Forms

Please tell us if you need assistance because you do not speak English or have a disability. Free language assistance and/or other aids and services are available upon request. To receive free interpreter services, call 866-719-0141 or ask at the DSS local office. After the recorded message, you will reach an operator who can provide you with an interpreter. If you have a disability and need communication assistance, call 866-719-0141 or TTY: 711.
Title Effective Date
DSS-5208: Health Summary Form - 30-day Comprehensive Visit Jun 03, 2016 03:00 PM
DSS-5209: Health Summary Form - Well-Visit Jun 03, 2016 03:05 PM
DSS-5211: Special Children's Adoption Incentive Fund - Request for Payment Jun 03, 2016 03:05 PM
DSS-5212: Supplemental Adoption Assistance Agreement Jun 03, 2016 03:05 PM
DSS-5213: Verification of Child's Need for Daily Supervision Jun 03, 2016 03:10 PM
DSS-5214: Agency Verification of Legal Custody and Child's Living Arrangement for Past Six Months Jun 03, 2016 03:10 PM
DSS-5215: Verification of Child's Health Condition Jun 03, 2016 03:10 PM
DSS-5217: Request for Reimbursement Of Links Special Funds Jun 03, 2016 03:10 PM
DSS-5218: Consent to Release of Identifying Information Jun 03, 2016 03:15 PM
DSS-5219: Certificate of Delivery of Preplacement Assessment Jun 03, 2016 03:15 PM
DSS-5225: Request for NC KIDS Legal Risk Search Mar 15, 2017 03:20 PM
DSS-5226: NC SDM Family Risk ReAssessment Jun 03, 2016 03:20 PM
DSS-5227: NC SDM Family Reunification Assessment Jun 03, 2016 03:20 PM
DSS-5229: North Carolina Family Assessment of Strengths and Needs Apr 30, 2019 03:20 PM
DSS-5230: NC SDM Family Risk Assessment of Child Abuse/Neglect Jun 03, 2016 03:25 PM
DSS-5231: North Carolina Safety Assessment Mar 06, 2017 03:25 PM
DSS-5231ins: North Carolina Safety Assessment Instructions Jan 01, 2017 03:25 PM
DSS-5233: Personalized Domestic Violence Safety Plan Jun 03, 2016 03:25 PM
DSS-5234: Domestic Violence Perpetrator Assessment Tool Jun 03, 2016 03:30 PM
DSS-5235 - Non-Offending Parent/Adult Victim Domestic Violence Assessment Tool Jun 03, 2016 05:15 PM
DSS-5236: North Carolina Monthly In-Home Contact Record Nov 25, 2019 10:00 AM
DSS-5236ins - North Carolina Monthly In-Home Contact Record Instructions Nov 25, 2019 10:05 AM
DSS-5236ins: North Carolina Monthly In-Home Contact Record Instructions Nov 25, 2019 10:35 AM
DSS-5237: Children’s Domestic Violence Assessment Tool Jun 03, 2016 07:45 AM
DSS-5238: DSS Referral Form for Early Intervention Services (CDSA) Dec 04, 2019 04:20 PM
DSS-5239: In Home Family Services Agreement Feb 18, 2020 10:00 AM
DSS-5239ins: In-Home family Services Agreement Completion Instructions Feb 18, 2020 10:05 AM
DSS-5240: Permanency Planning Family Services Agreement Dec 16, 2019 04:55 PM
DSS-5240ins: Permanency Planning Family Services Agreement Instructions Dec 12, 2019 10:05 AM
DSS-5241: Permanency Planning Review Dec 23, 2019 12:30 PM
DSS-5241ins: Permanency Planning Review Instructions Dec 12, 2019 10:05 AM
DSS-5242: Family Time and Contact Plan (Visitation) Sep 27, 2019 10:50 AM
