Get Dss-5115. Adoption Assistance Program Payment Instructions

The DSS-5115 form is essential for adoptive parents seeking reimbursement for psychological, therapeutic, remedial, and medical services for their child. This guide provides a clear, step-by-step process to ensure you complete this form accurately and efficiently online.

Follow the steps to fill out the DSS-5115 form smoothly.

1. Press the ‘Get Form’ button to retrieve the DSS-5115 form and open it in the digital editor.
2. In the first section, fill in the county and SIS number as indicated.
3. Provide the child's adoptive name and county case number in the designated fields.
4. Enter the adoptive parent(s) name(s) accurately.
5. Describe the child’s special needs in detail to ensure clarity regarding the services required.
6. In Section I, input the provider’s information including name, mailing address, city, state, zip code, telephone number, and email address.
7. Ensure the provider signs and dates this section to validate the information provided.
8. Move to Section II to have the Director or agency representative sign, include their position, telephone number, and fax number.
9. Attach two copies of your bill related to the services before submitting.
10. Review all details for accuracy and completeness, then save your changes, download, print, or share the completed form as needed.

Begin filling out the DSS-5115 form online today to ensure timely processing of your adoption assistance payment.