Get Dss 5759

Filling out the DSS 5759 form is an essential process for requesting supplemental adoption assistance for HIV positive adopted children. This guide will provide you with clear, step-by-step instructions to successfully complete the form online.

Follow the steps to effectively fill out the DSS 5759 form.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Complete the case manager information section, including your county, last name, first initial, and middle initial.
3. Fill in the child information section. Enter the SIS identification number, last name, first name, and middle initial of the adopted child.
4. In the supplemental adoption assistance payment section, provide the date and the monthly amount requested, as well as the funding source (IV-B or IV-E). Additionally, include the HIV code.
5. For the payee information, enter the first name, middle initial, last name, and social security number of the payee. Also, fill in the address, city, state, and ZIP code.
6. Once you have completed all sections of the form, review the information for accuracy.
7. After ensuring all details are correct, save your changes. You can then download, print, or share the completed form as needed.

Complete and submit the DSS 5759 form online today to ensure timely processing of your request.