DSS-5245: Child Education Status Nov 25, 2019 10:35 AM
DSS-5245ins: Child Education Status Instructions Nov 25, 2019 10:35 AM
DSS-5246: Information Sharing Achnowledgement Mar 15, 2017 08:20 AM
DSS-5247: Information Sharing Partnership Agreement Jun 03, 2016 08:20 AM
DSS-5248: ICAMA Form 6.02, Notice of Action Jun 03, 2016 08:20 AM
DSS-5249: Icama Form 6.01, Notice of Medicaid Eligibility/Case Activation Jun 03, 2016 08:25 AM
DSS-5250: ICAMA Form 6.03, Report of Change in Child(ren) Family Status Jun 03, 2016 08:25 AM
DSS-5251: ICPC Financial-Medical Plan Jun 03, 2016 08:25 AM
DSS-5252: ICPC Sending State Priority Home Study Request Dec 16, 2019 11:50 AM
DSS-5253: ICPC Receiving State Priority Home Study Request Dec 16, 2019 11:55 AM
DSS-5255: ICPC Checklist for Interstate Placement Requests Jun 03, 2016 08:30 AM
DSS-5256: Drug Endangered Children Protocol: Initial Medical Assessment Jun 03, 2016 08:30 AM
DSS-5257: Drug Endangered Children Protocol - Placement Guidelines Dec 22, 2022 08:40 AM
DSS-5258: Protocol for Field Assessment to Determine Need for On-Scene Decontamination Prior to Transport Jun 03, 2016 10:35 AM
DSS-5259: Drug Endangered Children Protocol: Exposure Record Jun 03, 2016 10:35 AM
DSS-5260: Drug Endangered Children Protocol Feedback Form: Law Enforcement Jun 03, 2016 10:35 AM
DSS-5261: Drug Endangered Children Protocol Feedback Form: Social Worker Jun 03, 2016 10:35 AM
DSS-5262: Drug Endangered Children Protocol Feedback Form: Health Care Provider Jun 03, 2016 10:45 AM
DSS-5263: Drug Endangered Children Protocol Feedback Form: Foster Care Provider Jun 03, 2016 10:45 AM
DSS-5264: Family Support Parent and Family Questionnaire - Client Satisfaction Survey Dec 10, 2019 11:40 AM
DSS-5266: 24 Month Time Limit Jun 03, 2016 10:50 AM
DSS-5267: 60 Month Lifetime Limit Jun 03, 2016 10:50 AM
DSS-5268: Responsible Individuals List (RIL) Information Request Aug 18, 2020 02:55 PM
DSS-5271: Individual Criminal Violations Declaration Statement Jun 03, 2016 10:55 AM
DSS-5272: Facility ID Number Application Jan 01, 2021 10:55 AM
DSS-5273: Verification of Participation Jun 03, 2016 11:00 AM
DSS-5274: Request for Adjustment to Foster Care Assistance Payment Jun 03, 2016 11:00 AM
DSS-5275: North Carolina Residency Declaration Jun 03, 2016 11:00 AM
DSS-5276: North Carolina Residency Applicant Statement Jun 03, 2016 11:00 AM
DSS-5277: Request for Confidential Information Regarding Child Abuse, Neglect and/or Dependency Mar 26, 2020 04:50 PM
DSS-5278: Request for Placement Evaluation for Infant Born to an Incarcerated Mother Jun 03, 2016 11:05 AM
DSS-5279: Request for Revocation of a Foster Home License Jun 03, 2016 11:05 AM
DSS-5280: Notice Foster Home Mandatory Criminal History Check Jun 03, 2016 11:05 AM
DSS-5281 Critical Incident Reporting Form Jun 02, 2022 09:55 AM
DSS-5282: Notification of CPS Involvement Jun 03, 2016 11:10 AM
DSS-5283: Regulatory and Licensing Services Complaint Form Jun 03, 2016 11:10 AM
DSS-5285: Child and Family Services Review Protocol for Pilot Counties Jun 03, 2016 11:15 AM
