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DETERMINATION OF FOSTER CARE ASSISTANCE BENEFITS AND/OR MEDICAL ASSISTANCE ONLY COUNTY DEPARTMENT OF SOCIAL SERVICES PART I: CHILD INFORMATION (completed by Social Worker) A. 1. CHILDS NAME B. Date.

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This guide provides a clear and supportive walkthrough for users seeking to fill out the Dss 5120 form online. By following these steps, you will be able to complete the form accurately and efficiently.

Follow the steps to complete the Dss 5120 form successfully.

  1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
  2. Begin with Part I: Child Information. Fill out the child's name, date of placement, and birth details accurately. Include the method of verification, remembering that a copy of the birth certificate is required.
  3. Proceed to Part II: Legal Responsibility for Removal. Indicate the removal method (VPA, Relinquishment, or Court Order) and complete the relevant section by providing dates and necessary documentation.
  4. In Part III, determine the removal home. Identify whether it's a parent or guardian and provide details such as the names and relationships. Ensure to record if the child resided there in the last six months.
  5. Move to Part IV: AFDC Connectedness. Classify the deprivation reasons and how they were verified. It's essential to mark all applicable responses to ensure proper eligibility determination.
  6. Complete Part V: AFDC Need Determination. The Income Maintenance Case Worker will fill out this section based on provided budgetary information, determining the income eligibility for the child.
  7. In Part VI: Decision, verify citizenship status and summarize all initial IV-E eligibility requirements. Mark the appropriate funding source.
  8. Fill out Part VII and Part VIII regarding additional information and TEA eligibility determination. Ensure all essential details are provided for effective processing.
  9. Finally, review all sections for accuracy. Save changes, download a copy for your records, print it if necessary, or share it with relevant parties.

Complete your Dss 5120 form online today for a smoother application process.

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North Carolina has a federally mandated, state supervised, county administered social services system. This means the federal government authorizes national programs and a majority of the funding, and the state provides oversight and support.

Individuals who file a complaint are notified in writing of any actions taken as a result of the complaint. Mailing Address. P.O. Box 1043. Asheboro, NC 27204. Physical Address. 1207 S. Cox Street, Suite F. Asheboro, NC 27203. Phone Numbers. Office: 336-625-1679. Fax: 336-625-4246. EMAIL US.

You can reach the ADA Information Line at 800-514-0301 (voice) or 1-833-610-1264 (TTY).

Currently, about 12,000 children are in the state's child welfare system.

Call 1-800-662-7030 (English, Spanish).

The NCFAST-20020 is a prepopulated renewal form for the beneficiary to validate that current information remains the same or indicate changes and provide self-attestation of eligibility requirements, including income.

E-mailing us is an efficient and easy way to get the information you need in a timely manner. Request for information or to send general comments please send us an email at dssweb@dhhs.nc.gov.

You may wish to file a consumer complaint with the North Carolina Consumer Protection Division. You can file a complaint online or call 1-877-5-NO-SCAM for assistance.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232