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-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-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
NCFAST-20009 North Carolina Rights and Responsibilities for Public Assistance Jun 30, 2022 11:10 AM