DSS-5286: Stakeholder Questionnaire Jun 03, 2016 11:15 AM
DSS-5287: NC DSS Child and Family Services Review Protocol Jun 03, 2016 11:15 AM
DSS-5288: Notice of Extension Hearing Jun 03, 2016 11:20 AM
DSS-5290-B: Notice of Work First 60-Month State Time Clock Starting Jan 27, 2020 01:44 PM
DSS-5290: Notice of Work First 24-Month State Time Clock Starting Jun 03, 2016 11:20 AM
DSS-5291: Indian Child Welfare Act Compliance Checklist Jun 03, 2016 11:20 AM
DSS-5292: Work First Participation Summary Jun 03, 2016 11:20 AM
DSS-5293: Notice of Hardship Exemption Hearing Jun 03, 2016 11:25 AM
DSS-5294: Notice of Decision on Hardship Exemption Request Jun 03, 2016 11:25 AM
DSS-5295: Monthly Permanency Planning Contact Record May 28, 2021 10:35 AM
DSS-5295ins: Monthly Permanency Planning Contact Record Instructions May 28, 2021 10:40 AM
DSS-5297: Consent for Release of Confidential Information Jun 03, 2016 11:30 AM
DSS-5298: North Carolina's Work First Family Assessment of Strengths and Needs Jun 03, 2016 11:30 AM
DSS-5299: 24-Month Time Limit Checklist Jun 03, 2016 11:30 AM
DSS-5300: Notice of Decision on Extension Request Jun 03, 2016 11:30 AM
DSS-5301: Extension Hearing Request Jun 03, 2016 11:35 AM
DSS-5302: Work First Extension/Exemption Monthly Report Jun 03, 2016 11:35 AM
DSS-5303: Request for NC Kids Child Registration Exemption Mar 15, 2017 11:35 AM
DSS-5304: Legal Risk Placement Agreement Jun 03, 2016 11:40 AM
DSS-5305: Purchase of Adoption Services Agreement Jun 03, 2016 11:40 AM
DSS-5306: Adoption Assistance Suspension Notice Nov 09, 2010 04:55 PM
DSS-5307: Adoption Assistance Agreement Amendment Jun 03, 2016 11:40 AM
DSS-5308: Adoption Assistance Termination Notice Jun 03, 2016 11:45 AM
DSS-5309: Excused Absence Log (For Unpaid Activities) Jun 03, 2016 11:45 AM
DSS-5310: Model Court Report for Dispositional and Review Hearings Jun 03, 2016 11:45 AM
DSS-5311: Model Court Report for Permanency Planning Hearings Apr 18, 2018 11:50 AM
DSS-5312: Model Court Report for Post Termination of Parental Rights Hearings Jun 03, 2016 11:50 AM
DSS-5313: Work Registration Indicator Feb 12, 2018 11:50 AM
DSS-5314: Sample Letter for Annual Adoptions Assistance Eligibility Review Jun 03, 2016 11:55 AM
DSS-5316: Relative Interest Form Dec 01, 2023 11:55 AM
DSS-5317: Relative Notification Letter Jun 03, 2016 11:55 AM
DSS-5318: Relative Search Information Jun 03, 2016 11:55 AM
DSS-5320: DSS - Monthly Adoption Reporting Form Nov 29, 2018 12:00 PM
DSS-5320a: Contract Agency - Monthly Adoption Reporting & Payment Form Nov 29, 2018 12:00 PM
DSS-5321: Workers Compensation Fraud in North Carolina Jun 03, 2016 12:00 PM
DSS-5322: Report of Injuries to Work First Participants in Work Experience/Community Service Jun 03, 2016 12:35 PM
DSS-5324: Adoptive Placement Agreement Nov 30, 2009 12:35 PM
DSS-5325: Substance Use Behavioral Indicator Checklist II Jun 03, 2016 12:35 PM
DSS-5326: Teen Pregnancy Prevention and Healthy Marriage Initiatives Fact Sheet Jun 03, 2016 12:40 PM
DSS-5327: Learning Needs Screening Tool Jun 03, 2016 12:40 PM
