CLIENT REGISTRATION FORM DAAS 101 Short Form NC Department of Health and Human Services Division of Aging and Adult Services Section I Required for all clients This Short Form of the DAAS-101Client Registration Form may only be used to register congregate meal and transportation clients.
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How to fill out the Daas 101 Form online
Filling out the Daas 101 Form online is an essential step for registering for necessary services such as congregate meals and transportation. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete the Daas 101 Form online.
- Click ‘Get Form’ button to obtain the form and open it in the online editing tool.
- Begin by completing Section I, which is required for all clients. Indicate your client status by checking the appropriate box and enter the date of any status changes.
- For the Client Status section, if applicable, provide the relevant information for new registrations or indicate if you are waiting for services.
- Provide your legal name by filling in the fields for last name, first name, middle initial, and suffix.
- Enter your last four digits of social security number, date of birth, and address. If your mailing address is the same as your street address, simply check the corresponding box.
- Complete the sections concerning your household size, poverty level, and marital status by checking the appropriate boxes.
- Identify your race and ethnicity by checking the relevant boxes, where applicable.
- Fill in your primary language spoken at home, name of an emergency contact, and their phone numbers if available.
- Assess and report your overall functional status by selecting the corresponding option.
- If you are registering for congregate meals, proceed to Section II and answer questions regarding your nutrition health score, including meal frequency and any dietary restrictions.
- Review all the information filled out to ensure accuracy before moving to Section VII.
- Sign the form in the designated area to authorize the providing agency to begin the requested services, making sure to date the signature.
- Upon completion, save your changes, and choose to download, print, or share the form as necessary.
Complete your Daas 101 Form online today to access vital services.
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