KBsocial-servicesformpdf
DSS-5800: Unlicensed Kinship Payment Eligibility Checklistpdf272 KBsocial-servicesformpdf
DSS-5801: Unlicensed Kinship Form-Facility ID Requestpdf240 KBsocial-servicesformpdf
DSS-5802: Unlicensed Kinship Acknowledgmentpdf154 KBsocial-servicesformpdf
DSS-5960: Law Enforcement and District Attorney Notificationpdf180 KBsocial-servicesformpdf
DSS-6187: Application for State Maternity Funds (Voucher, Social History & Service Plan) Problem Pregnancy Servicespdf263 KBsocial-servicesformpdf
DSS-6187I: Instructions for Completing Application for State Maternity Fund DSS-6187pdf166 KBsocial-servicesformpdf
DSS-6188: Notice of Action on Request for State Maternity Home Fundspdf60 KBsocial-servicesformpdf
DSS-6189: State Maternity Fund Residential Care Provider Agreementpdf133 KBsocial-servicesformpdf
DSS-6190 Rapid Response Team Referral Formpdf128 KBsocial-servicesformpdf
DSS-6191 Plan of Safe Care State Formpdf208 KBsocial-servicesformpdf
DSS-6192: Safe Surrender Health and Information Formpdf226 KBsocial-servicesformpdf
DSS-6195A: Trauma Screening Tool 0-5pdf199 KBsocial-servicesformpdf
DSS-6195B: Trauma Screening Tool 6-21pdf210 KBsocial-servicesformpdf
DSS-6211: State Abortion Fund Eligibility Certificationpdf32 KBsocial-servicesformpdf
DSS-6226: NC Division of Vocational Rehabilitation Services and County Social Services Agency/Department Referralpdf234 KBsocial-servicesformpdf
DSS-6228: NC Vocational Skills Training and Skills Recertifiation Plan (DSS-6228)pdf283 KBsocial-servicesformpdf
DSS-6229: NC Vocational Skills Training And Skills Recertification Agreement Plan of Action Requirements (DSS-6229)pdf143 KBsocial-servicesformpdf
DSS-6230A: Family Self-Sufficiency Planpdf172 KBsocial-servicesformpdf
DSS-6230B: Family Self Sufficiency Planpdf186 KBsocial-servicesformpdf
DSS-6231: NC State Refugee Office Service Planpdf257 KBsocial-servicesformpdf
DSS-6232: NC State Refugee Office Employability Planpdf317 KBsocial-servicesformpdf
DSS-6233: Client (ELT) Service Planpdf191 KBsocial-servicesformpdf
DSS-6234: ELT Learner Initial Assessment Formpdf257 KBsocial-servicesformpdf
DSS-6235: Case Review Formpdf162 KBsocial-servicesformpdf
DSS-6236: Informed Consent For Release Of Informationpdf175 KBsocial-servicesformpdf
DSS-6237: DSS Refugee Client Rights Formpdf132 KBsocial-servicesformpdf
DSS-6238: Refugee Cash Assistance Eligibility Monitoring Guidepdf304 KBsocial-servicesformpdf
DSS-6239A: Refugee Mutual Responsibility Agreementpdf172 KBsocial-servicesformpdf
DSS-6239B: Refugee MRA Plan of Action Requirementspdf140 KBsocial-servicesformpdf
DSS-6240: Simplified Nutritional Assistance Program (SNAP) Applicationpdf202 KBsocial-servicesformpdf
DSS-6241: Refugee Cash Assistance (RCA) Applicationpdf164 KBsocial-servicesformpdf
DSS-6242: Refugee Medical Assistance (RMA) Applicationpdf159 KBsocial-servicesformpdf
DSS-6246: Affidavit of Paternitypdf39 KBsocial-servicesformpdf
DSS-6247: Notification of Refugee Arrival and Intent to Apply for Benefitspdf141 KBsocial-servicesformpdf
DSS-6250: Legal Service Planpdf216 KBsocial-servicesformpdf
DSS-6852: Authorization / Receipt for Direct Paymentpdf10 KBsocial-servicesformpdf