DSS-5328: Request to Cancel Direct Deposit Jun 01, 2018 12:40 PM
DSS-5329: Complaint Procedures for the Work First Program Jun 03, 2016 12:40 PM
DSS-5330: Learning Needs Screening Tool Waiver & Consent Agreement Jun 03, 2016 12:45 PM
DSS-5331: ICPC Supervision Report - 30 Days Dec 13, 2010 10:45 AM
DSS-5332: ICPC Supervision Report - 90 Days Jun 03, 2016 02:05 PM
DSS-5333: Americans with Disabilities Act - Did you know? Jun 03, 2016 02:10 PM
DSS-5334: Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement Jun 03, 2016 02:10 PM
DSS-5335: Consent to Explore American Indian Heritage Jun 03, 2016 02:15 PM
DSS-5336: Fostering Connections/Tribal Relative Search (DSS-5336) Instructions Jun 03, 2016 02:15 PM
DSS-5337-C: Request for Patient Information Dec 23, 2020 01:25 PM
DSS-5339: CPS Expansion (TANF Transfer to SSBG) Eligibility Documentation Form Jun 03, 2016 02:15 PM
DSS-5340: TANF Federal Time Clock Verification Request Jun 03, 2016 02:15 PM
DSS-5401 Consent Form for a Clinical Assessment of Protective Parenting (CAPP) Jun 10, 2022 08:10 AM
DSS-5758: Supplemental Board Payment for HIV Positive Foster Children Request for Reimbursement Jun 03, 2016 02:20 PM
DSS-5759: Request for Supplemental Adoption Assistance for HIV Positive Adopted Children Jun 03, 2016 02:20 PM
DSS-5760 Verification of Custody Letter May 01, 2022 03:35 PM
DSS-5800: Unlicensed Kinship Payment Eligibility Checklist Nov 01, 2023 08:30 AM
DSS-5801: Unlicensed Kinship Form-Facility ID Request Nov 01, 2023 08:30 AM
DSS-5802: Unlicensed Kinship Acknowledgment Nov 01, 2023 08:30 AM
DSS-5960: Law Enforcement and District Attorney Notification Aug 25, 2020 02:15 PM
DSS-6187: Application for State Maternity Funds (Voucher, Social History & Service Plan) Problem Pregnancy Services Jan 23, 2020 01:05 PM
DSS-6187I: Instructions for Completing Application for State Maternity Fund DSS-6187 Jan 23, 2020 01:05 PM
DSS-6188: Notice of Action on Request for State Maternity Home Funds Jun 03, 2016 02:25 PM
DSS-6189: State Maternity Fund Residential Care Provider Agreement Jun 03, 2016 02:25 PM
DSS-6190 Rapid Response Team Referral Form Apr 08, 2022 08:53 AM
DSS-6191 Plan of Safe Care State Form Oct 01, 2022 02:55 PM
DSS-6192: Safe Surrender Health and Information Form Nov 01, 2023 04:20 PM
DSS-6211: State Abortion Fund Eligibility Certification May 01, 2006 05:00 PM
DSS-6226: NC Division of Vocational Rehabilitation Services and County Social Services Agency/Department Referral Oct 26, 2016 02:35 PM
DSS-6228: NC Vocational Skills Training and Skills Recertifiation Plan (DSS-6228) Oct 01, 2022 02:35 PM
DSS-6229: NC Vocational Skills Training And Skills Recertification Agreement Plan of Action Requirements (DSS-6229) Aug 01, 2022 02:40 PM
DSS-6230A: Family Self-Sufficiency Plan Aug 01, 2022 02:40 PM
DSS-6230B: Family Self Sufficiency Plan Aug 01, 2022 03:25 PM
DSS-6231: NC State Refugee Office Service Plan Nov 01, 2023 02:45 PM
DSS-6232: NC State Refugee Office Employability Plan Dec 01, 2023 02:45 PM
DSS-6233: Client (ELT) Service Plan Sep 01, 2022 02:45 PM
