Forms

Title Effective Date
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-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 Jun 03, 2016 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