Forms
State/County Special Assistance for Adult Forms
https://policies.ncdhhs.gov/divisional/aging-and-adult/special-assistance/forms
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Forms
State/County Special Assistance for Adult Forms
Title |
Effective Date |
DAAS 20201 Special Assistance Second Party Review Form APPLICATIONS
|
May 15, 2020 02:14 PM
|
DAAS 20202 Special Assistance Second Party Review Form RECERTIFICATIONS
|
May 15, 2020 02:13 PM
|
DAAS-3000 Appointment Follow-up Letter Regarding SA Assistance Request
|
Jun 17, 2022 12:00 AM
|
DAAS-3001 Special Assistance Notice of County of Residence Reassignment/Transfer
|
Oct 01, 2011 12:30 PM
|
DAAS-3001sp Notificación sobre reasignación o transferencia
|
Oct 01, 2011 12:05 PM
|
DAAS-3002 Agreement to Sell Property
|
Dec 01, 2011 12:30 PM
|
DAAS-3002sp Compromiso de venta propiedad
|
Dec 01, 2011 12:05 PM
|
DAAS-3003 Important Information About Your Special Assistance and Your Resources
|
Dec 01, 2011 12:35 PM
|
DAAS-3004 Referral to SSA for Waiver or Reduction of Overpayment Recoupment
|
Dec 01, 2011 12:40 PM
|
DAAS-3005 Documentation Regarding Continuation of Special Assistance When the LOC Is Upgraded, But No Bed Is Available
|
Dec 01, 2011 12:05 PM
|
DAAS-3006 Medical Care Special / Medical Expense Form
|
Dec 01, 2011 12:40 PM
|
DAAS-8190 SSI/Non-SSI Application Workbook
|
Jan 01, 2023 12:50 PM
|
DAAS-8191 Special Assistance Re-enrollment Information Notice
|
Nov 01, 2015 10:35 AM
|
SAIH Appendix E, Supplement 1
|
Feb 10, 2020 10:35 AM
|
SAIH Appendix E, Supplement 2
|
Feb 10, 2020 10:35 AM
|
DAAS-0040 SA Overpayment Tracking Tool
|
Dec 01, 2021 09:15 AM
|
DAAS-8190A SSI/Non-SSI Application Workbook Appendix A
|
Jan 01, 2023 04:25 PM
|
DAAS 20221 Special Assistance Recertification Budget Sheet
|
Jan 01, 2023 02:55 PM
|
DAAS-0032 SAIH Signature Attestation Form
|
Mar 17, 2023 01:42 PM
|
DAAS-0031 SAIH Program Interagency Referral Form
|
Mar 17, 2023 01:45 PM
|