DSS-6234: ELT Learner Initial Assessment Form Jun 13, 2023 11:05 AM
DSS-6235: Case Review Form Aug 01, 2022 02:50 PM
DSS-6236: Informed Consent For Release Of Information Aug 01, 2022 02:50 PM
DSS-6237: DSS Refugee Client Rights Form Aug 01, 2022 02:50 PM
DSS-6238: Refugee Cash Assistance Eligibility Monitoring Guide Mar 22, 2022 08:00 AM
DSS-6239A: Refugee Mutual Responsibility Agreement Aug 01, 2022 02:55 PM
DSS-6239B: Refugee MRA Plan of Action Requirements Aug 01, 2022 03:00 PM
DSS-6240: Simplified Nutritional Assistance Program (SNAP) Application Oct 01, 2023 11:15 AM
DSS-6241: Refugee Cash Assistance (RCA) Application Jun 29, 2022 03:00 PM
DSS-6242: Refugee Medical Assistance (RMA) Application Jun 29, 2022 03:05 PM
DSS-6246: Affidavit of Paternity Jun 03, 2016 03:05 PM
DSS-6247: Notification of Refugee Arrival and Intent to Apply for Benefits Jun 29, 2022 03:05 PM
DSS-6250: Legal Service Plan Nov 01, 2023 03:15 PM
DSS-6852: Authorization / Receipt for Direct Payment Jun 03, 2016 03:10 PM
DSS-6901: Work First Employment Services Assessment Form Jun 03, 2016 03:10 PM
DSS-6902: Screening for Child Well Being Mar 16, 2017 03:10 PM
DSS-6904: Work First Information Transmittal Jun 03, 2016 03:10 PM
DSS-6905: Work Experience/Community Service Agreement Feb 12, 2018 03:15 PM
DSS-6960: Job Search/Verification Log Jun 01, 2018 03:15 PM
DSS-6961: Verification of Household Composition Jun 01, 2017 03:15 PM
DSS-6962: Workers Compensation Guide for Work First Participants In Work Experience and Community Service Activities Feb 12, 2018 03:45 PM
DSS-6963a: Mutual Responsibility Agreement - Core Requirements Jun 03, 2016 03:45 PM
DSS-6963b: Mutual Responsibility Agreement Plan of Action Requirements Jun 03, 2016 03:45 PM
DSS-6963c: Mutual Responsibility Agreement Plan of Action Requirements for Work First Services Jun 03, 2016 03:50 PM
DSS-6964: Program Reference Guide Feb 12, 2018 03:50 PM
DSS-6965: Family Violence Option/Domestic Violence Work First Assessment Jun 03, 2016 03:50 PM
DSS-6966: Notification of Family Violence Option Jun 03, 2016 03:55 PM
DSS-6967: Family Violence Option Brochure Aug 07, 2023 01:24 PM
DSS-6968: Screening for Domestic Violence Jun 03, 2016 04:00 PM
DSS-6969: Consent for Release of Information Jun 03, 2016 04:05 PM
DSS-8104: Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement Jun 03, 2016 04:05 PM
DSS-8105A Water Assistance Program-Notice of Approval Nov 24, 2021 08:20 AM
DSS-8105B Water Assistance Program-Notice of Denial Nov 24, 2021 08:20 AM
DSS-8105C Water Assistance Program-Notice of Withdrawal Nov 24, 2021 08:25 AM
DSS-8107: Energy Programs Notice of Approval/Denial Jul 09, 2018 04:10 PM
DSS-8107b: Energy Programs Action Notice Dec 04, 2020 01:09 PM
DSS-8108: Notice of Benefits Aug 27, 2019 12:55 PM
DSS-8109: Your Application for Benefits is Being Denied or Withdrawn Aug 27, 2019 01:00 PM
DSS-8110: Notice of Modification, Termination, or Continuation of Public Assistance Sep 25, 2019 04:00 PM
DSS-8113: Wage Verification Form Jun 03, 2016 04:15 PM