DSS-6901: Work First Employment Services Assessment Formpdf368 KBsocial-servicesformpdf
DSS-6902: Screening for Child Well Beingpdf191 KBsocial-servicesformpdf
DSS-6904: Work First Information Transmittalpdf37 KBsocial-servicesformpdf
DSS-6905: Work Experience/Community Service Agreementpdf296 KBsocial-servicesformpdf
DSS-6960: Job Search/Verification Logpdf275 KBsocial-servicesformpdf
DSS-6961: Verification of Household Compositionpdf43 KBsocial-servicesformpdf
DSS-6962: Workers Compensation Guide for Work First Participants In Work Experience and Community Service Activitiespdf145 KBsocial-servicesformpdf
DSS-6963a: Mutual Responsibility Agreement – Core Requirementspdf22 KBsocial-servicesformpdf
DSS-6963b: Mutual Responsibility Agreement Plan of Action Requirementspdf64 KBsocial-servicesformpdf
DSS-6963c: Mutual Responsibility Agreement Plan of Action Requirements for Work First Servicespdf18 KBsocial-servicesformpdf
DSS-6964: Program Reference Guidepdf404 KBsocial-servicesformpdf
DSS-6965: Family Violence Option/Domestic Violence Work First Assessmentpdf301 KBsocial-servicesformpdf
DSS-6966: Notification of Family Violence Optionpdf107 KBsocial-servicesformpdf
DSS-6967: Family Violence Option Brochurepdf3 MBsocial-servicesformpdf
DSS-6968: Screening for Domestic Violencepdf23 KBsocial-servicesformpdf
DSS-6969: Consent for Release of Informationpdf55 KBsocial-servicesformpdf
DSS-8104: Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcementpdf23 KBsocial-servicesformpdf
DSS-8105A Water Assistance Program-Notice of Approvalpdf179 KBsocial-servicesformpdf
DSS-8105B Water Assistance Program-Notice of Denialpdf114 KBsocial-servicesformpdf
DSS-8105C Water Assistance Program-Notice of Withdrawalpdf113 KBsocial-servicesformpdf
DSS-8107: Energy Programs Notice of Approval/Denialpdf26 KBsocial-servicesformpdf
DSS-8107b: Energy Programs Action Noticepdf87 KBsocial-servicesformpdf
DSS-8107D_sp: Disaster Energy Assistance Notice of Approval/Denial, pdf110 KBenergy-programs social-servicesformpdf
DSS-8108: Notice of Benefitspdf110 KBsocial-servicesformpdf
DSS-8109: Your Application for Benefits is Being Denied or Withdrawnpdf87 KBsocial-servicesformpdf
DSS-8110: Notice of Modification, Termination, or Continuation of Public Assistancepdf114 KBsocial-servicesformpdf
DSS-8113: Wage Verification Formpdf51 KBsocial-servicesformpdf
DSS-8115: LIEAP Denial Noticepdf13 KBsocial-servicesformpdf
DSS-8116I: Low Income Energy Assistance Program Eligibility Worksheetpdf147 KBsocial-servicesformpdf
DSS-8117: North Carolina’s Energy Programs Brochurepdf150 KBsocial-servicesformpdf
DSS-8118: Certification Utilities Moratoriumpdf15 KBsocial-servicesformpdf
DSS-8119: Energy Programs Outreach Planpdf86 KBsocial-servicesformpdf
DSS-8124: Application for Work First Family Assistance, MA, Refugee, and SApdf98 KBsocial-servicesformpdf
DSS-8124a: EIS Application for Work First Family Assistance, MA, Refugee, and SApdf54 KBsocial-servicesformpdf
DSS-8124b: Rights and Responsibilitiespdf46 KBsocial-servicesformpdf
DSS-8127: Work First Family Assistance Reportpdf92 KBsocial-servicesformpdf
DSS-8129: Request for Replacement Checkpdf346 KBsocial-servicesformpdf
DSS-8131: Change in Situation Reportpdf10 KBsocial-servicesformpdf