DSS-8115: LIEAP Denial Notice Jun 03, 2016 04:15 PM
DSS-8116I: Low Income Energy Assistance Program Eligibility Worksheet Jun 03, 2016 04:15 PM
DSS-8117: North Carolina's Energy Programs Brochure Jun 03, 2016 04:15 PM
DSS-8118: Certification Utilities Moratorium Jun 03, 2016 07:50 AM
DSS-8119: Energy Programs Outreach Plan Jun 10, 2019 07:55 AM
DSS-8124: Application for Work First Family Assistance, MA, Refugee, and SA Jun 03, 2016 08:30 AM
DSS-8124a: EIS Application for Work First Family Assistance, MA, Refugee, and SA Jun 03, 2016 08:30 AM
DSS-8124b: Rights and Responsibilities Jun 03, 2016 08:35 AM
DSS-8127: Work First Family Assistance Report Jun 03, 2016 08:35 AM
DSS-8129: Request for Replacement Check Jun 03, 2016 08:35 AM
DSS-8131: Change in Situation Report May 26, 2005 11:30 AM
DSS-8137: Notice of Incomplete Work First Family Assistance Report Jun 03, 2016 08:35 AM
DSS-8146A: Notice of Information Needed to Determine Your Eligibility for Work First Family Assistance Jun 01, 2017 08:40 AM
DSS-8162 LIHWAP Agreement Sep 21, 2021 04:40 PM
DSS-8163: Energy Provider Agreement Jul 09, 2018 08:40 AM
DSS-8169: Work First Emergency Assistance Application Jun 03, 2016 08:45 AM
DSS-8173: Release For Enumeration Jun 03, 2016 08:45 AM
DSS-8174: Referral for Social Security Number Application Jun 03, 2016 08:50 AM
DSS-8176: Contribution Form Jun 03, 2016 08:50 AM
DSS-8178: Energy Programs Application Oct 01, 2023 08:55 AM
DSS-8178A: Crisis Intervention Program Worksheet Jun 03, 2016 08:55 AM
DSS-8178L: Low Income Energy Assistance Program Application (LIEAP) Oct 01, 2023 08:55 AM
DSS-8185: Low Income Energy Assistance Program Crisis Intervention Program Information Needed Nov 03, 2017 09:00 AM
DSS-8185A: Prepare for the Energy Program Application Interview Oct 09, 2020 01:58 PM
DSS-8189: Appointment Notice Jun 03, 2016 09:00 AM
DSS-8190ns: State County Special Assistance for Adults Workbook for Non-SSI Recipients Only Jun 03, 2016 09:00 AM
DSS-8190s: State / County Special Assistance for Adults Workbook for SSI Recipients Only Jun 03, 2016 09:05 AM
DSS-8191i: Work First / Medicaid Notice of Inquiry Jun 03, 2016 09:05 AM
DSS-8191w: Work First / Medicaid Notice of Withdrawal Jun 03, 2016 09:05 AM
DSS-8194: Income Maintenance Transmittal Form Jun 03, 2016 09:05 AM
DSS-8196: Special Announcement Letter Jun 03, 2016 09:35 AM
DSS-8197: Change in Caseworker Letter Jun 03, 2016 09:35 AM
DSS-8200: Third Party Query Request Jun 03, 2016 09:40 AM
DSS-8201: County Responsible Overpayment Jun 03, 2016 09:40 AM
DSS-8205: Landlord Verification Letter Jun 03, 2016 09:40 AM
DSS-8207: Application for Food and Nutrition Services Sep 01, 2023 05:45 PM
DSS-8207ssi: SSI/Food Stamp Application Jun 03, 2016 09:45 AM
DSS-8208: Medical Deduction Supplement Jun 03, 2016 09:45 AM
DSS-8214: Emotional Health Inventory – 13 Item Version - Administration Guide Jun 01, 2018 09:45 AM
DSS-8215: Substance Use Information Jun 03, 2016 09:50 AM
DSS-8216: Frequently Asked Questions about Electronic Benefit Issuance Jun 03, 2016 09:50 AM
DSS-8217: Electronic Benefit Transfer Account Debit Request Aug 01, 2023 09:50 AM
DSS-8218: Alcohol Use Disorders Identification Test (Audit) Jun 03, 2016 09:50 AM
DSS-8218A: Work First Program Substance Use Screening Notice Jun 03, 2016 09:55 AM
DSS-8218B: Work First Program Testing Notice Jun 03, 2016 09:55 AM
DSS-8219: Consent For Release of Confidential Information Aug 16, 2019 03:45 PM
DSS-8220A: Timely Notice of Pending Termination 22 Months Jun 03, 2016 10:05 AM
DSS-8220b: Timely Notice of Pending Termination 58 Months Jun 03, 2016 10:10 AM
DSS-8220c: Timely Notice of Pending Termination Work First Family Assistance Jun 03, 2016 10:40 AM
DSS-8221: What Happens If You Can't Meet Your Work Requirements Because Appropriate Child Care is Not Available? Jun 03, 2016 10:40 AM
DSS-8222: Notice of Work First Family Assistance Job Bonus Jun 03, 2016 10:40 AM
DSS-8223: Substance Use Referral Log Jun 03, 2016 10:45 AM
DSS-8224: Work First Program Referral to Qualified Professional in Substance Abuse May 01, 2023 04:15 PM
DSS-8225: Eligibility Worksheet Apr 27, 2021 11:10 AM
DSS-8226: Letter of Overpayment Jun 03, 2016 10:50 AM
DSS-8227: Important Information You Need to Know Jun 03, 2016 10:50 AM
DSS-8228: Work First Cash Assistance Application and Review Documentation Workbook Dec 21, 2017 10:50 AM
DSS-8230: Program Integrity Appointment Notice Nov 21, 2017 11:15 AM
DSS-8231: Request for Information Aug 01, 2023 11:15 AM
DSS-8232: Simplified Nutritional Assistance Program (SNAP) Notice of Expiration Oct 01, 2023 12:55 PM
DSS-8234: NCEL Notice to Debtor Jun 03, 2016 11:20 AM
DSS-8239: Alien Worksheet Jun 03, 2016 11:20 AM
DSS-8240: Food and Nutrition Services Complaint Procedures Oct 10, 2018 11:20 AM
DSS-8550: Change Report Form Oct 01, 2023 01:30 PM
DSS-8551: Notice of Eligibility, Denial, or Pending Status Sep 01, 2023 11:25 AM
DSS-8552: Food and Nutrition Services Makes North Carolina Stronger Oct 01, 2023 02:55 PM
DSS-8553: Notice of Adverse Action Sep 01, 2023 11:30 AM
DSS-8554: NC DHHS DSS Letter of Overissuance Sep 22, 2016 11:30 AM
DSS-8555: Food and Nutrition Services First Month of Overissuance Determination Semi-Annual Reporting Cases Jun 03, 2016 11:35 AM
DSS-8556: Advance Notice of Disqualification Hearing Jun 16, 2017 11:35 AM
DSS-8557: Notice of State Disqualificaiton Hearing Decision Nov 21, 2019 11:35 AM
DSS-8558: Action Taken on Administrative Disqualification Hearing Jun 03, 2016 11:40 AM
DSS-8560: Caseworker Desk Reference Dec 01, 2023 07:35 AM
DSS-8561: Food and Nutrition Services First Month of Overissuance Determination Simplified Reporting Cases Jun 03, 2016 11:40 AM
DSS-8562: Effect of Change Jun 03, 2016 12:05 PM
DSS-8566: FNS First Month of Overissuance Determination Standard and Simplified Cases Jun 03, 2016 12:25 PM
DSS-8567: Language Notice Oct 01, 2023 12:25 PM
DSS-8568: ABAWD Requirements Form Dec 13, 2017 12:25 PM
DSS-8569 Consolidated Work Notice Sep 01, 2023 03:10 PM
DSS-8584: Letter for Overissuance / Intentional Program Violation Jun 03, 2016 12:25 PM