DSS-8137: Notice of Incomplete Work First Family Assistance Reportpdf26 KBsocial-servicesformpdf
DSS-8146A: Notice of Information Needed to Determine Your Eligibility for Work First Family Assistancepdf61 KBsocial-servicesformpdf
DSS-8162 LIHWAP Agreementpdf45 KBsocial-servicesformpdf
DSS-8163: Energy Provider Agreementpdf358 KBsocial-servicesformpdf
DSS-8169: Work First Emergency Assistance Applicationpdf74 KBsocial-servicesformpdf
DSS-8173: Release For Enumerationpdf14 KBsocial-servicesformpdf
DSS-8174: Referral for Social Security Number Applicationpdf12 KBsocial-servicesformpdf
DSS-8176: Contribution Formpdf88 KBsocial-servicesformpdf
DSS-8178: Energy Programs Applicationpdf249 KBsocial-servicesformpdf
DSS-8178A: Crisis Intervention Program Worksheetpdf98 KBsocial-servicesformpdf
DSS-8178D: Energy Disaster Funds Application, pdf222 KBenergy-programs social-servicesformpdf
DSS-8178L: Low Income Energy Assistance Program Application (LIEAP)pdf225 KBsocial-servicesformpdf
DSS-8185: Low Income Energy Assistance Program Crisis Intervention Program Information Neededpdf254 KBsocial-servicesformpdf
DSS-8185A: Prepare for the Energy Program Application Interviewpdf90 KBsocial-servicesformpdf
DSS-8189: Appointment Noticepdf89 KBsocial-servicesformpdf
DSS-8190 SSI/Non-SSI Application Workbook, pdf800 KBsocial-services special-assistanceformpdf
DSS-8190A SSI/Non-SSI Application Workbook Appendix A, pdf118 KBsocial-services special-assistanceformpdf
DSS-8191 Special Assistance Re-enrollment Information Notice, pdf554 KBsocial-services special-assistanceformpdf
DSS-8191i: Work First / Medicaid Notice of Inquirypdf44 KBsocial-servicesformpdf
DSS-8191w: Work First / Medicaid Notice of Withdrawalpdf42 KBsocial-servicesformpdf
DSS-8194: Income Maintenance Transmittal Formpdf127 KBsocial-servicesformpdf
DSS-8196: Special Announcement Letterpdf16 KBsocial-servicesformpdf
DSS-8197: Change in Caseworker Letterpdf13 KBsocial-servicesformpdf
DSS-8200: Third Party Query Requestpdf16 KBsocial-servicesformpdf
DSS-8201: County Responsible Overpaymentpdf88 KBsocial-servicesformpdf
DSS-8205: Landlord Verification Letterpdf38 KBsocial-servicesformpdf
DSS-8207: Application for Food and Nutrition Servicespdf494 KBsocial-servicesformpdf
DSS-8207ssi: SSI/Food Stamp Applicationpdf146 KBsocial-servicesformpdf
DSS-8208: Medical Deduction Supplementpdf647 KBsocial-servicesformpdf
DSS-8209: FNS Medical Report Form, pdf138 KBfood-and-nutrition-services social-servicesformpdf
DSS-8214: Emotional Health Inventory ‚Äì 13 Item Version – Administration Guidepdf235 KBsocial-servicesformpdf
DSS-8215: Substance Use Informationpdf182 KBsocial-servicesformpdf
DSS-8216: Frequently Asked Questions about Electronic Benefit Issuancepdf61 KBsocial-servicesformpdf
DSS-8217: Electronic Benefit Transfer Account Debit Requestpdf97 KBsocial-servicesformpdf
DSS-8218: Alcohol Use Disorders Identification Test (Audit)pdf233 KBsocial-servicesformpdf
DSS-8218A: Work First Program Substance Use Screening Noticepdf88 KBsocial-servicesformpdf
DSS-8218B: Work First Program Testing Noticepdf204 KBsocial-servicesformpdf
DSS-8219: Consent For Release of Confidential Informationpdf127 KBsocial-servicesformpdf