DSS-8586: Notice of Disqualification Jun 03, 2016 12:45 PM
DSS-8587: Action Taken on Waiver of Administrative Disqualification Hearing Jun 03, 2016 02:15 PM
DSS-8588: Waiver of Disqualification Hearing Jun 16, 2017 02:15 PM
DSS-8590: Food and Nutrition Services Client Record Jun 03, 2016 02:15 PM
DSS-8593: Food Stamp Benefit Issuance Transactions Jun 03, 2016 02:20 PM
DSS-8594: Appointment Notice-Notice of Expiration Jun 03, 2016 02:20 PM
DSS-8600: Important Disaster Food and Nutrition Services Program Information Jun 03, 2016 02:25 PM
DSS-8601: Food and Nutrition Services Disaster EBT Card Delivery and Receipt Oct 21, 2016 02:25 PM
DSS-8602: Food and Nutrition Services Disaster Electronic Benefit Transfer Card Destruction Oct 21, 2016 02:30 PM
DSS-8603: Food and Nutrition Services Returned Disaster EBT Card Oct 21, 2016 02:30 PM
DSS-8604: Overissuance Repayment Agreement Sep 22, 2016 02:30 PM
DSS-8605: Notice of Intent to Submit Debt to U.S. Treasury for Offset Collection Jun 03, 2016 02:35 PM
DSS-8606: Notice of Local TOP Review Decision Jun 03, 2016 02:35 PM
DSS-8607: Refund Notice Jun 03, 2016 02:35 PM
DSS-8608: TOP Reversal Jun 03, 2016 02:40 PM
DSS-8609: Balance Due Jun 03, 2016 02:40 PM
DSS-8610: Paid in Full Notice Jun 03, 2016 02:40 PM
DSS-8616: Food and Nutrition Services Workfare Referral Form Jun 03, 2016 02:40 PM
DSS-8625: Food and Nutrition Services Program Facts Jun 03, 2016 02:45 PM
DSS-8627: A Serious Crime Public Assistance Fraud Jun 03, 2016 02:45 PM
DSS-8628: Food and Nutrition Services Workfare Information Transmittal Jun 03, 2016 02:45 PM
DSS-8632: Confirmation of Voluntary Reduction or Termination of Benefits Jun 03, 2016 02:45 PM
DSS-8633: Computer Inquiry Checklist Jun 03, 2016 02:50 PM
DSS-8636: Notice of Suspension Nov 09, 2010 02:30 PM
DSS-8639: Effect of Mass Change on Your Food and Nutrition Services Benefits Jun 03, 2016 02:50 PM
DSS-8640: Work Requirement Responsibilities Dec 13, 2017 02:50 PM
DSS-8641: Work Readiness Checklist and Referral Form Nov 12, 2020 05:21 PM
DSS-8642: Explanation of Disqualification Jun 03, 2016 02:55 PM
DSS-8643: Approval or Denial For Stolen Benefits Sep 01, 2023 03:55 PM
DSS-8644: Affidavit For Stolen Benefits Sep 01, 2023 09:20 AM
DSS-8650: Notice of Information Needed to Complete your Food and Nutrition Services (FNS) Jun 03, 2016 02:55 PM
DSS-8650A: Notice of Information Needed English Version Jun 03, 2016 02:55 PM
DSS-8653: Notice to Debtor Nov 29, 2017 03:00 PM
DSS-8654: Student Income Verification Form Jun 03, 2016 04:00 PM
DSS-8655: Report of Medical Examination Requested by County DSS Feb 12, 2018 04:05 PM
DSS-8657: Benefit Diversion Agreement Mar 30, 2020 11:50 AM
DSS-8658: Post Hearing Repayment Notice Sep 22, 2016 04:05 PM
DSS-9000 Policy Questions Form Jun 10, 2022 07:55 AM
DSS-9000SA: SA Policy Questions Form Feb 26, 2024 08:27 AM
DSS-9001: Food and Nutrition Services (FNS) Qualified Professional in Substance Abuse Request for Good Cause Apr 01, 2023 07:55 AM
NCFAST-20009 North Carolina Rights and Responsibilities for Public Assistance Jun 30, 2022 11:10 AM