DSS-8220A: Timely Notice of Pending Termination 22 Monthspdf25 KBsocial-servicesformpdf
DSS-8220b: Timely Notice of Pending Termination 58 Monthspdf25 KBsocial-servicesformpdf
DSS-8220c: Timely Notice of Pending Termination Work First Family Assistancepdf24 KBsocial-servicesformpdf
DSS-8221: What Happens If You Can’t Meet Your Work Requirements Because Appropriate Child Care is Not Available?pdf20 KBsocial-servicesformpdf
DSS-8222: Notice of Work First Family Assistance Job Bonuspdf87 KBsocial-servicesformpdf
DSS-8223: Substance Use Referral Logpdf284 KBsocial-servicesformpdf
DSS-8224: Work First Program Referral to Qualified Professional in Substance Abusepdf195 KBsocial-servicesformpdf
DSS-8225: Eligibility Worksheetpdf239 KBsocial-servicesformpdf
DSS-8226: Letter of Overpaymentpdf43 KBsocial-servicesformpdf
DSS-8227: Important Information You Need to Knowpdf21 KBsocial-servicesformpdf
DSS-8228: Work First Cash Assistance Application and Review Documentation Workbookpdf735 KBsocial-servicesformpdf
DSS-8230: Program Integrity Appointment Noticepdf34 KBsocial-servicesformpdf
DSS-8231: Request for Informationpdf102 KBsocial-servicesformpdf
DSS-8232: Simplified Nutritional Assistance Program (SNAP) Notice of Expirationpdf227 KBsocial-servicesformpdf
DSS-8234: NCEL Notice to Debtorpdf33 KBsocial-servicesformpdf
DSS-8239: Alien Worksheetpdf120 KBsocial-servicesformpdf
DSS-8240: Food and Nutrition Services Complaint Procedurespdf14 KBsocial-servicesformpdf
DSS-8550: Change Report Formpdf125 KBsocial-servicesformpdf
DSS-8551: Notice of Eligibility, Denial, or Pending Statuspdf210 KBsocial-servicesformpdf
DSS-8552: Food and Nutrition Services Makes North Carolina Strongerpdf127 KBsocial-servicesformpdf
DSS-8553: Notice of Adverse Actionpdf209 KBsocial-servicesformpdf
DSS-8554: NC DHHS DSS Letter of Overissuancepdf38 KBsocial-servicesformpdf
DSS-8555: Food and Nutrition Services First Month of Overissuance Determination Semi-Annual Reporting Casespdf65 KBsocial-servicesformpdf
DSS-8556: Advance Notice of Disqualification Hearingpdf44 KBsocial-servicesformpdf
DSS-8557: Notice of State Disqualificaiton Hearing Decisionpdf53 KBsocial-servicesformpdf
DSS-8558: Action Taken on Administrative Disqualification Hearingpdf24 KBsocial-servicesformpdf
DSS-8560: Caseworker Desk Referencepdf144 KBsocial-servicesformpdf
DSS-8561: Food and Nutrition Services First Month of Overissuance Determination Simplified Reporting Casespdf77 KBsocial-servicesformpdf
DSS-8562: Effect of Changepdf49 KBsocial-servicesformpdf
DSS-8566: FNS First Month of Overissuance Determination Standard and Simplified Casespdf46 KBsocial-servicesformpdf
DSS-8567: Language Noticepdf452 KBsocial-servicesformpdf
DSS-8568: ABAWD Requirements Formpdf267 KBsocial-servicesformpdf
DSS-8569 Consolidated Work Noticepdf204 KBsocial-servicesformpdf
DSS-8584: Letter for Overissuance / Intentional Program Violationpdf10 KBsocial-servicesformpdf
DSS-8586: Notice of Disqualificationpdf29 KBsocial-servicesformpdf
DSS-8587: Action Taken on Waiver of Administrative Disqualification Hearingpdf46 KBsocial-servicesformpdf
DSS-8588: Waiver of Disqualification Hearingpdf103 KBsocial-servicesformpdf
DSS-8590: Food and Nutrition Services Client Recordpdf37 KBsocial-servicesformpdf
DSS-8593: Food Stamp Benefit Issuance Transactionspdf134 KBsocial-servicesformpdf
DSS-8594: Appointment Notice-Notice of Expirationpdf31 KBsocial-servicesformpdf
DSS-8600: Important Disaster Food and Nutrition Services Program Informationpdf25 KBsocial-servicesformpdf
DSS-8601: Food and Nutrition Services Disaster EBT Card Delivery and Receiptpdf24 KBsocial-servicesformpdf
DSS-8602: Food and Nutrition Services Disaster Electronic Benefit Transfer Card Destructionpdf21 KBsocial-servicesformpdf
DSS-8603: Food and Nutrition Services Returned Disaster EBT Cardpdf24 KBsocial-servicesformpdf
DSS-8604: Overissuance Repayment Agreementpdf116 KBsocial-servicesformpdf
DSS-8605: Notice of Intent to Submit Debt to U.S. Treasury for Offset Collectionpdf35 KBsocial-servicesformpdf
DSS-8606: Notice of Local TOP Review Decisionpdf25 KBsocial-servicesformpdf
DSS-8607: Refund Noticepdf17 KBsocial-servicesformpdf
DSS-8608: TOP Reversalpdf15 KBsocial-servicesformpdf
DSS-8609: Balance Duepdf17 KBsocial-servicesformpdf
DSS-8610: Paid in Full Noticepdf17 KBsocial-servicesformpdf
DSS-8616: Food and Nutrition Services Workfare Referral Formpdf34 KBsocial-servicesformpdf
DSS-8625: Food and Nutrition Services Program Factspdf254 KBsocial-servicesformpdf
DSS-8627: A Serious Crime Public Assistance Fraudpdf91 KBsocial-servicesformpdf
DSS-8628: Food and Nutrition Services Workfare Information Transmittalpdf216 KBsocial-servicesformpdf
DSS-8632: Confirmation of Voluntary Reduction or Termination of Benefitspdf232 KBsocial-servicesformpdf
DSS-8633: Computer Inquiry Checklistpdf10 KBsocial-servicesformpdf
DSS-8636: Notice of Suspensionpdf37 KBsocial-servicesformpdf
DSS-8639: Effect of Mass Change on Your Food and Nutrition Services Benefitspdf58 KBsocial-servicesformpdf
DSS-8640: Work Requirement Responsibilitiespdf134 KBsocial-servicesformpdf
DSS-8641: Work Readiness Checklist and Referral Formpdf309 KBsocial-servicesformpdf
DSS-8642: Explanation of Disqualificationpdf29 KBsocial-servicesformpdf
DSS-8643: Approval or Denial For Stolen Benefitspdf90 KBsocial-servicesformpdf
DSS-8644: Affidavit For Stolen Benefitspdf115 KBsocial-servicesformpdf
DSS-8650: Notice of Information Needed to Complete your Food and Nutrition Services (FNS)pdf203 KBsocial-servicesformpdf
DSS-8650A: Notice of Information Needed English Versionpdf74 KBsocial-servicesformpdf
DSS-8653: Notice to Debtorpdf188 KBsocial-servicesformpdf
DSS-8654: Student Income Verification Formpdf17 KBsocial-servicesformpdf
DSS-8655: Report of Medical Examination Requested by County DSSpdf206 KBsocial-servicesformpdf
DSS-8657: Benefit Diversion Agreementpdf141 KBsocial-servicesformpdf
DSS-8658: Post Hearing Repayment Noticepdf27 KBsocial-servicesformpdf
DSS-9000 Policy Questions Formpdf116 KBsocial-servicesformpdf
DSS-9000 SA: Policy Question Formpdf117 KBsocial-servicesformpdf
DSS-9001: Food and Nutrition Services (FNS) Qualified Professional in Substance Abuse Request for Good Causepdf135 KBsocial-servicesformpdf
NCFAST-20009 North Carolina Rights and Responsibilities for Public Assistance, , pdf277 KBchild-development-and-early-education social-services subsidized-child-care-assistanceformpdf